Problem: How Does Policy Influence Your Decision?

You are the evening house supervisor of a small, private, rural hospital. In your role as house supervisor, you are responsible for staffi ng the upcoming shift and for troubleshooting any and all problems that cannot be handled at the unit level. Because of legislative changes and reductions in federal monies being reimbursed to your facility over the last few years, the hospital has developed a policy that says that emergency care will be provided to indigent patients (patients who cannot pay for services) only when the patient needs immediate medical intervention and would not tolerate a transfer to county facilities, which are approximately 30 minutes away. Tonight, you receive a call to come to the emergency department (ED) to handle a "patient complaint." When you arrive, you fi nd a Hispanic woman in her mid-20s arguing vehemently with the ED charge nurse and physician. When you intercede, the patient introduces herself as Teresa Garcia and states, "There is something wrong with my father, and they won't help him because we can't pay.

They say we must go to the county hospital, and the care he would get there will not be as good. If we had money, you would be willing to do something." The charge nurse intercedes by saying, "Teresa's father began vomiting about 2 hours ago and blacked out approximately 45 minutes ago, following a 14-hour drinking binge." The ED physician added, "Mr. Garcia's blood alcohol level is 0.25 (two and one-half times the level required to be declared legally intoxicated), and my baseline physical examination would indicate nothing other than he is drunk and needs to sleep it off. Besides, I have seen Mr. Garcia in the ED before, and it's always for the same thing. If he wants further treatment, it should be provided at the county facility." Teresa persists in her pleas to you that "there is something different this time" and that she believes this hospital should evaluate her father further. She intuitively feels that something terrible will happen to her father if he is not cared for immediately. The ED physician becomes even angrier after this comment and states to you, "I am not going to waste my time and energy on someone who is just drunk, and I refuse to order any more expensive lab tests or x-rays on this patient. If you want something else done, you will have to fi nd someone else to order it." With that, he walks off and returns to the examination room, where other patients are waiting to be seen. The ED nurse turns to look at you and is waiting for further directions.

ASSIGNMENT: How will you handle this situation? Would your decision be any easier if there were no limitations in resource allocation? Are your values to act as an agent for the patient or for the agency more strongly developed?