MHA6060: Health Law and Ethics Week 5 Assignment APPLICATION OF ETHICS TO LEGAL ISSUES Please review the following case: The defendant in State v. Cunningham, the owner, and administrator of a residential care facility housed thirty to thirty-seven mentally ill, mentally retarded, and senior residents. The Iowa Department of Inspections and Appeals conducted various surveys at the defendant’s facility between October 1989 and May 1990. All of the surveys except one resulted in a fifty-dollar daily fine assessed against the defendant for violations of the regulations. On August 16, 1990, a grand jury filed an indictment charging the defendant with several counts of wanton neglect of a resident in violation of the Iowa Code section 726.7 (1989), which provides, “A person commits wanton neglect of a resident of a healthcare facility when the person knowingly acts in a manner likely to be injurious to the physical, mental, or moral welfare of a resident of a healthcare facility. . . . Wanton neglect of a resident of a healthcare facility is a serious misdemeanor.” The district court held that the defendant had knowledge of the dangerous conditions that existed in the healthcare facility but willfully and consciously refused to provide or to exercise adequate supervision to remedy or attempt to remedy the dangerous conditions. The residents were exposed to physical dangers and unhealthy and unsanitary physical conditions and were grossly deprived of the much-needed medical care and personal attention. The conditions were likely to and did cause injury to the physical and mental well-being of the facility’s residents. The defendant was found guilty on five counts of wanton neglect. The district court sentenced the defendant to one year in jail for each of the five counts, to run concurrently. The district court suspended all but two days of the defendant’s sentence and ordered him to pay $200 for each count, plus a surcharge and costs, and to perform community service. A motion for a new trial was denied, and the defendant appealed. The Iowa Court of Appeals held that there was substantial evidence to support a finding that the defendant was responsible for not properly maintaining the nursing facility, which led to prosecution for wanton neglect of the facility’s residents. The defendant was found guilty of knowingly acting in a manner likely to be injurious to the physical or mental welfare of the facility’s residents by creating, directing, or maintaining hazardous conditions and unsafe practices. The facility was not properly maintained (for example, findings included broken glass in patients’ rooms, excessive hot water in faucets, dried feces on public bathroom walls and grab bars, insufficient towels and linens, cockroaches and worms in the food preparation area, no soap available in the kitchen, and at one point, only one bar of soap and one container of shampoo found in the entire facility). Dietary facilities were unsanitary an ...

1. MHA6060: Health Law and Ethics
Week 5 Assignment
APPLICATION OF ETHICS TO LEGAL ISSUES
Please review the following case:
The defendant in State v. Cunningham, the owner, and
administrator of a residential care facility housed thirty to
thirty-seven mentally ill, mentally retarded, and senior
residents. The Iowa Department of Inspections and Appeals
conducted various surveys at the defendant’s facility between
October 1989 and May 1990. All of the surveys except one
resulted in a fifty-dollar daily fine assessed against the
defendant for violations of the regulations.
On August 16, 1990, a grand jury filed an indictment charging
the defendant with several counts of wanton neglect of a
resident in violation of the Iowa Code section 726.7 (1989),
which provides, “A person commits wanton neglect of a resident
of a healthcare facility when the person knowingly acts in a
manner likely to be injurious to the physical, mental, or moral
welfare of a resident of a healthcare facility. . . . Wanton
neglect of a resident of a healthcare facility is a serious
misdemeanor.”
The district court held that the defendant had knowledge of the
dangerous conditions that existed in the healthcare facility but
willfully and consciously refused to provide or to exercise
adequate supervision to remedy or attempt to remedy the
dangerous conditions. The residents were exposed to physical
dangers and unhealthy and unsanitary physical conditions and

