Crime Scene Investigations Workgroup
Chair
Major Susan
Barker,
Miami-Dade
Police
MDPD
Bomb
Squad FBI
Hazardous
Material
Response
Unit
Jackson
Memorial
Hospital
Trauma
Unit
Miami PD
Crime
Scene
Section
Broward
County SO
Crime
Scene
Bureau
MDPD
Crime Lab
Miami-Dade
Fire Rescue
Urban
Search &
Rescue
Fla Nat.
Guard
44th Civil
Support
Team
Miami-Dade
Medical
Examiner’s
Office
Module 4 - SLP
DISTRIBUTIVE JUSTICE
The goal of the Session Long Project is to identify and evaluate the ethical principles used in resolving ethical dilemmas, and to apply the principles to specific ethical issues that may have professional, sociological, economic, legal or political implications.
Often times a patient needs a lot of resources prior to being discharged from the hospital. Some organizations use discharge planners or case managers to aid in acquiring these resources. The topic of this SLP is about Jenna, a young woman who could not be discharged home until the issue of resources to care for her was resolved. This story demonstrates that resource allocation decision making is inherently complex, a process that is dynamic, multidimensional, and iterative. After reading the article, "The relational nature of case manager resource allocation decision making: An illustrated case" by Fraser, Estabrooks, and Strang and doing additional research, please respond to the questions listed below:
1. Provide a brief summary of Jenna's case. What was her medical condition? What was her prognosis? Why was it important for her to go home? Did she get to go home? If so, how did that impact her recovery?
2. What were the resources that Jenna needed to go home? What barriers did her case manager encounter in acquiring these resources?
3. Discuss the theory of relational ethics as it applies to this case. What is it? How does it impact the allocation of resources? Think about your own discipline of study, how does this theory apply to acquiring scare resources? Provide an example.
4. Based on what you have read about this case and resource allocation, do you agree with the statement "that resource allocation decision making is inherently complex, a process that is dynamic, multidimensional, and iterative"? Why or why not? What are your views on the fairness of the process? Was it done in a fair manner in this case? Did Jenna get preferential treatment because of her case manager? If there was no one advocating for her, what do you think the outcome would have been?
SLP Assignment Expectations
1. You will be expected to provide a scholarly basis for your response.
2. Your opinions must be justified with evidence from the literature.
3. References should be cited properly in the text of your essay (either in parentheses or as footnotes), as well as at the end.
4. Several (3-5) scholarly references should be cited for this assignment.
5. Please limit your response to 3 pages maximum, not including title and refer.
Crime Scene Investigations Workgroup Chair Major Susan .docx
1. Crime Scene Investigations Workgroup
Chair
Major Susan
Barker,
Miami-Dade
Police
MDPD
Bomb
Squad FBI
Hazardous
Material
Response
Unit
Jackson
Memorial
Hospital
Trauma
Unit
Miami PD
Crime
Scene
Section
3. Module 4 - SLP
DISTRIBUTIVE JUSTICE
The goal of the Session Long Project is to identify and evaluate
the ethical principles used in resolving ethical dilemmas, and to
apply the principles to specific ethical issues that may have
professional, sociological, economic, legal or political
implications.
Often times a patient needs a lot of resources prior to being
discharged from the hospital. Some organizations use discharge
planners or case managers to aid in acquiring these resources.
The topic of this SLP is about Jenna, a young woman who could
not be discharged home until the issue of resources to care for
her was resolved. This story demonstrates that resource
allocation decision making is inherently complex, a process that
is dynamic, multidimensional, and iterative. After reading the
article, "The relational nature of case manager resource
allocation decision making: An illustrated case" by Fraser,
Estabrooks, and Strang and doing additional research, please
respond to the questions listed below:
1. Provide a brief summary of Jenna's case. What was her
medical condition? What was her prognosis? Why was it
important for her to go home? Did she get to go home? If so,
how did that impact her recovery?
2. What were the resources that Jenna needed to go home? What
barriers did her case manager encounter in acquiring these
resources?
3. Discuss the theory of relational ethics as it applies to this
case. What is it? How does it impact the allocation of
resources? Think about your own discipline of study, how does
this theory apply to acquiring scare resources? Provide an
example.
4. Based on what you have read about this case and resource
allocation, do you agree with the statement "that resource
allocation decision making is inherently complex, a process that
is dynamic, multidimensional, and iterative"? Why or why not?
What are your views on the fairness of the process? Was it done
4. in a fair manner in this case? Did Jenna get preferential
treatment because of her case manager? If there was no one
advocating for her, what do you think the outcome would have
been?
SLP Assignment Expectations
1. You will be expected to provide a scholarly basis for your
response.
2. Your opinions must be justified with evidence from the
literature.
3. References should be cited properly in the text of your essay
(either in parentheses or as footnotes), as well as at the end.
4. Several (3-5) scholarly references should be cited for this
assignment.
5. Please limit your response to 3 pages maximum, not
including title and reference pages.
6. Be sure to apply critical thinking skills to your assignment
write-up.
Your paper will be evaluated based on the rubric criteria.
Please be sure to provide citations of sources consulted in
preparing your paper in the body of the actual document itself
(i.e. in addition to furnishing a reference list). Remember, any
statement that you make that is not common knowledge or that
originates from your synthesis or interpretation of materials you
have read must have a citation associated with it. For guidelines
on in-text citations, visit the following web
site: http://owl.english.purdue.edu/handouts/research/r_apa.html
Module 4 - Case
DISTRIBUTIVE JUSTICE
Case Assignment
One of the most difficult dilemmas to resolve relates to the
allocation of valuable, but scarce resources. Setting standards
by which resources are allocated is not an easy task. We hear
about patients every day that don't make it because there aren't
enough organs for those on the list. Please read the article:
5. History of deceased organ donation, transplantation, and organ
procurement organizations by Howard, Cornell, and Cochran.
