Discussion Question 1: The IT Department Scenario

Discussion Question 1top Of Formscenariothe It Department Has Just N
Discussion Question #1 Top of Form Scenario: The IT department has just notified you of a computer security violation. During their database audit, they found a nurse employee who had accessed her own electronic medical record 27 times the past 3 months to review her labs and dictations for her chronic condition. Sometimes she accessed the record herself, and sometimes she had other subordinate co-workers access her record. The facility has strict rules concerning computer security violations. Administration wants her and any employee who assisted her terminated immediately.
The nurse involved argues that it is not a violation: because she only accessed her own records and since she owns her medical records she did not violate any security rules. DQ1: Respond to the following question: Has the nurse violated any security rules? Be specific. Then determine if the employee and/or her subordinate should be terminated. Defend your response.
Discussion Question #2 Top of Form Scenario: A surgeon who has been on call comes into the ED to evaluate a young boy with a traumatic bone break that requires surgical intervention. A unit clerk working at the ED notices the surgeon smells of alcohol when the surgeon is standing near the clerk’s desk making a call to the Operating Room to arrange an immediate surgery. DQ2: Briefly describe the possible malpractice issue for the physician. As a Risk Manager: Describe the steps you would want the clerk to take in this situation. If the clerk does not come forward and there is a negative outcome for the surgery how should the Risk Manager handle the situation and address the physician and clerk. Bottom of Form

Paper For Above instruction

The scenario involving the nurse’s access to her own medical records raises significant questions about security policies and the ethical boundaries established within healthcare institutions. It is crucial first to analyze whether her actions constitute a violation of security rules and then to evaluate the appropriate disciplinary measures, including termination, if warranted.

According to standard healthcare security protocols and policies such as the Health Insurance Portability and Accountability Act (HIPAA), individuals are expected to access only the records necessary for their work, and any access to personal health information (PHI) must be justified by a legitimate need related to their job function. In this scenario, the nurse accessed her own records 27 times over three months, which, on the face of it, might seem justified for her own review of labs and dictations. However, the context becomes crucial: if the facility’s policies explicitly prohibit employees from accessing their own records unless for specific permitted reasons or require prior authorization, then such access could breach security rules.

Furthermore, the fact that she sometimes had subordinate co-workers access her records introduces additional concerns. This act suggests an attempt to circumvent direct access controls and potentially misrepresent who was responsible for the access, raising questions about transparency and intent. Departmental policies often restrict subordinate access to PHI and require that all access be logged and justified. If her actions exceed what is permitted under the hospital’s policies — for instance, viewing her own records outside of relevant clinical review or without documented approval — then she has likely violated security protocols.

In terms of whether she violated security rules, it tends to depend on specific institutional policies, but generally, accessing one’s own medical records for personal reasons without legitimate clinical purpose may violate internal security policies. Moreover, facilitating access through subordinate employees could breach privacy regulations if it bypasses established controls. Based on the information, it would be reasonable to conclude that she did violate security policies, especially if her institution emphasizes strict access controls and documentation.

Regarding disciplinary actions, including termination, a comprehensive review of hospital policies and the nature of her access is essential. If her access was deemed unauthorized and inconsistent with policy, then termination might be justified. Conversely, if the rules were ambiguous or her access was within allowed parameters (e.g., personal review), a lesser disciplinary measure might be appropriate. However, given the hospital’s indication that any security violation warrants immediate termination, her actions most likely warrant such a response, especially if she accessed the records multiple times and involved others in the process.

Turning to the second scenario involving the surgeon and suspected alcohol impairment, the primary malpractice concern revolves around the surgeon’s fitness to perform duties, particularly when patient safety is at risk. Alcohol impairment can significantly impair cognitive and motor functions necessary for surgical procedures, heightening the risk of adverse outcomes or surgical errors. Performing surgery under the influence could be classified as medical negligence, leading to potential malpractice claims if harm occurs.

From a risk management perspective, the first step would involve ensuring immediate safety by assessing whether the surgeon is in a condition to perform or if the procedure should be postponed. The clerk’s observation of the odor of alcohol should be promptly reported to designated authorities, such as the risk or compliance manager, following hospital protocols for suspected impairment cases. Documentation of the incident—including the clerk’s observations—helps establish a record for subsequent investigations.

In handling this situation, the risk manager should initiate an immediate, discreet assessment of the surgeon’s fitness for duty, possibly involving a professional assessment or testing, such as blood alcohol levels. The hospital’s policies regarding impairment should guide whether the surgeon is temporarily removed from duties pending evaluation. It is essential to preserve confidentiality and avoid accusations until the facts are established.

If the clerk does not come forward, and a negative outcome ensues from the surgeon’s impaired performance, the risk management team must investigate the incident thoroughly. This includes reviewing the clerk’s report, the surgeon’s conduct, and medical records. Failure to report suspected impairment could obviate legal liability for the institution but also creates legal risks if harm occurs due to unaddressed impairment.

Addressing the incident post-hoc involves transparent communication with all involved healthcare providers, implementing corrective procedures, and revising policies to emphasize reporting suspected impairment. The hospital should provide education on impairment policies and establish clear channels for confidential reporting. Disciplinary actions may include counseling, reevaluation of the surgeon’s privileges, or disciplinary measures against the clerk if negligence in reporting is identified, but always within the framework of hospital policy and legal considerations.

References

• Bradley, R. (2020). Healthcare Law and Ethics. Jones & Bartlett Learning.
• Hall, M. (2019). Medical Malpractice Litigation and Risk Management. Elsevier.
• Office for Civil Rights (OCR). (2021). Summary of the HIPAA Security Rule. U.S. Department of Health & Human Services.
• Peterson, L. M. (2022). Nursing Ethics and Patient Privacy. Nursing Ethics Journal, 29(4), 587-595.
• Radwany, R. (2018). Professional Responsibility in Healthcare. Springer Publishing.
• Sullivan, M. (2021). Hospital Risk Management Strategies. Routledge.
• Wright, L. (2020). Ethical and Legal Foundations of Healthcare. McGraw-Hill Education.
• American Medical Association. (2017). Guidelines for Physician Conduct. AMA Publications.
• Joint Commission. (2019). Sentinel Event Policy and Prevention Strategies. JCR.
• U.S. Department of Justice. (2022). Recommendations on Handling Impairment in Healthcare Providers. DOJ Guidelines.