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John Q Application Paper

Student Name

Institution

Course

Date
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1) WHAT – What was the issue shown in the film? What was the hospital’s decision?

What was the potential impact of the hospital’s decision? What was your overall

reaction? What was the impact of health policy on the hospital’s decision?

The issue that is demonstrated in the John Q film is the case of Michael, the son of John and

Denise, who collapsed in a baseball game. The two parents rushed the small boy to the hospital,

and after several tests, Michael is diagnosed with an enlarged heart, and therefore, the only way

the boy could survive is undergoing heart transplant (Burg & Cassavetes, 2002). However, the

doctor and the directors informed John that the health insurance policy would not cater to the

total cost of his son's heart transplant as the company he was working for had dropped him from

being a full-time employee to a part-time worker. Therefore, John was told that he had to cater to

30% of the total cost, which was $250,000. This meant that John had to contribute $75,000 so

that Michael could get into the donor's list (Burg & Cassavetes, 2002). John had no such huge

cash, and therefore, he tried to raise money through his family to raise 30% of the total payment

but in vain.

After some time, the hospital ran out of patience and released Michael from the hospital, and this

made Denise ask his husband to do something to get their son treated. As John did not want to let

his son die, he walked into the emergency room (ER) with a handgun and held all the patients

hostage and demanded his son to get into the recipient list (Burg & Cassavetes, 2002). The

hostage negotiator remained calm to allow John to cool off. Meanwhile, John continued to

converse with the other patients as they try to learn and understand each other situation. The

patients from ER understood John's situation, and some supported him. John, on the other hand,

helps the patients to receive treatments for whatever they had come to the emergency room for.

Each had different problems like Miriam was pregnant, and Julie had a broken arm.
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John agreed to release the hostages only after his son was put on the recipient list. After his son

was included in the list, John released three hostages who included Miriam, Steve, and Rosa,

together with her kid. Learning how the situation was, Chicago police sent a snipper into the

hospital building in a SWAT. The snipper affords to shoot John, but John just got a small would

that was treated right away. As the snipper was shooting, his leg fell through the ceiling, and

John pulled him out of the air shaft, beat him and used the SWAT as a human guard as he

stepped outside to face the police who were all pointing gun at him (Burg & Cassavettes, 2002).

John asked for his son to be brought to the emergency room, and the policemen agreed so that

John could give them the snipper's SWAT. After his son arrived at the ER, John tells the

hostages that he wanted to commit suicide so that his heart could be used to save his son's life.

Afterward, John bid his son goodbye and goes and went to the operation room, ready to shoot

himself. However, before he could pull the trigger, his wife comes in and informs him that a

woman who had died in a car accident had the same blood group as that of their son and that she

had been brought to the hospital for organ recovery.

Finally, Michael goes through the lifesaving operation in the watch of his parents, and later, John

is taken to custody by the police. During his trial, John is acquitted of attempted murder, armed

criminal action but is found guilty of kidnapping due to holding patients hostage. Although

John's sentence term is not known, his lawyer says that no judge can sentence him for more than

three years, and also he was going to try and drop it to two years (Burg & Cassavetes, 2002).

The hospital's decision after John could not raise 30% of the total cost of his son's heart

transplant was to release Michael and go and die at home. The hospital had even not entered

Michael’s name into the recipient name despite the critical condition of Michael. They had

decided to do so only after John had paid $75,000.

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The hospital's decision to release John's son to die at home was wrong and would have a lot of

negative impacts. John had tried to raise the money and even paid the part the doctors were

asking for. First, Michael would die as a result of not undergoing operation because his father

could not afford it. Secondly, the hospital's image will be dented after people learn that the

hospital refused to treat the boy because his father was unable to pay for the medical bills.

Although the terms of John’s health insurance cover had been changed without his knowledge,

he continued paying for full health coverage of his family.

My overall reaction to this case is that it was unethical and wrong for the hospital to take the

decision that they took. Physicians and doctors should not leave patients untreated because of

their inability to pay their bills (Hartman, DesJardins & MacDonald, 2018). It is an unethical

practice that should be banned in all health organizations. If a patient is not able to afford for

urgent costly treatment, the healthcare providers should first treat the patient and reduce the fees

through fee waivers or through adjusted billing to enable the patient to pay. Healthcare providers

have no unlimited discretion to refuse to attend patients because they cannot afford their medical

bills (Hartman et al., 2018).

Furthermore, much of the medicine and equipment used to treat patients is provided by the

federal government. Based on the above arguments, I believe and do not feel that the healthcare

providers were doing the right thing considering that John had been paying the full amount of his

health insurance cover despite his employer changing the terms of employment and terms of the

health insurance policy without his knowledge. They should have attended to Michael and asked

John to pay the huge bill slowly. The doctors are expected by the American ethical bodies to

comply and demonstrate sound awareness of ethical principles that guide them throughout their

practice. For instance, doctors and physicians working emergency departments are prohibited
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from turning away patients in critical conditions by the Emergency Medical and Treatment

Labor Act.

