After witnessing your presentation to the staff of Lincoln Terrace Community Hospital, the chief executive officer is impressed and asks you to conduct more in-service training regarding a current case against the hospital. You are given the details of the case, but told to observe the Health Insurance Portability and Accountability Act (HIPAA) standards of privacy, security, and confidentiality of the patient in the case. You are asked to address the ethical, legal, and regulatory considerations of patient care, and the goals, standards, and requirements of effective health provider/patient relationships in a scholarly manner.J. R. vs. Lincoln Terrace Community Hospital
J. R., a 35 year old woman, at 37 weeks pregnant began feeling intense pain in her lower abdomen. Upon arrival at the emergency room (ER), she was assessed and then sent home. Over the next 2 weeks J.R. returned to the ER three times with complaints of pressure in her lower pelvic area and pain at level 7. On all three occasions J.R was assessed and sent home. Three days later the pain became unbearable and J. R. once again returned to the ER. This time her blood pressure was 180/130, and her pain level was 9. She was immediately admitted. Nine hours after her admission was completed, J. R. still had not dilated. The decision for cesarean was made, which was successful. While in the hospital she received custodial care from a patient care associate (PCA), but never saw a physician. Once she saw a woman with a badge, "RN'. But no one cleaned the wound site, nor did J. R. receive instructions on how to clean her wound. The education checklist J. R. received upon discharge from the maternity unit indicating areas requiring patient education was blank, but signed by the registered nurse. Three days after discharge from the hospital J. R. returned to the ER with infection at the post surgical wound site.
A month later J. R. contacted a lawyer who requested her medical records. After the third request to the medical records department was unsuccessful, the lawyer requested a subpoena for the medical records. An unidentified woman representing the hospital left a detailed message of the specifics of the subpoena and the status of the release of the medical record on the lawyer's office voice mail. A week later, finally J. R.'s medical records arrived at her lawyer's office. The education checklist was found after a thorough review of the medical record. The signature on the education checklist in the medical records was the same on the education checklist J. R. produced to the lawyer, the dates were the same. The difference was, the education checklist in the medical record was complete, indicating J. R. received proper care for her wound site while in the hospital, and received instructions on how to clean her post surgical wound site.
- Discuss the Physician/Patient relationship as it relates to this case.
- Discuss HIPAA standards of privacy, security, and confidentiality and relate these standards to the case.