Health Care Service Delivery & the Law

by | Feb 16, 2025 | healthcare

 

The case study below is designed to test your ability to issue spot and apply the legal principles discussed in the course to isolated fact patterns. Questions, issues, and, importantly, responses may be pulled from all of the Course Materials (e.g. lectures, readings, etc.). You may use your notes, your book, the slide decks, the internet. But you cannot consult one another or otherwise coordinate with each other in any way. In addition, you cannot use any type of Artificial Intelligence program or software (e.g., ChatGPT).

You are to approach each question as if you are corporate and/or individual counsel engaged by your client to identify the legal issues involved in each fact pattern below. There are no word limits for responses, however in rendering your advice you should endeavor to be accurate and concise (e.g. you will not be awarded extra points for providing additional analysis that is not applicable to the situation at hand). Answers receiving full points will (1) correctly identify all applicable legal issues; (2) summarize the rule(s) applied to each legal issue; and (3) correctly apply the rule to the fact pattern at hand.

Point Total Description
5 Student accurately identifies all major issue(s) and correctly applies the legal analysis to the fact pattern to provide the correct response for all subcomponents of the question. The Student’s answer is complete and concise.
4 Student accurately identifies all major issue(s) and correctly applies the legal analysis to the fact pattern to provide the correct response for all subcomponents of the question.
3 Student accurately identifies all major issue(s) and correctly applies the legal analysis to the fact pattern.
2 Student accurately identifies all major issue(s) and incorrectly applies the legal analysis to the fact pattern.
1 Student fails to identify the major issue(s) and incorrectly applies the legal analysis to the fact pattern.
0 Student does not attempt to answer the question and/or it is determined student utilized artificial intelligence software (e.g. ChatGPT) in the preparation of their answer.

Question 1 (20 points)

Patient is admitted to the hospital with severe headaches. Patient initially seems to have all his mental faculties, but the nurses notice that while he understands the diagnoses of his symptoms as the nurses communicate them, he has trouble remembering certain facts (such as his wife’s name or the last time IU made the NCAA tournament). The longer the day goes on he has trouble speaking in coherent sentences when talking to the nursing staff and physicians.

a. Will this patient be deemed to have decisional capacity? Discuss what factors will be considered by the physician, and how those appear to cut in this case?

b. Assume that the patient has become incapacitated and has not executed an advance directive naming a Health Care Representative or Health Care Power of Attorney. Knowing that the patient’s health has been deteriorating throughout the day, the patient’s wife and only sister are at the hospital when the physician recommends that the patient undergo surgery because the benefits of the surgery would outweigh the risks of not having the surgery. The patient’s sister agrees with the physician’s recommendation, but the wife disagrees because she can’t bear the thought of her husband undergoing surgery. The physician calls you to ask whether she can perform the surgery. What do you tell the physician? What steps do you take to reach that conclusion?

c. Assume the patient has become incapacitated, has not executed an advance directive naming a Health Care Representative or Health Care Power of Attorney, and the sister tells you that the wife just recently filed for a petition for dissolution of marriage in court. Does this change your answer in (b)? Why or why not?

d. Assume the patient has become incapacitated, but has executed an advance directive naming his sister as his Health Care Representative. Does this change your answer in (b)? Why or why not?

Question 2 (15 points)

Rob Knight, avid Purdue fan living in Indianapolis, hits the bars hard the night after Purdue loses yet another basketball game. The next morning, he has a raging headache and asks one of his roommates to take him to the nearest hospital emergency room (which happens to be an IU Health facility). Other than a massive headache, there does not seem to be anything wrong with Rob.

a. What obligation does the hospital have to Rob Knight under these circumstances?

While IU Health Hospital properly completes its obligations (as you’ve just described), they discover that Rob has what they believe to be Purdue-Basketball-phobia (fear of rooting for a team that never fulfills expectations). However, to their relief it is determined that when Rob Knight was out drowning his sorrows, he fell and hit his head (as he is in severe pain).

b. What additional obligations does this discovery create for the hospital?

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Question 1

a. Decisional capacity is a patient’s ability to understand the nature of a medical condition, the risks and benefits of proposed treatments (including no treatment), and to make and communicate a choice about their care. Several factors are considered, including:

  • Understanding: Can the patient comprehend the information presented to them?
  • Appreciation: Does the patient understand the significance of the information for their own situation?
  • Reasoning: Can the patient rationally evaluate the available options?
  • Communication: Can the patient express their wishes, whether verbally, in writing, or through other means?