After reading the article and doing additional research, please
respond to the following questions.
1. Discuss some of the earliest examples of transplantation. Do
you think these early experiments made it easier for it to
become so commonplace today? What lessons can we learn from
the early pioneers?
2. Discuss the process of using organs from deceased patients.
What are at least two ethical principles that apply to this
process? Be sure to address distributive justice as one of your
choices. What are the ethical issues that may arise? What are
some instances where the dead donor rule has been violated?
3. Briefly discuss the origins of organ procurement
organizations (OPO). What role do they play in organ
donations? What ethical issues do you see with these
organizations? What are the rules and regulations that govern
these organizations?
4. We tend to think of organ transplantation as pertaining to
healthcare alone. Provide some examples of how your specific
discipline might impact some aspect of organ donation. For
example, how might a public health agency impact the process
or rules and regulations for organ donation?
Use the information in the modular background readings as well
as resources you find through ProQuest or other online sources.
Please be sure to cite all sources and provide a reference list at
the end of the paper. Submit the paper as a WORD document
through the link provided for the assignment.
Assignment Expectations
1. Discuss Mr. Krampitz's case from the perspective of
distributive justice and the allocation of scarce resources.
2. Limit your responses to three pages, not including title and
reference pages.
3. Be sure to incorporate module and course concepts into your
discussion.
4. Be sure to apply critical thinking skills in your write-up.
6. 5. Provide several (3-5) scholarly references to support your
discussions and be certain to properly cite all references.
Please be sure to provide citations of sources consulted in
preparing your paper in the body of the actual document itself
(i.e. in addition to furnishing a reference list). Remember, any
statement that you make that is not common knowledge or that
originates from your synthesis or interpretation of materials you
have read must have a citation associated with it. For guidelines
on in-text citations, visit the following web
site: http://owl.english.purdue.edu/handouts/research/r_apa.html
Your paper will be evaluated based on the following criteria.
Ethics Mod 4 discussion
Ethics and Organ Transplantation
Actions for 'Ethics and Organ Transplantation'
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Your comments will be graded on how well they meet the
Discussion Requirements posted under “Before You Begin.”
The rationing of scarce healthcare resources is a subject that is
both politically sensitive and raises a number of ethical
dilemmas for those charged with making treatment decisions.
The ethical dilemma is health care is how to balance the
precepts of autonomy, beneficence, and distributive justice.
Rationing may affect 3 dimensions of coverage: the share of the
population covered; the services covered; and the extent to
which services are covered (Teutsch & Rechel, 2012). The U.S.
spends 50% more per capita on health care than any other
country while achieving worse health than many (Teutsch &
Rechel, 2012). Poorly coordinated insurance mechanisms leave
19% of the population uninsured (Teutsch & Rechel, 2012).
Until passage of the Patient Protection and Affordable Care Act
(PPACA) in 2010, health care was effectively a privilege, not a
right (Teutsch & Rechel, 2012). While PPACA seeks to rectify
7. this, by 2019 five percent of non-elderly U.S. residents will
likely remain uninsured (Tuetsch & Rechel, 2012). There are
some who believe the U.S. healthcare system is broken and in
desperate need of a radical change—the very change that the
passage of the ACA represents. It could be argued that the ACA
will only worsen the rationing of healthcare services in the
United States. What is your position on this matter? Is the
rationing of healthcare a bad thing or a necessary action? What
ethical dilemmas might be associated with the rationing of
healthcare services and how could they be effectively
addressed? Please support your positions/arguments with
credible evidence.
Reference
Teutsch, S. & Rechel, B. (2012). Ethics of resource allocation
and rationing medical care in a time of fiscal restraint – U.S.
and Europe. Public Health Review, 34(1).
Module 4 - Home
DISTRIBUTIVE JUSTICE
Modular Learning Outcomes
Upon successful completion of this module, the student will be
able to satisfy the following outcomes:
· Case
· Discuss the ethical issues related to healthcare rationing and
organ transplantation.
· Identify and discuss the origins of organ procurement
organizations (OPOs).
· Discuss the early beginnings of transplantation and lessons
learned.
· SLP
· Examine and resolve ethical dilemmas related to resource
allocation.
· Discuss the theory of relational ethics as it relates to resource
allocation.
· Discussion
8. · Discuss ethical dimensions of resource allocation and
rationing in healthcare. What ethical guidelines should
influence resource allocation in healthcare?
Module Overview
Rationing
According to Chris Hackler, in health care, we see rationing in
one of three practices:
· Limit the amount money spent on health care is an example of
the allocation of financial resources;
· Distribution of scarce organs for transplantation is an example
of the distribution of scarce goods; and
· The practice of triage in the emergency room is an example of
prioritizing services.
Managed Care and Rationing
While the managed care concept has been around since the early
1900s, it wasn't until the Nixon administration that we saw the
birth of the HMO and proliferation of "managed care." As you
are well aware, Managed Care is a financing philosophy that
emphasizes the cost effective delivery of health care.
This approach to health care delivery has raised a number of
ethical questions, one of which is whether managed care
organizations (MCO) ration health care services due to the costs
of such care, and the obligation and desire to be profitable.
This approach has placed providers in the unenviable position
of gatekeepers. Providers are required to consider the costs of
health care services being recommended; specially, in Health
Maintenance Organizations where the providers receive annual
bonuses based on the savings they created during the year by
not referring patients to specialists and/or specialty care. The
effect of these bonus arrangements has been obvious. There is a
built in incentive to under-treat or limit care. Also, the
providers have been prevented from acting as advocates for
their patients; instead, they are agents for the MCOs.
