I.

Introduction

In this scenario, a 17-year-old girl was brought into the emergency room and Dr. Paul Griner

took her case. This patient had been in remission for a few years, but was now undergoing

treatment for a relapse of acute lymphoblastic leukemia. Her regular physician was out of town

so the patient’s mother informed Dr. Griner that she did not want her daughter to know the

diagnosis. The mother made sure that everyone involved in her daughter’s care so far maintained

that the diagnosis was an “unusual anemia.” Dr. Griner told the mother that while he was

uncomfortable with the request, he would respect her wishes for the weekend and consult with

their regular physician when he got back. When their physician returned, he elected to comply

with the mother’s wishes. The key stakeholders include the current treating physician, the mother

of the young girl, the original physician, supervisor, and any other doctors or nurses that have

worked the case. Board members on the hospital committee may need to get involved if the

situation is unable to be resolved internally.

II. Problem Statement

This case is more complex than it seems at first. The mother raised a number of concerns,

indicating that she was overwhelmed with “other problems” and that she was concerned Dr.

Griner would tell her daughter’s friends about her true diagnosis. This would be an issue of a

HIPAA violation regarding doctor-patient confidentiality. The mother is asking a number of

healthcare professionals to lie to her daughter. Dr. Griner clearly stated he is uncomfortable with

the situation and felt the daughter should know her real diagnosis. The main problem to address

in this case is whether or not a 17-year-old patient should be informed of her diagnosis despite

her mother’s wishes, especially since this is likely a lifelong illness.

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III. SWOT Analysis

Strengths
● Communication and adherence of parent wishes
by hospital staff.
● Freedom to express opinions and discuss best
path forward while working on a team.
● Physicians recognize that there is an ethical
issue and are concerned with finding the best
way to handle it.
Weaknesses
● Uncertainty regarding the best way forward and
how to handle the situation.
● Lack of confidence on how to handle a patient’s
care.
● Mother is too involved and letting her emotions
get in the way of patient care, which can lead to
trust issues between the patient and the care
team.

Opportunities
● Physicians can focus on providing the best care
possible for the patient.
● Physicians can build trust with the mother if
they respect her wishes.
● Reason to implement training protocols and
keep hospital staff up to date on HIPAA
protocols.
Threats
● Lawsuits to both physician and hospital if the
doctor violates the parent wishes.
● Damage to hospital reputation if the mother
feels her trust was violated.
● Patient care is compromised because physicians
are focused on hiding the truth from the patient
and have to go around standard care
procedures.

IV. Alternative Solution / Narrow to Optimal Solution

To resolve this issue, the first feasible scenario is that the substitute doctor agrees to continue

with the mother’s wishes. The doctor was put in a very difficult position considering he is not the

patient's treating physician. Once the treating physician is back in town the two doctors can then

have a conversation. If the doctors could not come to a reasonable solution, then the substitute

physician would report the issue to a hospital supervisor. This solution will allow the supervisor

and other hospital staff to figure out the appropriate way to handle the situation. Handling the

circumstance in this manner will protect the substitute physician if the mom became upset with

the hospital for deciding to inform her daughter of her current health status.

The second scenario is that the substitute physician could inform the mother of HIPAA’s privacy

policies the U.S. Department of Health and Human Services “Privacy Rule” (U.S. Department of
3 Case Study Group 5

Health and Human Services, 2003). The physician could then explain to the mother that it is his

priority to inform his patients how and what they are being treated for. This is an issue of

“respect for persons,” specifically truth-telling. The principles of truth-telling imply that health

care officials are honest with patients as much as possible (Buchbinder & Shanks, 2017, p. 431).

This scenario could lead to the mother lashing out with the substitute physician, since all

previous hospital staff conspired with her wishes.

The third potential scenario involves the substitute physician refraining from taking any further

action. This situation could lead to the young girl finding out her true health status down the road

and filing a lawsuit with the hospital. Both the second and third scenario could lead to the

hospital receiving negative media attention and detrimental publicity. The first scenario will be

the best option to attempt to maintain the trust of the mother, while following hospital policy. In

addition, an ethics committee will be formed so that in the future, care teams will have a resource

to consult in the event of ethically questionable situations. According to doctors Aulisio and

Arnold of the CHEST Journal, “Ethics committees can be helpful to clinicians in addressing

value conflict or uncertainty as it arises in their practices primarily through a threefold function

of ethics education, policy formation and review, an ethics consultation” (p. 417).