2. were grossly deprived of the much-needed medical care and
personal attention.
The conditions were likely to and did cause injury to the
physical and mental well-being of the facility’s residents. The
defendant was found guilty on five counts of wanton neglect.
The district court sentenced the defendant to one year in jail for
each of the five counts, to run concurrently. The district court
suspended all but two days of the defendant’s sentence and
ordered him to pay $200 for each count, plus a surcharge and
costs, and to perform community service. A motion for a new
trial was denied, and the defendant appealed.
The Iowa Court of Appeals held that there was substantial
evidence to support a finding that the defendant was responsible
for not properly maintaining the nursing facility, which led to
prosecution for wanton neglect of the facility’s residents. The
defendant was found guilty of knowingly acting in a manner
likely to be injurious to the physical or mental welfare of the
facility’s residents by creating, directing, or maintaining
hazardous conditions and unsafe practices.
The facility was not properly maintained (for example, findings
included broken glass in patients’ rooms, excessive hot water in
faucets, dried feces on public bathroom walls and grab bars,
insufficient towels and linens, cockroaches and worms in the
food preparation area, no soap available in the kitchen, and at
one point, only one bar of soap and one container of shampoo
found in the entire facility). Dietary facilities were unsanitary
and inadequate to meet the dietary needs of the residents. There
were inadequate staffing patterns and supervision in the facility,
and improper dosages of medications were administered to the
residents.
The defendant argued that he or she did not “create” the unsafe
conditions at the facility. The court of appeals disagreed. The

3. statute does not require that the defendant create the conditions
at the facility to sustain a conviction. The defendant was the
administrator of the facility and responsible for the conditions
that existed.
Please address the following questions drawing support from
your course resources and credible scholarly resources cited in
APA format:
Analyze this case from the perspective of the four ethical
theories presented throughout the course—consequential ethics,
utilitarian ethics, deontological ethics, and nonconsequential
ethics.
Discuss how ethics and the law are intertwined in this case.
Present your assessment of the court’s finding and whether it
was just.
References
MHA6060 WEEK 5 LECTURE, DISCUSSION, AND PROJECT
INSTRUCTIONS 1
Physician Ethical and Legal Issues
Physicians are heavily guided by the elements of the
Hippocratic Oath and code of medical ethics outlined by the
American Medical Association. When it comes to ethical
practice in the treatment of patients, both ethics and law
intertwine. For example, the law stipulates that preventable
harm warrants compensation, that is, when a physician injures a
patient due to negligence, that physician must be penalized and
that patient must be compensated. Such malpractice cases are,
of course, an egregious violation of a physician’s ethical and
legal responsibilities. Of similar importance are training
physicians and their staff to show professionalism and
compassion to build honest and trusting relationships with their

4. patients. As healthcare administrators, you are likely to see
cases of physician negligence involving patient assessments,
medical diagnoses, and treatment, that is, the most common
medical errors involve the following:
· Patient assessments encompass all processes that collect
patient data needed to create appropriate and effective care
plans. A myriad of healthcare professionals must work together
to gather accurate information. A physician who performs a
substandard patient assessment is more likely to misdiagnose
health issues or provide incomplete care.
· Patient diagnoses require physicians to identify the most
likely disease or disease process in a patient to support further
actions for additional testing or treatment. However, despite the
improvements in medical imaging and diagnostic testing, an
overdependence on the results can be harmful to the patient.
· Finally, patient treatment, or the strategies used to restore the
patient to health, may result in more harm than good. Whether
the treatment is conservative or palliative, it is important that
physicians periodically review best practices in the field and
follow currently prescribed guidelines based on evidence.
Legal Action against Healthcare Professionals
Review each tab to learn more.
· Supreme Court of Nevada
Piroozi, M.D., and Martin Blahnik, M.D., Petitioners, v. the
eighth judicial district court of the state of Nevada, in and for
the County of Clark; and the Honorable James M. Bdcler,
District Judge.