Organ Transplantation
According to the United Network of Organ Sharing (UNOS),
every 14 minutes a new name is added to the transplant waiting
9. list. Although the number of issues are great, the number one
issue related to organ transplantation is the shortage of organ
donors. The implications become clear when one recognizes that
there simply are insufficient number of donors and organs to
effectively treat those in need.
In America, organ donations are made through a volunteer
system. While pre-mortem donation is legally accepted in the
United States, family members of a potential donor are always
asked for permission before organs are removed.
In many countries, "presumed consent" is the accepted practice.
With presumed consent, physicians and hospitals remove and
transplant needed organs unless the decedent has expressly
objected prior to his death.
As technology advances and medicine obtains better results
from certain transplant procedures, ethical issues arise in the
context of transplantation for patients with histories of drug or
alcohol abuse. For example, should a recovering alcoholic
receive a liver transplant? Should a smoker receive a lung
transplant? Should an obese patient receive a heart transplant?
Take a look at the assigned readings and let see if we can
answer some of the questions raised.
Please click on this link for a news report regarding a Dutch
reality program involving a kidney
donation:http://www.usatoday.com/life/television/2007-06-01-
kidneys_N.htm
PSDA - The Patient Self Determination Act of 1991 requires
health care organizations receiving federal money (Medicare or
Medicaid) to inform their in-patients, in writing, about their
rights to make health care decisions including the right to
accept or refuse proposed treatment and the right to complete
state permitted "advance directives."
As medical technology advances and improves, and patients
gain a better understanding of their rights, patients and families
have and continue to insist on receiving life-sustaining
treatment that may be considered as "futile" by health care
professionals.
10. FUTILITY - According to Charles Weijer (Medical Futility,
1999) the term medical futility was coined in 1990 as a response
to demands by patients and families for treatment thought to be
inappropriate. Medical Futility is a professional judgment that
takes precedence over the patient's self-determination and
autonomous rights.
Some define "medical futility" as a medical determination that a
therapy or treatment is of no value to a patient and consequently
should not be prescribed or provided.
It has been argued that treatments that merely preserve
permanent unconsciousness or that cannot end dependence on
intensive medical care should be considered as futile. (L. J.
Schneiderman, "Medical Futility: Its meaning and Ethical
Implications", 1990)
Some health care providers view "futility" as legal practitioners
and scholars view pornography: They may not be able to define
it but they know it when they see it. Jacobellis v. State of Ohio
(1964)
Cardio-Pulmonary Resuscitation and Do Not Resuscitate
We see futility raised in cases involving Cardio-Pulmonary
Resuscitation and Do Not Resuscitate orders. CPR was
originally intended for use in cases involving reversible cardiac
arrests. The current practice appears to be the use of CPR in all
cases unless there is a contrary order. DNR was intended to
avoid aggressive attempts to revive patients where death was
anticipated and inevitable. Patients and families; however, have
demanded that CPR be performed at all times, even when health
care providers believe it to be futile.
Research of the PSDA will lead to the conclusion that
Cardiopulmonary resuscitation and emergency cardiac care are
meant to reverse premature death. They should restore the
process of living, not prolong the process of dying. When
people reach the end of life, continued resuscitative efforts are
inappropriate, futile, undignified and demeaning to both the
patient and the rescuers.
Persistent Vegetative State (PVS)
11. The question of futility is also raised in cases involving patients
in a persistent vegetative state (PVS). These patients receive
treatment that is effective, but does nothing more than
"maintain" a patient in PVS. As mentioned in module one,
bioethics was placed on the map with the Karen Ann Quinlan
case, where the parents of a young woman in a drug induced
coma sought termination of life-support treatment. The Quinlan
case initiated discussions about when to stop treatment.
What if the patient or family members have unrealistic
expectations and demands with respect to treatment? Where
patient and family cultural and religious beliefs demand
continued or discontinued treatment, the physician's ethical
obligations are clearly invoked.
Module 4 - Background
DISTRIBUTIVE JUSTICE
Required Reading
Delmonico, F. L., Domínguez-Gil, B., Matesanz, R., & Noel, L.
(2011). Organ transplantation 1: A call for government
accountability to achieve national self-sufficiency in organ
donation and transplantation. The Lancet, 378(9800), 1414-8.
Retrieved from
http://search.proquest.com/docview/900104741?accountid=1437
5
Doig, C. & Rocker, G. (2003). Retrieving organs from non-
heart-beating organ donors: a review of medical and ethical
issues. Canadian Journal of Anesthesia, 50(10), 1069-
1076.http://www.springerlink.com/content/xq622m7g54h87301/
Fraser, Kimberly D,R.N., PhD., Estabrooks, Carole,R.N., PhD.,
Allen, Marion,R.N., PhD., & Strang, Vicki,R.N., PhD. (2010).
The relational nature of case manager resource allocation
decision making: An illustrated case. Care Management
Journals, 11(3), 151-6.
Frunza, M., Frunza, S., Catalin, V. B., & Grad, O. (2010).
Altruistic living unrelated organ donation at the crossroads of
ethics and religion. a case study. Journal for the Study of
Religions and Ideologies, 9(27), 3-24. Retrieved
12. from http://search.proquest.com/docview/816629192?accountid
=14375
Howard, Richard J,M.D., PhD., Cornell, Danielle L,R.N.,
B.S.N., & Cochran, L. (2012). History of deceased organ
donation, transplantation, and organ procurement
organizations. Progress in Transplantation, 22(1), 6-16; quiz 17
Miller, F. G., & Truog, R. D. (2008). Rethinking the ethics of
VITAL ORGAN DONATIONS. The Hastings Center Report,
38(6), 38-46. Retrieved from
http://search.proquest.com/docview/222366351?accountid=1437
5
Optional Reading
Benning, T. M., Breugelmans, E., Dellaert, B. G., & C. (2012).
