Elizabeth J., a 55-year-old uninsured female with a newly diagnosed bleeding disorder, was airlifted to a large urban teaching facility (Big Town Medical Center) from her rural hospital. Though initially very unstable, Ms. J. was stabilized with a costly experimental therapy, not covered by Medicaid. She is now ready for discharge. Her current hospitalization has cost $1.7M; Medicaid will pay $42K. The difference will be considered bad debt. Though there is consensus that her local community facility (Small Town Hospital) will not be able to provide the same level of care and the need for additional care is likely given the chronic nature of her bleeding disorder, there is disagreement about whether Ms. J should be discouraged from returning to Big Town Medical Center (Waymack, 2014).
Additional background not delineated by Waymack (2014) includes seven key points. First, Elizabeth J. would like to return to Big Town Medical Center for routine outpatient care and inpatient care as needed to include administration of experimental therapy. Second, Ms. J.'s primary physician at home is comfortable monitoring her bleeding disorder but would also like her to retum to Big Town as needed for acute changes. Third, the interdisciplinary team caring for Ms. J. during this hospitalization would like her to retum to as needed, though understands that uncompensated care is a financial strain on institutional resources. Fourth, Big Town Medical Center's executive team is concemed about the impact that uncompensated care will have on the institution's ability to provide care to future patients. Fifth, federal law requires healthcare organizations to provide emergency life-saving care to patients regardless of ability to pay. However, there is no state or federal mandate to provide non-emergent care or experimental therapy. Six, neither Big Town Medical Center nor Small Town Hospital has a specific policy on uncompensated care. Finally, although Ms. J, was initially airlifted to Big Town, the nearby university hospital is generally considered the region's safety-net health system Using the template provided, analyze this case using Nelson's (2015) six-step framework for ethical decision-making
- Recognize the background (the circumstances leading to the ethics conflict), 2. Identify the specific ethical question that needs clarification. 3. Consider the related ethical principles and/or organizational values. 4. Determine the options for response, 5. Recommend a response, 6. Anticipate the ethical conflict, Nelson's (2015) Six-step process to guide ethical decision-making File
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