Health insurance policies are there to help patients to raise their medical bills. In exchange,

patients have to pay premiums either monthly or annually (Hartman et al., 2018). Based on the

kind of work a person does, and insurance health policy can either be a Health Maintenance

Organization (HMO) or Preferred Provider Organization (PPO). The premiums a patient pays for

each differs. In the case of John, as shown in the film, he was initially entitled to PPO, but his

employer changed without his knowledge of HMO. No knowing, John continued to pay the same

amount, until he learned that his benefits had been reduced when he needed them most.

Therefore, since the health policy had reduced John's benefits, the hospital had to turn to John

and asked him to raise the part that was not to be paid by the insurance policy. After John tried

his best to raise funds to little success, the hospital had to take the brutal decision of releasing

Michael to go and die at home. Therefore, the hospital's decision was impacted by the health

policy that did not want doctors to perform expensive tests in order to reduce costs.

2) WHY – Why did the hospital make their decision? Why was this issue important both

to the family and to the hospital?

The hospital made their decision to release Michael to go and die at home because his father

could not raise the amount he was supposed to. Additionally, the health policy that John had

been paying was not ready to pay the total cost of Michael's heart transplant, saying that John's

health policy was changed from PPO to HMO after he started to work as a part-time employee

for the Chicago employer (Shi and Singh. 2019). John, however, had continued paying for the

PPO and believed that his whole family was fully covered. Since the heart transplant is a costly

operation, the hospital decided that it would be better to release Michael as the amount required
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could not be raised. Although the emergency department is not required to turn away from

patients who need emergency care, there were no assurances that the health policy and John

would pay the amount to cater to Michael's operation.

Michael's operation issue was really important both to John's family and the hospital. First,

John's family knew that if their son did not undergo a heart transplant, he was going to die. John

had faithfully been paying for the full coverage of his family. Therefore, it would be detrimental

for the family if their son died because the health policy and John's employer had changed John's

insurance cover without his knowledge. This meant that the family was going to be burdened

with paying much of the hospital bills, which they could not afford. The issue was also important

to the family because after spending all the money they had, they were to be left without money

to cater to daily upkeep as well as helping Michael to recover. Therefore, this issue to

detrimental to John's family both emotionally and finally.

The issue was also important to the hospital that diagnosed John with an enlarged heart. First,

healthcare providers are guided by standards and principles that they have to adhere to all the

time (Shi and Singh, 2019). A good example is that EMTALA prohibits all healthcare providers

working in the emergency department from turning away patients whose emergency need care

because they are unable to afford it (Moy & Moffat, 2016). Additionally, the act all prohibits

healthcare providers from transferring patients unnecessary when they are under treatment. It

also prohibits doctors and physicians from suspending care when they initiate it. These are some

of the main reasons that make this issue to be important to the hospital as the act forbids them

from denying patients emergency care because of patient’s inability to cater for their medical

bills. Another reason why this issue is of importance to the hospital is because of the care cost.

HIPAA body requires healthcare organizations to preserve revenue for emergencies and
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improving the systems of the hospital (Hartman et al., 2018). Therefore, delivering such service

without assurances that the money would be paid would seriously affect their revenue

preservation capability. Finally, the issue present in the film also becomes even more important

to the hospital due to the overall impact it would have on its reputation. Healthcare organizations

are just like any other business entity, and therefore, they need to maintain a good reputation in

order to maintain their customers (Shi and Singh, 2019). For instance, if John had not taken

action he took to have his son attended. Eventually, the son dies due to the hospital's negligence,

patients would have started perceiving all the healthcare providers in the hospital negatively. As

a result, they would avoid going to the hospital, and as a result, the hospital would lose a lot of

its revenues.

(3) WHO – Who was the patient? Who was all impacted (identify the stakeholders)?

As said earlier, the film presented Michael, who was the son of John and Denise, as the patient

had needed emergency care of heart transplant. Michael was, of course, the main stakeholder of

this issue. However, his health issue affected many other people who had to either bear the cost

or consequences of not attending to the issue. The noticeable stakeholders of Michael's issue

were his parents, both John and Denise, who are the most important stakeholders to both Michael

and his issue. Others who were impacted by Michael's issue include the health insurance

company, the hospital, the healthcare providers, John’s employer, and other patients who were in

the emergency room were also impacted by Michael's issue (Burg & Cassavetes, 2002).

Michael's parents were seriously affected by their son's problem, and they were desperately

hoping that the doctors in the hospital would adhere to the standards provided by HIPAA and

EMTALA as well as utilize their ethical virtues to help their son to have another chance to live

(Burg & Cassavetes, 2002).