Consumers' evaluation of allocation policies for scarce health
care services: Vested interest activation trumps spatial and
temporal distance. Marketing Letters, 23(3), 531-543
Denny, B. & Kienhuis, M. (2011). Using crisis theory to explain
the quality of life of organ transplant patients. Progress in
Transplantation, 21(3), 182-189
Hoy, H., Alexander, S., & Frith, K. (2011). Effect of transplant
education on nurses' attitudes toward organ donation and plans
to work with transplant patients. Progress in Transplantation,
21(4), 317-321
Spicer, J. (2008, Nov. 21). Distributive justice. Practice Nurse,
36(9), 45-48.
Websites
Moon, L. (2002). Organ Allocation. Retrieved
fromhttp://www.miracosta.edu/home/lmoon/allocate.html.
Consent forms for Research must include several elements
13. Identify ResearchThe subject’s involvement must be identified
as researchThe research must be describedThe purpose of the
research must be explained
RisksRisks and consequences of the research activity must be
clearly set forth
BenefitsThe benefits of the proposed research must be explained
AlternativesIf the investigations is clinical, the diagnostic and
therapeutic alternatives must be described
Research RecordsThe mechanism and process of protecting
privacy and maintaining confidentiality of records and data
must be described
CompensationThe availability of compensation for participation
must be explainedThe availability of treatment in the event of
injury must be explained
Contact PersonThe consent form must clearly identify the
14. person to contact with questions, concerns, inquiries, or in the
event of injury
Individual RightsThe right of the individual to refuse
participation or withdraw from the research must be explained
Ethics mod 5 discussion
Consent to Terminate Care
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Discussion Requirements posted under “Before You Begin.”
In Belgium, where euthanasia has been legal for people over the
age of 18 since 2002, the government is considering an
amendment to the law to include children. This is something
that no other developed country has permitted (Belgium). The
same bill would offer the right to die to adults with early
dementia (Belgium). Advocates argue that euthanasia for
children, with the consent of their parents, is necessary to give
families an option in a desperately painful situation (Belgium).
However, opponents have questioned whether children can
reasonably decide to end their own lives (Belgium). In the last
decade, the number of reported cases per year has risen from
235 deaths in 2003 to 1,432 in 2012, the last year for which
statistics are available (Belgium). Doctors typically give
patients a powerful sedative before injecting another drug to
stop their heart. Only a few countries have legalized euthanasia
or anything approaching it. In the Netherlands, euthanasia is
legal under specific circumstances and for children over the age
of 12 with parental consent (there is an understanding that
infants, too, can be euthanized, and that doctors will not be
prosecuted if they act appropriately) (Belgium). Elsewhere in
15. Europe, euthanasia is only legal in Luxembourg. In the U.S.,
Oregon is the only state that legalized physician-assisted
suicide. Assisted suicide, where doctors help a patient to die but
do not actively kill them, is allowed in Switzerland. Is it ethical
for healthcare professionals to support the practice of assisted
suicide/euthanasia? Regardless of your personal view on the
topic, please provide an argument which supports, and then
opposes the practice of assisted suicide/euthanasia. Be certain
to support your positions with credible evidence.
Reference
Belgium considering controversial new euthanasia law for
children. (October 31, 2013) Associated Press. Retrieved
from:http://www.foxnews.com/health/2013/10/31/belgium-
considering-controversial-new-euthanasia-law-for-children/
Module 5 - SLP
CONSENT AND RESEARCH
The ultimate goal of the Session Long Project is to identify and
evaluate the ethical principles used in resolving ethical
dilemmas, and to apply the principles to specific ethical issues
that may have professional, sociological, economic, and legal or
political implications.
Select a national (government) healthcare agency and discuss
the ethical practices that it applies to experimentation and
research.
SLP Assignment Expectations
1. Identify the practice along with a companion theory.
2. Are these practices enough to ensure safe and ethical
research? If not what should be added to them?
3. Limit your responses to a maximum of three pages, not
including title and reference pages.
4. Be sure to provide scholarly support for your discussion.
5. Several (3-5) scholarly references should be cited for this
assignment. Be sure to properly cite all references.
6. Apply critical thinking skills within the write-up for this
16. assignment.
Your paper will be evaluated based on the rubric criteria.
Please be sure to provide citations of sources consulted in
preparing your paper in the body of the actual document itself
(i.e. in addition to furnishing a reference list). Remember, any
statement that you make that is not common knowledge or that
originates from your synthesis or interpretation of materials you
have read must have a citation associated with it. For guidelines
on in-text citations, visit the following web
site: http://owl.english.purdue.edu/handouts/research/r_apa.html
Module 5 - Case
CONSENT AND RESEARCH
Assignment Overview
For this Case Assignment, you are part of a medical research
team and are tasked with gaining informed consent from
potential participants. The study will seek to test an
experimental drug with patients suffering from late-stage
leukemia. The sample will be divided into a control group and
the experimental group. Participants in the control group will be
given a placebo, which could increase the progression of their
disease. The sample will be composed of children.
Case Assignment
Discuss how you would go about seeking the consent of
participants.
· What questions would you expect from their
parents/guardians?
· How much information should you share with the children?
· Should this type of study involve children given the risks of
speeding the progression of the disease?
Assignment Expectations
1. Apply critical thinking skills within the write-up for this
assignment, especially with regard to #2 and #3 above.
2. Limit your responses to a maximum of three pages, not
including title and reference pages.
17. 3. Provide scholarly support for your justifications. Be sure to
properly cite all references.
Your paper will be evaluated based on the rubric criteria.
Module 5 - Home
CONSENT AND RESEARCH
Modular Learning Outcomes
Upon successful completion of this module, the student will be
able to satisfy the following outcomes:
· Case
· Examine the ethical implications of "consent."