V. Implementation of Optimal Solution

The implementation of an ethics committee is the optimal solution for this particular case

scenario, as well as any future ethical dilemmas. The ethics committee will be responsible for

evaluating ethically questionable situations and making a decision about how to proceed with the

case. The committee will review similar programs at other hospitals and use them to aid in the

development of this program. For example, the UNC health care system has had success

implementing a hospital ethics committee by introducing resources such as a help line and an
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email for patients to send in suggestions (UNC Medical Center, 2019). The team will have a five

step checklist to follow for each case that includes;

1. Discuss the particular case with the healthcare team

2. Discuss the case as a committee without the healthcare team present

3. Investigate by talking to the patient and families

4. Evaluate possible solutions

5. Implement a final solution

The ethics committee that will be hired will consist of a lawyer, physician, insurance staff

representative, HIPAA representative, hospital chief, and a social worker. Committee members

will be recruited from existing hospital staff, and external representatives (i.e. insurance, social

work, HIPAA) will apply for a position. The hospital will hold an interest meeting to advertise

available positions on the committee for the existing staff. Salaries for each member will be

dependent on individual qualifications, but will be between $60,000 - 90,000. Funding of

member salaries will be provided through grants, fundraising by the hospital, and an increased

tax on hospital services. The ethics committee will be implemented first in the pediatrics unit and

eventually for the entire hospital. After executing a solution, the ethics committee will evaluate

and assess the outcomes for the case within the following month. Here the committee will look at

what worked and what did not work, and how future improvements can be made. The committee

will meet as needed based on the severity of a case.

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VI. Action Plan

The implementation of an ethics committee will take place over two years. If, after

implementation in the pediatrics unit of the hospital, the committee is successful then it will be

expanded to cover the entire hospital.

January-March: Raise money for hiring committee members. As stated in Phase V, the

salaries for those in the ethics committee will be between $60,000 - 90,000.

Raising the money will include objectives such as applying for grants,

fundraising, and implementing a tax on certain hospital services. The

hospital’s finance committee will assist in grant applications. Fundraising

will include 5K walks, blood drives, T-shirt fundraising, crowdfunding

(using social media to spread the word), peer-to-peer fundraising, and

raffles (ABC Fundraising, 2019). The tax on hospital food sales will be

increased to aid in committee financing.

March-April Interviews for potential committee members. An estimated 20 applicants

will be interviewed. An application will be available online and current

hospital staff will be recruited where possible. An interest meeting will be

held on March 1𝑠𝑡 . An integrated healthcare staff will be hired including a

lawyer, physician, nurse, insurance staff representative, HIPAA

representative, and a social worker. The hospital chief will also be a part

of the committee.

May-July Training the ethics committee. Training will take a minimum of three
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months. At the beginning of each month, there will be an in-person

training session or online modules for the ethics committee to complete in

order to supplement their knowledge. The committee will develop a

general form to guide future case evaluations. This form will be based on

the 5-step checklist outlined in Phase V.

August-May Implementation. Using the developed guidelines, the ethics committee will

be introduced to the pediatric unit of the hospital. Here, the committee will

assess any ethical dilemmas raised by hospital staff or patients and

develop a solution, meeting as often as necessary for each case. The

committee will reevaluate each case a month after implementation of the

solution and make adjustments as needed.

May-December Upon success in the pediatric unit, the ethics committee will be

introduced to the entire hospital over the course of 7 months. Here, they

will see cases brought up by any department and use their guidelines and

previously set precedents to implement solutions for each case. They will

continue to reevaluate cases to ensure satisfaction of hospital staff and

patients.

VII. Conclusion
The main problem addressed in this case centered on whether or not a 17-year-old patient should

be informed of her diagnosis despite her mother’s wishes, especially since this is likely a lifelong

illness. This has caused issues because the mother is asking a number of healthcare professionals

to lie to her daughter. Dr. Griner clearly stated he was uncomfortable with the situation and felt
7 Case Study Group 5

the daughter should know her accurate diagnosis. Another problem that was addressed in this

case was the potential HIPAA violation regarding doctor-patient confidentiality. This problem

emerged because the mother raised a number of concerns, indicating that she was overwhelmed

with “other problems,” and that she was concerned Dr. Griner would tell her daughter’s friends

about her true diagnosis because he lives in their area.

To resolve this particular case, all medical staff involved with this patient will meet with a

hospital supervisor and discuss the best way to proceed. Furthermore, to prevent future

disagreements, an ethics committee will be developed that will be responsible for evaluating

ethically questionable situations and making a decision about how to proceed on a case-by-case

basis. The committee will first be implemented within the pediatrics unit, and upon success will

be expanded to serve the entire hospital. Once fully incorporated into the hospital, this committee

will be an asset to patients and physicians who want their voices heard and their rights protected.
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VIII. References

ABC Fundraising. (2019). Fundraising ideas for nonprofits. Retrieved from https://www.abcf

undraising.com/fundraising-ideas/fundraising-ideas-nonprofits

Aulisio, M., & Arnold, R. (2008). Role of the ethics committee. CHEST Journal, 134(7),

417-424. http://dx.doi.org/10.1378/chest.08-0136

Buchbinder, S., & Shanks, N. (2017). Introduction to Health Care Management (3 rd ed).

Burlington, MA: Jones & Bartlett Learning.

UNC Medical Center. (2019). Hospital ethics committee. Retrieved from https://www.uncmedic

alcenter.org/uncmc/patients-visitors/hospital-ethics-committee/

U.S. Department of Health and Human Services. (2003). Summary of the HIPAA Privacy Rule

(NIH Publication No. 02-2650). Retrieved from https://www.hhs.gov/hipaa/for-profes

sionals/privacy/laws-regulations/index.html