Question

Case 87

The Case of the Dishonest Employee

Dale Buchbinder

Dr. Jonas was examining a patient in the office who needed a dialysis access procedure performed on one of her arms. Dr. Jones reviewed the vital signs done by Ms. Smith, a med tech/secretary. Her documentation in the medical record clearly stated the blood pressure was equal in both arms. Dr. Jonas performed his own examination and realized that the radial pulse in the left arm felt diminished as compared to the right. After completing a thorough examination, he was still somewhat concerned by the discrepancy between the physical exams and the vital signs placed on the chart by Ms. Smith. He repeated the blood pressures himself. Sure enough, the systolic blood pressure in the left arm was 60 mm/hg less than the right. The patient’s left arm would have been the preferred site to perform an access procedure because the patient was right-handed. Now it was clear only the right arm would be suitable unless another intervention was performed first. If Dr. Jonas had relied on the information placed in the chart he would have conducted an access procedure in the left arm. With a low systolic blood pressure in the left arm, the access would have been doomed to either failure, or given the patient’s physical status, a severe complication such as steal.* Since he was trying to sort through the facts and what happened, Dr. Jonas asked the patient if blood pressure readings were performed in both arms. The patient replied the pressure had only been taken in the right arm. Dr. Jonas confronted his employee and told her that her blood pressures were not correct, and, in fact, the patient had stated that they had not been taken in the left arm. Ms. Smith stated that she was quite busy and felt that these pressures were never different. With her response, she admitted to having falsified the data.

• Background Statement

• Major Problems and Secondary Issues

• Your Role

• Organizational Strengths and Weakness

• Alternatives and Recommended Solutions

• Evaluation

Answer 1

The background statement is that the Smith has conducted the false data records and it is a medical negligence when the records are not properly documented and the physical examination should b dine properly with the guidelines

Major problem in this case is that pts a v graft is made on the wrong side and which can cause problem in the procedure ,the secondary issues are that the pt may suffer from the dialysis issues like low speed, much time in dialysis etc

The role in this case is to we must punish the care give for improper physical examination of the pt and aware the other for the future time

The organization strengths are that the other individuals are taking responsibility of the pt like other person did the physical examination by checking the bp ,weaknesses are that we must aware the care givers to give the proper care and if their is any difficulty you can ask to your seniors for the help, we must make protocols for the Physical examination what should be included in this and hiw to perform PE

Alternative and recommended solutions are that we must be carefully next time in taking care of the pt

Evaluation.... The protocols set should b evaluated time to time to check whether the care givers are following them are not