· SLP
· Select a national healthcare agency and discuss the ethical
standards that apply to experimentation and research.
· Discussion
· Discuss whether healthcare personnel should be involved in
assisted suicide from an ethical perspective.
Module Overview
Human Experimentation
The Nuremberg Code of 1946 was the first publicly written
international document providing a code of ethics relating to
research on human subjects. The Code represented an absolute
commitment to the doctrine of informed consent. "The voluntary
consent of the human subject is absolutely essential." Also, the
duty and responsibility for ascertaining the quality of consent
rests "upon each individual who initiates, directs, or engages in
the experiment. It is a personal duty and responsibility which
may not be delegated to another with impunity." Trials of War
Criminals before the Nuremberg Military Tribunal under
Control Council Law No. 10 (Vol. 2) (Washington, D.C.,: U.S.
Government Printing Office, 1949).
While the Nuremberg Code focused on the responsibility of the
individual engaging in research activities, the United States
Federal Government has placed responsibility on institutions as
well as the individual. By 1970, the first federal guidelines
18. designed to protect human research subjects were issued by
what is now the Department of Health and Human Services.
Federal regulations now require that all research projects
funded by the DHHS be reviewed by local institutional review
boards (IRB). The IRB is said to be the central mechanism
through which the regulatory goal of protecting the rights and
welfare of subjects of research is carried out.
Informed Consent
Medical procedures and experimentation required the expressed
written consent of patients and participants. Consent sometimes
called informed consent involves obtaining permission to
proceed with procedures or experimentation after the
patient/participant was informed of the risks, procedures,
benefits, and safeguards that are in place to protect the best
interest of the patient/participant.
The matter of consent can raise legal and ethical challenges if
the patient/participant is mentally handicapped or otherwise
incapacitated. Those lacking the cognitive faculties to
understand the information may rely upon caretakers.
End-of-life
End-of-life decisions can be difficult for family members of
those incapacitated and not expected to recover. When does life
end? Who should decide when life should end? Should medical
professionals rely on the subjective opinions of family members
in making the decision?
Codes of Ethics
National organizations that serve individuals working in the
human services or health-related fields offer codes of ethics for
their members. The codes of ethics typically build on common
virtues that promote the best interests of clients and patients.
The virtues can be reduced to “Do no harm.” The codes cover
the scope of practice and include guidelines for consent and for
end-of-life decisions. The codes of ethics can be obtained on
organizational websites.
Click for a PowerPoint presentation on federal regulations
regarding consent forms.
19. Module 5 - Background
CONSENT AND RESEARCH
Required Reading
Atac, A., et al. (2005). A Study of the Opinions and Behaviors
of Physicians with Regard to Informed Consent and Refusing
Treatment. Military Medicine, 170(7), 566-71.
Brudney, D. (2009, Mar./Apr.). Choosing for another: beyond
autonomy and best interests. The Hastings Center Report. 39(2),
31-38.
Dickman, R. L. (2000, March). Bending the rules to get a
medication. American Family Physician 61 (5),
1563. http://www.aafp.org/afp/2000/0301/p1563.html
Erlen, J. A. (2010). Informed consent: Revisiting the
issues. Orthopaedic Nursing, 29(4), 276-80. Retrieved from
Lambert, V., & Glacken, M. (2011). Engaging with children in
research: Theoretical and practical implications of negotiating
informed consent/assent. Nursing Ethics, 18(6), 781-801. doi:
http://dx.doi.org/10.1177/0969733011401122
Miller, F. G., & Wertheimer, A. (2011). The fair transaction
model of informed consent: An alternative to autonomous
authorization. Kennedy Institute of Ethics Journal, 21(3), 201-
18. Retrieved from Waller, B. N., & Repko, R. A. (2008).
Informed consent: Good medicine, dangerous side
effects.Cambridge Quarterly of Healthcare Ethics, 17(1), 66-74.
Websites
GAO Highlights (2005). Un-compensated Care. Retrieved
fromhttp://www.gao.gov/new.items/d05743t.pdf.
CRJ 548 – Crime Scene Investigation and Management
DRNC Scenario
This scenario corresponds with Course Objective I (see below).
20. Objective I: Definitively identify and assess crime scene
requirements as to special needs and support
logistics, to include, but not limited to, the needs and materials
to establish proper search procedures and
patterns, identify hazardous materials and situations, and
considerations specific to mass crime scenes.
Students will have a knowledge of the proper methods of crime
scene photography as well as crime
scene mapping and sketching and skills such as triangulation of
crime scenes.
The following story is a fictional account of an incident
occurring during the mythical Democratic-
Republican National Convention (DRNC) event in Miami,
Florida. The story is loosely based on an
amalgamation of real life occurrences. The names of all the
characters in the story are fictional.
Background
Miami-Dade Police has been designated as the lead local agency
and lead operational planner for the
event security. Since this event meets the criteria of a National
Special Security Event (NSSE), the U.S.
Secret Service has been designated as the lead coordinating
agency with overarching statutory authority
21. for the planning and execution of the event. U.S. Secret Service
Supervisory Special Agent Samantha
Salerno has been appointed as the lead agent in-charge for the
event.
Due to the influx of tens of thousands of delegates, visitors, and
protestors, it is expected that the forensic
processing and evidence retention for a mass number of
assaults, larcenies and other crimes will
increase considerably during the week of the event. It is clear
that a multi-agency approach such as the
ones used for the 2003 FTAA Conference, the 2004 Presidential
Debates, and the Super Bowls of 2007
and 2010 must be employed for this large-scale special event as
well.
