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An Ethical Dilemma

An Ethical Dilemma

Cicero once said, “Treat not with men who have no honor. You are both dishonored in the exchange but they have nothing to lose.” What, then, is the proper course of action when confronted with a powerful organization that one believes itself as behaving unethically? The easy answer, the one that most people will give automatically (and somewhat self-righteously), is to refuse to do business with that organization. But what if the organization is behaving in a perfectly legal and businesslike manner? What if, nevertheless, that behavior violates your own code of ethics, and arguably the larger ethical standard of ‘what is right and just’? I find myself wrestling with that question right now. Many of my peers think I’m overstating the problem, or that I’m being too idealistic. Many agree that the organization may not be a paragon of virtue, but they are scrupulously obeying the letter of the law, so there are no grounds for complaint. The large hospital system that operates the hospital where I do most of my elective surgery (not the trauma center where I also work) has instituted a policy of requiring payment in full of that portion of the total bill for which the patient is responsible before any non-emergent surgery can be scheduled. In other words, if you have one of the 80/20 insurance plans sold under the ACA exchange, or if your employer provided plan has such a payment scheme, the hospital wants your 20% up front. They won’t waive it or let you finance it other than on a major credit card. The only exceptions are ‘emergencies.’ “I object...
Guidance for Social Media Use in Emergency Medicine

Guidance for Social Media Use in Emergency Medicine

share content with other users. In addition to social networking websites like Facebook, other technologies continue to penetrate the market, including video and picture sharing sites, forums, blogs, and other tools. The social media boom has reached the healthcare community, with physicians from all backgrounds gravitating towards using these platforms for various purposes. Recent reports suggest that social media use among emergency medicine (EM) physicians is especially strong, most likely because they tend to embrace the healthcare side of this type of networking in ways not typically seen with other specialists. Some institutions have used social media to develop EM blogs and websites that cover daily practice issues. Others have used it to enhance emergency preparedness efforts. “Social media has become an important method of communication and information sharing in EM,” explains Malford T. Pillow, MD, MEd. “It offers the potential to create an attractive internet presence and brand specific programs, including EM residency programs.” Considering Risks & Negative Consequences of Social Media Social media offers tremendous benefits for recruiting, communication, and education, but it also carries legal, ethical, personal, and professional risks. Negative consequences of social media use include violating professional and personal boundaries, among other potential problems. “Even simple actions like ‘friending’ someone or posting something on Facebook can be misinterpreted,” says Dr. Pillow. “There needs to be deliberate, transparent policies in place that are designed to optimize the benefits of social media while minimizing risks.” Important Recommendations to Guide Social Media Use Guidance statements for social media use have been released by leaders in various medical fields. These documents are helpful for developing an overall structure...
Anesthesiologist Guilty on 2 Counts of Manslaughter

Anesthesiologist Guilty on 2 Counts of Manslaughter

A Manhattan jury found Stan Xuhui Li, MD, guilty of manslaughter for overprescribing painkillers to two patients, Joseph Haeg, 37, and Nicholas Rappold, 21, who later suffered fatal overdoses. The 60-year-old anesthesiologist from New Jersey, was found guilty of two counts of second-degree manslaughter, six counts of recklessly endangering the lives of six other patients, and 180 counts of selling prescriptions for controlled substances (view all charges here). Dr. Li ran a pain-management clinic out of a basement office in Queens 1 day each weekend, seeing up to 100 patients a day. Posting a price list on his wall for drugs, Dr. Li accepted payment primarily in cash and pocketed nearly $500,000 over 2.5 years. He prescribed opioids such as oxycodone and anti-anxiety drugs such as alprazolam to high-risk patients—ignoring evidence of drug abuse and addiction, drug diversion, prior overdoses, and degenerating health. Manslaughter In both manslaughter counts, Dr. Li was charged with failing to perform adequate examinations to verify Haeg and Rappold’s reports of chronic pain and ignored repeated warning signs of addiction. According to prosecutors, Haeg received 15 prescriptions for controlled substances from Dr. Li, including oxycodone, within 3 months leading up to his death. In the final month, Haeg received more than 500 pills in two visits, the last visit only 3 days before he died of acute oxycodone intoxication. Rappold also died 3 days after his last appointment with Dr. Li. He was found with a bottle of Xanax with only 35 pills remaining of 90 from a prescription prescribed only 3 days before. Cause of death was acute intoxication by the combined effects of Xanax...

Searching for Drugs and Crossing Ethical Lines

Back in September, I blogged about a case of a man in Tennessee who was sedated, intubated, and placed on a ventilator without his consent so that an emergency physician could perform a rectal exam looking for drugs. The court ruled that the man’s Fourth Amendment rights against an unreasonable search were violated. It gets worse. In New Mexico, a man is suing several law enforcement agencies and officers and doctors because of what some might consider an excessive search. See what you think. When the man was pulled over for running a stop sign, officers say he was clenching his buttocks, which led them to suspect he was hiding drugs in his rectum. They obtained a search warrant, but a doctor at the first hospital they took the prisoner to refused to do the search saying he believed it was not ethical. A second hospital was much more accommodating. At that institution, he allegedly underwent two digital rectal exams, two abdominal x-rays, and three enemas—all without his consent. He was forced to defecate in front of the police. After those procedures yielded nothing, he was sedated, and a colonoscopy was performed, also without consent and also negative for drugs. According to the report, the search warrant was not valid for the county in which the second hospital was located and had expired well before the colonoscopy was done. Here’s the punch line. At the end of the video in the link to the story, the reporter mentions that the hospital has billed the man for its services and is considering sending the bill to a collection agency if...

Ethics Anyone?

Is it OK for a doctor to give a prisoner medications to induce paralysis, intubate his airway, place him on a ventilator, and perform a rectal examination to look for drugs? Is it OK to threaten a prisoner with the above actions in order to persuade him to consent to a rectal examination? Without a court order, is it OK for a doctor to do a rectal examination on a prisoner who does not consent? In the emergency department of a hospital in Tennessee the answer to all three of the above questions was “yes.” But a ruling by a US Court of Appeals overturned the man’s conviction for possession of crack cocaine with intent to sell because the acts of “paralysis, intubation, and rectal examination” were in clear violation of [his] Fourth Amendment rights. (page 18 of the ruling). The Fourth Amendment prohibits unreasonable searches, and warrants must be based on probable cause. A lawyer representing the police blamed it all on the doctor, but the court ruled that he was “a tool” used by the police to search the man. One article said the doctor, an emergency medicine specialist, testified as follows, “That exam was going to occur with or without his consent.” At least one other victim, a man who was threatened with paralysis by the same doctor and consented to the search, has filed suit against the police. No drugs were found on that occasion. There was no emergency in either situation. There was plenty of time to obtain a warrant. Other options such as a plain x-ray of the abdomen and pelvis, could have...
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