5. Respondents: Tiffani D. Hurst; and Brian Abbington, Jointly
and on Behalf of their Minor Child, Mayrose Lili–Abbington
Hurst, Real Parties in Interest.
No. 64946.
Decided: December 31, 2015
Summary: An infant suffered brain injury as a result of
untreated anemia.
Verdict: $14.5 million to parents of infant
· District of Columbia Court of Appeals
Sibley Memorial hospital, Petitioner, v. District of Columbia
department of employment services.
Respondent: Ann Garrett, Intervenor.
No. 97-AA-263.
Decided: May 07, 1998
Summary: The surgeon failed to recognize inappropriate blood
flow post-knee replacement, leading to amputation.
Verdict: $8.35 million to the plaintiff

6. · Superior Court of New Jersey, Appellate Division
Marquis A. Walker, Executor and Personal Representative of
the Estate of Sabrina griffin.
Deceased: Plaintiff–Appellant, v. Ilmia Choudhary, M.D., Tara
Kiger, M.D., Dominic Diorio, M.D., Frank Lasala, M.D.,
S.J.E.R. Physicians, P.C., South Jersey Regional Medical
Center, and South Jersey Healthcare.
Defendants–Respondents.
DOCKET NO. A–1425–10T1.
Decided: March 30, 2012
Summary: Doctors failed to report suspected abuse of a child
who later suffered a brain injury.
Verdict: $45 million to child via guardian
Additional Materials
From your textbook, Legal and Ethical Issues for Health
Professionals, review the following chapter:
· Physician Ethical and Legal Issues
From the South University Online Library, review the following
article:
· Expanding Access to Care: Scope of Practice Laws
Patient Abuse
There are a number of ways that a healthcare professional may
become involved in a case of abuse, which is pervasive.
Hospital-based workers are most often confronted with patient
abuse, which is any level of mistreatment of individuals

7. receiving care from the agency. It is important to note that a
physician may be the perpetrator of the abuse or the one to
identify and report the abuse a patient experienced outside the
facility. Such abuse may include any physical, psychological,
medical, or financial abuse inflicted on a patient.
Child abuse is the abuse of a child under the age of eighteen
years, and all states have child abuse statutes to mandate
accurate reporting. Detecting child abuse may prove
challenging, and any caregivers who suspect a pattern of abuse,
such as repeated visits for broken bones or bruises, should
report suspicions. In order to promote quick identification and
intervention in child abuse cases, the caregivers are immune
from liability for any good faith reporting.
Senior abuse is a significant concern as many older adults fail
to report incidents out of fear. A majority of states mandate
reporting of senior abuse, which may involve anything from
emotional outbursts or malnourishment to unexpected bank
activity or death. Caregivers who suspect abuse are encouraged
to document accurately and extensively and report suspected
abuse.
Case Study: Incidents of Patient Abuse
Review each case study to learn more
Case Study 1
Abusive Search
A nurse in People v. Coe (1988) was charged with a willful
violation of the public health law in connection with an
allegedly abusive search of an eighty-six-year-old resident at a
geriatric center and with the falsification of business records in
the first degree. The resident, Mr. Gersh, had a heart disease
and difficulty in expressing himself verbally. Another resident
claimed that two $5 bills were missing. Nurse Coe assumed that
Gersh had taken them because he had been known to take things
in the past. The nurse proceeded to search Gersh, who resisted.
A security guard was summoned, and another search was
undertaken. When Gersh again resisted, the security guard

8. slammed a chair down in front of him and pinned his arms while
the defendant nurse searched his pockets, failing to retrieve the
two $5 bills. Five minutes later, Gersh collapsed in a chair
gasping for air. Coe administered cardiopulmonary resuscitation
but was unsuccessful, and Gersh died.
Coe was charged with violation of the New York Penal Law for
falsifying records because of the defendant’s “omission” of the
facts relating to the search of Gersh. These facts were
considered relevant and should have been included in the
nurse’s notes regarding this incident. The first sentence states,
“Observed resident was extremely confused and talks
incoherently. Suddenly this became unresponsi ve …” This
statement is simply false. It could only be true if some reference
to the search and the loud noise was included. A motion was
made to dismiss the indictment at the end of the trial.
The court held that the search became an act of physical abuse
and mistreatment, that the evidence was sufficient to warrant a
finding of guilt on both charges, and that the fact that searches
took place frequently did not excuse an otherwise illegal
procedure.
Forcible Administration of Medication
The medical employee in In re Axelrod sought review of a
determination by the commissioner of health that she was guilty
of resident abuse. Evidence showed that the employee, after a
resident refused medication, “held the patient’s chin and poured
the medication down her throat.” There was no indication or
convincing evidence that an emergency existed that would have
required the forced administration of the medication. The court
held that substantial evidence supported the commissioner’s
finding that the employee had been guilty of resident abuse.
Deficient Care
In Montgomery Health Care Facility v. Ballard (1990), three
nurses testified that the facility was understaffed. One nurse
testified that she asked her supervisor for more help but that she