Neither the Miami Police Department (MPD), nor the Miami-
Dade Police Department (MDPD) have the
forensic assets adequate to handle such a large-scale event by
themselves. It would take some degree of
shared responsibility between MPD and MDPD, as well as some
of the 30+ other incorporated areas
such as Miami Beach, Hialeah, and Coral Gables. In addition to
the local and federal agencies already
mentioned, crime scene and forensic units from Florida’s
Regional Domestic Security Task Force
22. (RDSTF - Region 7) have been detached to this event. These
include, but are not limited to the Bomb
Squads of Broward and Palm Beach Counties, as well as the
crime scene units from both of those
Region 7 counties.
Other key players for the DRNC include the Federal Bureau of
Investigations (FBI), the Bureau of Alcohol
Tobacco & Firearms (ATF), the Department of Homeland
Security (DHS), the Department of Energy
(DOE), and the Florida National Guard’s 44th Civil Support
Team.
For the DRNC special event, a multi-agency Crime Scene
Investigations Workgroup has been created
under the Security & Public Safety Subcommittee. This
workgroup is comprised of personnel from the
Miami-Dade Police Crime Lab, the Broward County Sheriff’s
Office Crime Scene Investigations Bureau,
the City of Miami PD Crime Scene Section, Jackson Memorial
Hospital, the FBI’s Hazardous Material
Response Unit, the Miami-Dade Police Bomb Squad, the ATF’s
explosive ordnance investigators, the
Miami-Dade Medical Examiner’s Office, the 44th Civil Support
Team of the Florida National Guard, and
Miami-Dade Fire Rescue’s Urban Search & Rescue Team (see
23. the DRNC Crime Scene Investigations
Workgroup Org Chart provided).
The Crime Scene Investigations Workgroup created several
multi-agency teams specifically designed to
respond to mass casualty chemical, biological, radiological,
nuclear, or explosive (CBRNE) incidents
occurring during the event. One such team was the Joint Hazard
Response Team (JHRT). The JHRTs
are comprised of multi-disciplinary experts from MDPD, MPD,
ATF, FBI, and the 44th CST (see the JHRT
org chart provided).
Another multi-agency team specifically created for the DRNC
was the Joint Forensic Investigation Team
(JFIT). The difference between the JHRTs and the JFITs is that
the former responds to bombing and
WMD incidents before, or during the threat, while the latter
respond after the bombing or threat has
become apparent. Simply stated, JHRTs are first responders and
assessors of CBRNE incidents, while
the JFITs are responsible for post-blast investigations.
However, it should be noted that many of the
same expert personnel serve on both the JHRT and JFIT teams.
24. In addition to these two event-specific teams, the South Florida
Joint Terrorism Task Force (JTTF) is also
involved in the DRNC security planning before the event, as
well as investigative response during and
after the event. The JTTF is a long-standing multi-agency
investigative group that is headed by the FBI,
and supported with personnel by the local law enforcement
agencies. Table 1 provides a brief explanation
of what each of these multi-jurisdictional organizations provide.
Jurisdictional Authority
While the U.S. Secret Service has been designated as the lead
coordinating agency for the DRNC event,
there are other jurisdictional issues that need to be aware of.
Miami-Dade Police have jurisdictional
authority for crimes occurring within Miami-Dade County. The
same holds true for Broward County and
Palm Beach County respectively. In other words, jurisdictional
issues during the DRNC event will be no
different than during regular times.
One important jurisdictional issue has to do with the
investigation of bombings. If the explosion is
determined to be a result of a terrorist incident, the FBI has the
authority as the lead investigative agency.
25. Non-terror related bombings are relegated to the ATF. Of
course, immediately after a bomb explodes, it is
almost impossible to determine whether it was due to a terrorist,
or a non-terrorist act. Typically, that is
determined later during the investigation, as the pieces of the
puzzle start to point to one direction or
another. Since there is so much uncertainty during the first few
hours of a bombing incident, both the FBI
and the ATF respond, along with the local bomb squads and
crime scene investigation units. That is why
both the JHRTs and the JFITs are comprised of ATF and FBI
agents.
Table 1
Multi-Agency
Group
Permanent
or Ad
Hoc?
Mission Comprised of
Southeast Florida
26. Regional Domestic
Security Task Force
(RDSTF – Region 7)
Permanent This is a multi-jurisdictional
agency that is headed by the
Florida Department of Law
Enforcement (FDLE) and whose
mission is to coordinate the flow
of resources (funding as well as
equipment), the flow of
Miami-Dade Police, Miami PD,
Broward County Sheriff’s Office,
Ft. Lauderdale PD, Palm Beach
County Sheriff’s Office, Monroe
County Sheriff’s Office, FBI,
ATF, Florida National Guard,
Florida Highway Patrol,
27. information, and the coordination
of a multiple jurisdictional
response to terrorist incidents.
Regional hospitals, and the
Emergency Management
departments of the four
counties in Region 7.
South Florida Joint
Terrorism Task
Force (JTTF)
Permanent This group is headed by the FBI.
Its mission is to coordinate all
terrorism-related investigations
in the South Florida area. The
JTTF also manages the
Southeast Florida Fusion
Center, which serves as a data
collection, and intelligence
28. dissemination function.
FBI, ATF, FDLE, MDPD, Miami
PD, Broward Sheriff’s Office, Ft.
Lauderdale PD, Palm Beach
County Sheriff’s Office, and
other local police departments.
Joint all-Hazards
Response Teams
(JHRTs)
Ad Hoc for
the DRNC
event only
This ad hoc team is responsible
for mitigating chemical,
biological, radiological, nuclear,
and explosive (CBRNE) threats
before they occur, and
responding to an incident which
29. has already occurred in order to
minimize the effects of the
threat.