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However, hospitals and generally the doctors seemed to apply the utilitarianism principle, which

seeks to provide the greatest benefit to the greatest number of people. Therefore, the hospital

could not carry out Michael's operation without assurances and guarantors that the amount would

be paid in full. This is because money and resources had to be diverted from other important

operations of the hospital to cater to only one patient. The health insurance company was another

important stakeholder in Michael's case. The health insurance had been receiving the full amount

for PPO from, and they did not tell him that his policy had been changed, and therefore it was

not covering total medical costs for his family (Burg & Cassavetes, 2002). Looking at the act of

health insurance Company, its actions can be described as egoistic as they only acted for their

interests without caring for their customers.

The patients in the emergency room were also stakeholders of Michael's issue as they were

affected during hostage. Still, they also took part in forcing doctors to carry out Michael's

operation. Later, they supported John during his sentence as, according to them, John was a very

good man who meant good for everyone. John's employer was also a stakeholder in this issue as

he started everything that happened (Burg & Cassavetes, 2002). The employer changed the terms

of John's insurance, and he did not inform him. His actions can be seen as self-centered as he

only cared for John's results at work but not his health or whereabouts of his family. If John did

not force the hospital to perform the heart transplant, John would have died. The employer and

the insurance company would have been held responsible for Michael's death probable in a court

due to their deceptive actions regarding the change of John's insurance plan. The employer

should have explained to John that the policy was changed and the implications the change in

policies would have on his family. However, the employer just changed the insurance plan,

which could have helped John's son to undergo a heart transplant without his family incurring
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any cost. However, he was not responsible, and his actions set the entire motion of Michael's

issue.

4) HOW – How would you have handled the situation if you were the hospital

administrator? Insurance company? Parent? How could changes in health policy have

helped or hindered this situation?

This issue, which involved the hospital, insurance company, and John, as the main stakeholders,

presents many ethical implications that need to think carefully by anyone in the position of a

hospital administrator. First, money could not be diverted from other operations helpful to one

person to care for one patient. That would not have been in accordance with the principle of

utilitarianism. Additionally, it would be ethically wrong for the hospital administrator to let

John's son die because of the deceptive actions of both the insurance company and John's

employer.

Putting the above scenarios into consideration, I would allow doctors to undertake Michael's

operation on a charity basis after the insurance company had paid part of the total cost. Health

organizations should provide charity services to patients from time to time, especially those who

cannot cater for their medical bills. Charity services enable healthcare organizations to give back

to society, which helps to build the reputation and popularity of the healthcare organization to the

surrounding communities. Communities around a healthcare organization are the main

customers, as in the United States, many health organizations are serving different communities.

Therefore, if a healthcare organization fails to take care of its surrounding community, then its

popularity would go down. Patients from the communities around would prefer to travel far for

better medical care from other health organizations far away. Health organizations spend a lot of

money on charity services. Therefore, as the hospital's administrator, I would authorize the
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operation of Michael and this service to be classified as a charity. Therefore, from what the

hospital would have put aside for charity purposes, $250,000 would be deducted to cater for the

cost of Michael's heart transplant. As an administrator, this would have been the best course of

action that would have helped John's son without involving other stakeholders like an insurance

company who would complicate the process and make it take longer, hence risking Michael's

life.

As an insurance company administrator, I would just approve Michael’s surgery as his father had

been paying the full amount for PPO. Also, based on the severity of Michael’s condition, it

would have been ethical and humane to make a decision that would give the young boy a second

chance to live (Shi and Singh, 2019). Furthermore, John had been paying premiums, and

therefore, allowing his son to die may have negative implications on the reputation of the

company. It may have led to not only John withdrawing and registering in another insurance

company but also other existing customers who may negatively perceive the company's action

may decide to quit.

As a parent, I would take two actions. Since I am supposed to raise $75,000, I would first

mobilize people in my community and my close friends to help me in raising the amount. Since

$75,000 is not little, the remaining amount I would borrow it from a bank and use my house as

collateral in case I fail to pay.

If the health policy (HMO) had been changed not to cater to more expensive medical costs, it

would have negative implications for both the patients and the insurance companies (Shi and

Singh, 2019). First, patients would have to pay for the expensive medical bills, whether they

have an insurance cover or not. On the other hand, if the HMO was changed not to cover

expensive medical costs, very few patients would be willing to take insurance cover. Studies
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show that many patients pay for medical insurance coverage so that they can be covered in case

of expensive medical bills that may affect their financial position (Shi and Singh. 2019). As a

result, many insurance companies would lose customers, and their existence would be

meaningless.

References

Burg, M. (Producer), & Cassavetes, N. (Director). (2002). John Q (Film]. The USA.

Hartman, DesJardins & MacDonald. (2018). Business Ethics Decision Making for Personal

Integrity & Social Responsibility 4th Edition. New York, NY: McGraw Hill Education.

Moy, M., & Moffat, J. (2016). EMTALA answer book. Frederick: Aspen Publ, Inc. ISBN:

9781454810353

Shi. L. and Singh. D. (2019). Essentials of the U.S. Health Care System.