9. did not get it. A nursing home resident, Mrs. Stovall, expired as
the result of multiple infected bedsores. The estate of the
patient brought a malpractice action against the nursing home.
First American Health Care, Inc., is the parent corporation of
the Montgomery Health Care Facility, a nursing home. The trial
court entered a judgment on a jury verdict against the home, and
an appeal was taken. The Alabama Supreme Court held that
reports compiled by the Alabama Department of Public Health,
concerning deficiencies found in the nursing home, were
admissible as evidence.
Evidence showed that the care given to the deceased was
deficient in the same ways as noted in the survey and complaint
reports, which indicated that deficiencies in the home included:
· Inadequate documentation of treatment given for decubitus
ulcers
· Twenty-three patients found with decubitus ulcers, ten of
whom developed those ulcers in the facility
· Dressings on the sores were not changed as ordered
· Nursing progress notes did not describe patients’ ongoing
conditions, particularly with respect to descriptions of decubitus
ulcers
· Ineffective policies and procedures with respect to sterile
dressing supplies
· Lack of nursing assessments
· Incomplete patient care plans
· Inadequate documentation of doctor’s visits and orders or
progress notes not consistently documented
· Inadequate documentation of turning of patients
· Incomplete activities of daily living sheets
· Range of motion exercises not documented
· Patients found wet and soiled with dried fecal matter
· Lack of bowel and bladder retaining programs
· Incomplete documentation of ordered force fluids
From a corporate standpoint, the parent corporation of the
nursing facility could be held liable for the nursing facility’s
negligence, where the parent company controlled or retained the

10. right to control the day-to-day operations of the home. The
defendants had argued that the punitive damage award of $2
million against the home was greater than what was necessary to
meet society’s goal of punishing them. The Alabama Supreme
Court, however, found the award not to be excessive. The trial
court also found that because of the large number of nursing
home residents vulnerable to the type of neglect found in Mrs.
Stovall’s case, the verdict would further the goal of
discouraging others from similar conduct in the future.
References:
· People v. Coe, 71 N.Y. 2d 852 (1988).
· Montgomery Health Care Facility v. Ballard, 565 So. 2d 221
(1990).
Additional Materials
From your textbook, Legal and Ethical Issues for Health
Professionals, review the following chapter:
· Patient Abuse
From the South University Online Library, review the following
article:
· Using Forum Play to Prevent Abuse in Health Care
Organizations: A Qualitative Study Exploring Potentials and
Limitations for Learning
Healthcare Ethics Committee
Many healthcare organizations create advisory bodies to help
guide them in the discussions and decisions related to ethical
healthcare practice. Such healthcare ethics committees are often
comprises a number of stakeholders and are often in the
position to offer an objective perspective on healthcare issues.

11. While such advisory boards are critical elements in supporting
relationships between the healthcare providers and their
patients, members of the ethics committee must maintain some
distance from that relationship. As such, the committee
members are often tasked with discussing issues of morality and
patient autonomy, as well as new and revised legislation at the
state and federal levels.
As a healthcare administrator, there is a high likelihood that
you may serve as a hospital representative, for example, on a
hospital-based ethics committee. You will need to develop
professional working relationships with others in your hospital
such as nurses and physicians or patient advocates.
Additionally, you will need to build trust between you and the
community representatives on the committee, who may include
ethical specialists, legal counsel, or community religious
leaders. Many hospital-based ethics committee are relatively
large to allow for multiple perspectives to be represented. This,
however, may also present challenges for effective
communication and appropriate conflict resolution.
Ultimately, a role on any hospital-based ethics committee will
demand attention to the following goals:
· Promotion and protection of patient rights
· Promotion and protection of shared decision making
· Promotion and protection of the patient-physician relationship
Ethics Committees: Goals and Functions
Review each component to learn more.
Goals of Ethics Committees
· Promote the rights of patients.
· Promote shared decision making between patients and
clinicians.
· Assist the patient and family in coming to consensus when
faced with ethical dilemmas.