Bomb squad and Hazmat
technicians from the following
agencies:
Miami-Dade Police, Miami PD,
Broward County Sheriff’s Office,
Ft. Lauderdale PD, Palm Beach
County Sheriff’s Office, Monroe
County Sheriff’s Office, FBI,
ATF, Florida National Guard,
Miami-Dade Fire Rescue Dept.,
Broward Fire-Rescue…
Joint Forensic
Investigation Team
(JFIT)
Ad Hoc for
30. the DRNC
event only
This ad hoc team is responsible
for post-blast investigations that
may occur during the DRNC
event.
Crime scene investigations and
forensic laboratory assets of the
above listed agencies.
Scenario
The DRNC is a five-day event that takes over a year to plan for.
The epicenter of the convention is
located at the American Airlines Arena (also known as the
“Triple A”) in Downtown Miami. A buffer zone
has been erected around the arena, as well as the entire Bayside
and Bayfront Park areas, and the
Intercontinental Hotel. The area inside the buffer zone is
considered as the “security zone” and is where
the delegates who attend the convention will have free access.
The security zone extends to the waters
31. of Biscayne Bay, and includes the entire Port of Miami.
Entry into the secure zone is strictly monitored at four locations
along the buffer zone perimeter. Only
persons with the proper credentials are allowed into the security
zone. Two of the four entry/exit gates are
located at the AAA, and the west gate into the Intercontinental
Hotel grounds. The other two access
points into the secure zone are from the dockyard at the east
side of the AAA, and the pier at the east
side of the Intercontinental Hotel. These two access points are
for pre-screened ferry boats that help to
shuttle the delegates from the hotel to the AAA arena. All
persons (including on-duty law enforcement
personnel) must be screened prior to entry into the security
zone. The screening involves a multi-stop
queue whereby all vehicles and persons entering the security
zone are subjected to an X-ray examination
(VACIS machine for vehicles), magnetometers, explosive
detection K-9s, and a physical pat down
search. In addition, SWAT team counter-snipers are placed at
high locations at various places in order to
prevent any terrorist bombers (and their vehicles) from getting
access into the security zone. This
32. screening process is one of the strictest and most elaborate in
the world, yet it is not completely infallible.
There have been several accounts of people getting past the
security gates, into the security zone during
previous Super Bowls and political conventions. So far, the
intruders have been non-terrorists.
One week prior to the start of the DRNC in early August, a team
of 40 K-9 officers and their dogs swept
every inch of the AAA and its surrounding property. These K-9
officers came from all parts of Florida, as
well as a few federal agencies from Washington, D.C.
Immediately after sweeping certain areas in and
around the AAA, security guards were posted on a 24-hour basis
to make sure that no explosive devices
would be placed after the sweep. Once the K-9 team’s
commander felt comfortable that the areas had
been secured, a guard would be posted and then the K-9s would
go onto somewhere else to sweep
another critical area (such as the Intercontinental Hotel).
The police were not the only ones who were getting ready the
week prior to the start of the DRNC event.
It appears that some adversarial groups were getting ready as
well. Five days before the DRNC, the
33. Bomb Management Center (located at the Broward County
Emergency Operations Center) received a
barrage of suspicious device calls (i.e., bombs) at various
locations in Miami-Dade County. The Miami-
Dade Bomb Squad responded to seven different calls in which
backpacks had been abandoned in the
Downtown Miami area (outside the exclusionary area). One of
them turned out to be the belongings of a
homeless person who slept under the Metrorail station in
Overtown. However, the other six turned out to
be elaborate hoax devices. All six of these devices were
determined by the bomb techs to be inert, and
posed no danger of explosion. Nevertheless, the fact that so
many hoax devices were turning up during
the week prior to the DRNC was somewhat troublesome.
That week, Tim Johnson the FBI Supervisory Special Agent,
and lead worker of the Miami JTTF, called
an impromptu meeting at the South Florida Fusion Center,
located in Broward County to discuss the
recent rash of hoax bomb calls. Also present at the meeting
were Mary Straight (Fusion Center Chief
Analyst), Detective Mike Warner (MDPD and JTTF member),
Detective Frank Gomez (City of Miami PD,
and JTTF member), Detective Josh Marcussen (Broward
34. Sheriff’s Office, and JTTF member), and
Detective Fred White (Palm Beach SO, and JTTF member).
Sergeant James Boyd of the Miami-Dade PD
Bomb Squad was also invited and asked to debrief the JTTF
investigators regarding the hoax devices.
At the onset of the meeting, Tim Johnson asked Sergeant Boyd
to describe the six hoax devices that
were found at various locations around Downtown. Sergeant
Boyd reported that in his opinion, all six
hoax devices were very similar in composition, and were likely
constructed by the same person. Next,
Mary Straight reported that in five of the six hoax bomb cases
had been captured on video from the pole
cameras in the Downtown area.
Several months before the DRNC, pole video cameras were
placed at almost every corner of Downtown
Miami. These high resolution cameras covered almost every
conceivable angle in the Downtown area,
and could be zoomed in to get a fairly clear picture of
individual peoples’ faces. It is fairly well known
within law enforcement and security realms that hired personnel
cannot conceivably monitor every
possible angle that these cameras reached. However, some new
software advances had made the task
35. of video surveillance much better in that the software was
programed to sense when items had been left
behind by suspects. If after 10 seconds the item had not been
recovered by a person, then the alarm at
the video monitoring station would sound, and the attention of
the security monitor would be brought to
that screen. This was an excellent surveillance tool that had
been first used at a large scale special event
during the 2007 Super Bowl in Miami.
Mary passed out printed handouts of close-up screen capture
photos of the two subjects who had
dropped off the hoax devices in five out of the six cases. Mary
stated, “we have run these two through our
facial recognition software, and compared them to all of our
data banks, but we don’t have any matches
so far. All I can tell you so far is that these guys are white
males, about 5’ 6” and both weighing about 140
pounds.”