In this case, the patient initially appears to have capacity, as he understands the diagnoses. However, his increasing memory problems and declining coherence suggest that his capacity is fluctuating and likely deteriorating. The physician must assess the patient’s capacity throughout the day, recognizing that a patient may have capacity for some decisions but not others. The described facts suggest that the patient likely loses decisional capacity as the day progresses.

b. When a patient is incapacitated and has not executed an advance directive, treatment decisions are typically made by a surrogate decision-maker. Most states have default surrogate consent laws that prioritize family members, typically starting with a spouse. However, disputes can arise. Generally, the physician should follow the wishes of the highest-priority surrogate available. If there is disagreement among surrogates in the same priority class, the physician

Question 1

a. Decisional capacity is a patient’s ability to understand the nature of a medical condition, the risks and benefits of proposed treatments (including no treatment), and to make and communicate a choice about their care. Several factors are considered, including:

  • Understanding: Can the patient comprehend the information presented to them?
  • Appreciation: Does the patient understand the significance of the information for their own situation?
  • Reasoning: Can the patient rationally evaluate the available options?
  • Communication: Can the patient express their wishes, whether verbally, in writing, or through other means?

In this case, the patient initially appears to have capacity, as he understands the diagnoses. However, his increasing memory problems and declining coherence suggest that his capacity is fluctuating and likely deteriorating. The physician must assess the patient’s capacity throughout the day, recognizing that a patient may have capacity for some decisions but not others. The described facts suggest that the patient likely loses decisional capacity as the day progresses.

b. When a patient is incapacitated and has not executed an advance directive, treatment decisions are typically made by a surrogate decision-maker. Most states have default surrogate consent laws that prioritize family members, typically starting with a spouse. However, disputes can arise. Generally, the physician should follow the wishes of the highest-priority surrogate available. If there is disagreement among surrogates in the same priority class, the physician

should try to facilitate a consensus. If consensus cannot be reached, and the decision is time-sensitive, the physician may have to make the decision they believe is in the patient’s best interests. If the decision isn’t time-sensitive, the physician may need to seek guidance from an ethics committee or the courts.

In this case, the wife, as the spouse, would generally be the优先 surrogate. However, she is refusing a recommended treatment. The physician should attempt to understand the wife’s concerns. If the wife’s refusal is not reasonable (i.e. is based on something other than the patient’s best interests), the physician may need to seek legal counsel or ethics committee consultation. If the wife’s refusal is based on a genuine concern for what her husband would want, but the sister believes he would want the surgery, the physician should try to facilitate a consensus. If this is not possible, and the surgery is urgently needed, the physician may proceed with the surgery believing it to be in the patient’s best interest.

c. The pending divorce petition significantly complicates the situation. While the wife is still legally the spouse until the divorce is finalized, her pending petition suggests a potential conflict of interest. The physician should be very cautious about relying solely on her decision, especially given the disagreement with the sister. The physician should consult with legal counsel and/or the ethics committee immediately. The existence of the divorce petition makes it more likely a court would need to resolve the disagreement about the surgery.

d. If the patient has executed an advance directive naming his sister as his Health Care Representative, then the sister is the appropriate decision-maker, and her consent to the surgery would generally be sufficient, even if the wife disagrees. The sister’s authority stems from the patient’s explicit designation, superseding the default surrogate consent laws. The physician should still communicate with the wife and explain the sister’s authority, but ultimately, the sister’s decision as the designated representative is controlling.

Question 2

a. Hospitals have a duty to provide emergency medical care to all individuals, regardless of their ability to pay or other factors, under the Emergency Medical Treatment and Labor Act (EMTALA). This includes providing a medical screening examination (MSE) to determine if an emergency medical condition (EMC) exists. If an EMC is diagnosed, the hospital must provide further treatment to stabilize the condition or transfer the patient to another facility equipped to provide the necessary care. In Rob’s case, the hospital must provide an MSE to determine if his headache is related to a serious medical condition.

b. The discovery of a potential head injury (from the fall) creates additional obligations. The hospital must now fully evaluate and treat the head injury. This likely involves more extensive diagnostic testing (e.g., CT scan of the head) and appropriate treatment based on the severity of the injury. The hospital’s obligations under EMTALA continue until the patient’s EMC is stabilized. If the hospital lacks the resources to treat the head injury, it has a duty to transfer Rob to an appropriate facility.

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