12. Functions of Ethics Committees
· A resource tool in resolving ethical dilemmas.
· Patients and family should be encouraged to participate in
addressing ethical dilemmas.
community education.
CAdditional Materials
From your textbook, Legal and Ethical Issues for Health
Professionals, review the following chapter:
· Health Care Ethics Committee
From the South University Online Library, review the following
article:
· Ethics by Committee: A Textbook on Consultation,
Organization, and Education for Hospital Ethics Committees
· coWeek 5 Discussion
Discussion Topic
Top of Form
Due September 16 at 11:59 PM
Bottom of Form
Before beginning work on this discussion forum, please review
the link “Doing Discussion Questions Right” and any specific

13. instructions for this topic.
Your initial posting should be addressed at 300–500 words.
Make your post to this Discussion Area by the due date
assigned.
Before the end of the week, begin commenting on at least two
of your classmates’ responses. You can ask technical questions
or respond generally to the overall experience. Be objective,
clear, and concise. Always use constructive language, even in
criticism, to work toward the goal of positive progress. Submit
your responses in the Discussion Area.
ETHICAL ISSUES IN HEALTHCARE
Review the following case study and address the questions that
follow:
Mark was waiting to be seen by his physician in a
multispecialty physician office practice. As Mark was waiting
to see his physician, he observed a woman, most likely in her
late seventies, limping into the office. She had a large leg brace
that ran from her thigh to the calf of her leg. She struggled to
push her husband in a wheelchair into the office. She carefully
parked the wheelchair and approached the check-in counter. She
apologized for being late for her appointment as she was late
getting out of another physician’s office. The patient was told,
“You are late for your appointment. The office has a fifteen-
minute late arrival rule. You will have to reschedule your
appointment.” She apologized for being late and said that she
did tell the office staff she would be late.
She was then told, “You can wait, and I will try to squeeze you
into the schedule, but I don’t know how long you will have to
wait.” The lady said, “I don’t want to bother anyone. I will
reschedule my appointment.” She was directed around the
corner to another desk to reschedule her appointment. Mark got
out of his chair, walked over to the scheduler, and said, “I don’t
believe this. Her husband is sitting in a wheelchair, and she is
having difficulty walking. She can have my appointment, and I
can reschedule.” The lady suddenly turned to Mark and gave
him a big hug. The scheduler asked, “Who is your physician?”

14. Mark told her, and he was told, “I am sorry, but this lady has a
different physician.” The lady, now a bit teary eyed, continued
to make her appointment.
Tasks:
1. Describe the ethical issues involved in this observation.
2. Consider and discuss how this event could have had a more
pleasant outcome.
To support your work, use your course and textbook readings
and also use the South University Online Library. As in all
assignments, cite your sources in your work and provide
references for the citations in APA format.
· Week 5 Project
Assignment
Top of Form
Due September 20 at 11:59 PM
Bottom of Form
Before beginning work on this assignment, please review the
expanded grading rubric for specific instructions relating to
content and formatting.
APPLICATION OF ETHICS TO LEGAL ISSUES
In each of the previous weeks, you had the opportunity to
explore an ethical theory—consequential ethics, utilitarian

15. ethics, deontological ethics, and nonconsequential ethics—in
the context of a case scenario from your textbook. In this week,
the focus will be on how those ethical paradigms apply to legal
issues involving patient abuse.
Tasks:
1. Download and save the assignment template to your computer
and update the file name to include your last name.
2. Review the assigned case in its entirety.
3. Address the questions posed in detail and with appropriate
scholarly support.
To support your work, use your course and textbook readings
and also use the South University Online Library. As in all
assignments, cite your sources in your work and provide
references for the citations in APA format.
Submission Details
. By the due date assigned, submit your document to
the Submissions Area.
.
· A resource tool in resolving ethical dilemmas.
· Patients and family should be encouraged to participate in
addressing ethical dilemmas.