“Geez...these two guys look almost like the two Boston
Marathon bombers,” stated Johnson. They’re
dressed the same, and even their faces are similar. If I didn’t
know better, I would say that those two had
36. been resurrected.”
“Well...they haven’t been resurrected, but it looks like these
two guys have resurrected the idea,”
remarked Mary. “We don’t have any other leads on these two at
the moment...and we don’t know if
they’re just Anarchist hoaxers who are doing this to spread our
bomb squad resources thin, or whether
these guys are serious bombers. There’s no way to tell right
now.”
Sergeant Boyd interrupted, “yeah...even though these were all
hoax devices, let’s not discount the
possibility that these subjects are real bombers who are placing
these hoax devices to see how we
respond to them. Every time that we go to a bomb call, we are
always wary that someone is watching us
and our procedures.”
“Agreed,” said Johnson. “We need to have a couple of
surveillance teams on the ground in case these
guys show up again. If we find them...we’ll tail them for a
while and try to find out if they’re working alone,
or as part of a larger group. I already have Detective Phil
Herrera’s surveillance team on standby in
Downtown Miami from 7 a.m. to 7 p.m., and Tom Sullivan’s
37. team from the Tampa JTTF is handling the
evening shift.”
Detective Mike Warner asked, “Tim...what are your thoughts of
putting out a press release to the public
with these guys’ picture on it like they did up in Boston for the
Marathon bombers?”
“Mike, we may have to that eventually, but I think it’s
premature at this point. Even if a concerned citizen
who knows their identity reported them to us, we don’t have
much in the way of criminal charges against
them.”
“That’s true, but at least we can nail them on State charges
related to the building and possession of hoax
devices,” replied Warner.
“You make a good point Mike, but let’s try to find them with
our surveillance teams first...and if we don’t
do it within the next two days, then we’ll release the
information and pictures to the public and try that
route. If we do the press release now, these two guys will know
that we’re looking for them, and they may
take off to who knows where. So far, none of the devices
contained any explosives, so I don’t view this as
an imminent threat to the public.”
38. Warner responded, “OK...I see your point, and I agree with
what you’re saying. However, if by Monday
morning we haven’t found these guys, then I think we need to
alert the public.” Warner turned to Sergeant
Boyd and asked, “Jim, we’ll need your Bomb Squad on standby
all weekend, in case we find these guys
and they lead us to their stash of bomb making materials.”
“No problem Mike. In fact, all six of my guys are already
assigned to ad hoc J-HRT teams and their days
off have been cancelled until the DRNC is over,” replied
Sergeant Boyd. With that, the meeting at the
South Florida Fusion Center concluded.
Five Days Later (Monday, the first day of the DRNC event)
It was early Monday morning...the first day of the DRNC event
in Downtown Miami. Supervisory Special
Agent Tim Johnson called another meeting of the JTTF.
Johnson started the meeting, “alright…so far the surveillance
teams or the cameras have not picked up
on the two subjects that we’ve been looking for. I think it’s
time to release the subjects’ pictures to the
public and seek their assistance.”
39. Detective Warner interrupted, “Tim, I just got a text message
from the Bomb Squad sergeant. He said that
his bomb squad got called out late Sunday night for five
separate suspicious package calls at various
Metrorail stations. According to Jim Boyd, so far his teams
have rendered safe three out of the five, and
this time no hoax devices...all of them turned out to be real
bombs.”
Johnson stated, “it sounds like we have some real live bombers
on our hand. Mary, do we have anything
on video this time?”
Analyst Mary Straight answered, “yes we do…as a matter of a
fact, that’s how one of the calls for the
Bomb Squad came from. We have a video of the same two
guys...wearing the same clothing as last
week…dropping off a backpack at the train level of the
Overtown Metrorail station. Unfortunately, by the
time we got a hold of the surveillance team on the ground, the
two guys disappeared and we have
nothing on their location or direction of travel.”
“Well I guess it’s time to release the information to the public,”
said Johnson.
“Tim...I just got additional information from the Bomb Squad
40. sergeant. He’s now telling me that two other
devices have detonated...one south in the Vizcaya Metrorail
station, and another north of Downtown, in
the Earlington Heights Metrorail. Apparently, there have been
many casualties…as many as 100 dead or
injured…it’s too early to say,” said Detective Warner.
“OK...I’m hearing the same thing from my sources,” stated
Detective Frank Gomez (City of Miami PD).
“Over a hundred casualties...mostly Metrorail commuters…It
looks like many of the injured at the Vizcaya
station are being transported to South Miami Hospital. The
injured persons from the Earlington Heights
explosion are being transported to Jackson Memorial Hospital’s
trauma unit.”
“OK...it sounds like we have at least five…maybe seven
different crime scenes…not counting the two
hospitals,” stated Detective Warren. “I’ll get a hold of Major
Susan Barker, who’s in charge of the joint
forensic teams that have assembled for the event. They’re going
to have their hands full with so many
different crime scenes. I hope she has enough people on her
teams.”
“Mary...can you please get a hold of our Joint Information
Center (JIC) and give them the press release
41. that we put together last week?”
Mary Straight nodded in agreement, but then said, “are you sure
you want to release this information right
now? You realize that the reporters are going to ask a lot of
questions, and they are sure to ask why we
didn’t release the information last week, when we first had it.”
“Mary, I realize that we will come under a lot of scrutiny for
not having released the pictures earlier...but
let me deal with that later. Right now we need to find these two
guys as soon as possible.”
Assignment Instructions
For this assignment, you are to write a 1200- to 2000-word
essay. Your essay must identify and assess
crime scene requirements as to special needs and support
logistics, to include, but not limited to, the
needs and materials to establish proper search procedures and
patterns, identify hazardous materials
and situations, and considerations specific to mass crime
scenes. Consider how you would handle these
related multiple crime scenes as if you were in Major Susan
Barker’s shoes.