Question

A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented to an internist complaining of a cough and wheezing. The patient had immigrated to the United States from Ecuador several years earlier, and she spoke mainly Spanish. She lived with her son, who had been in the U.S. longer, spoke English fairly well, and worked as a computer technician. The son had sometimes come to medical visits with the patient in the past, but he did not come to this visit. The internist diagnosed sinusitis and attempted to convey to the patient, without using an interpreter, that she should take acetaminophen, rest, and drink fluids.

This physician had a very strong and often-expressed view that people who come to the U.S. should learn to speak English. His grandparents had emigrated from Italy, and the physician liked to point them out as an example of people who had quickly adopted the language of their new country and successfully assimilated to American culture. He had repeatedly said he did not agree with spending his practice’s money on interpreters. If patients wanted interpreters, they could hire their own or use family members, this internist believed. He had expressed this view to the patient and her son at some past visits.

A week after this visit, the patient was significantly worse, and her son took her to the emergency department of the local hospital. Her examination in the emergency department revealed bilateral wheezing. A chest x-ray showed left lower lobe consolidation. Labs taken in the emergency department included elevated blood glucose, slightly elevated white blood cell count and abnormal CPK and troponin levels. The patient was admitted to a general medical floor with a diagnosis of pneumonia, and a nephrology consult was ordered. The patient’s internist was her attending physician. He did not use a language interpreter while she was in the hospital. For the first two days of the hospitalization, the patient’s status seemed to be improving: her respiratory symptoms and kidney function were better. However, the patient then developed shortness of breath and nausea. The internist ordered furosemide and an antiemetic. Repeat labs still showed an elevated CPK level.

The next day the patient had continuing nausea and shortness of breath, and her internist ordered a 100% NRB (non-rebreather) mask and intravenous theophylline. The patient developed respiratory and metabolic acidosis. That evening, at about 11 p.m., the patient had a cardiac arrest. She was resuscitated but remained minimally responsive in the intensive care unit (where she was transferred). Her son withdrew medical care two days later and the patient subsequently expired.

What are the ethical and legal issues in this case?

What event could have been done differently?

Answer 1

Ethical and legal issues are there in this, here the physician violated the medical ethics that is informed cinsent, it means the physician should give detailed information about the disease to the patient, so that they have autonomy over the treatment they receive. The health care provider should give complete document to the patient inorder to identify the risk, benefits and possible complication. The physician not giving any respect to the patient right also.Here the physician didn't giving correct information about the disease to the patient and relatives, because of they didn't learn english instead of spanish. So that the patient was unaware of the condition and repeatedly admitted in the hospital. The legal issue were arise here is medical malpractice, All doctors must take the Hippocratic oath and promise that they will do their utmost to help patients and will not harm them further. But most of them violating this. Here also the doctor's treatment was not in properway. Another on is non maleficency, the doctor shouldnot harm the patient.they should give care as much as possible.no right to withdrew medical care in any situation.

If the physician diagnosed her earlier itself they could have save her life. Because he didn't diagnosed the patient properly.inthe investigation results repeatedly showing that elevated level of cpk and troponin. It may be due to cardiac problem. He didn't evaluate that. And also in these serious condition also he didn't transferred the patient to intensive care unit. The patient had metabolic and respiratory acidosis, that means she need proper ventillation and icu care.

The health care providers are the professional have major responsibility to save people. They don't have the right to harm the patient in anyway. Healthcare provider are here to serve the people not harm them.