Chapter 8organizational Ethics And The Lawthere Are Lots Of Important ✓ Solved

Chapter 8 Organizational Ethics And The Law There are lots of important concepts in this chapter, be sure to read it and take notes, as some are sure to be on the final exam. Learning Objectives Describe corporate structure. Describe a code of ethics for organizations. Discuss organizational misconduct. Explain respondeat superior and corporate negligence.

Describe corporate duties and responsibilities. Describe strategies to restore organizational trust. Corporate Authority Healthcare organizations are incorporated under state law. Governing body. Duties and responsibilities: Described in a corporation’s articles of incorporation.

Day-to-day operations are delegated to the CEO. Fiduciary Responsibility Express corporate authority Delegated by statute Implied corporate authority Corporate powers not specifically granted in articles of incorporation Ultra vires acts Acting beyond scope of authority Corporate Ethics Promote responsible behavior Mission, vision, and values Build trust Increase awareness of ethical issues Provide staff Code of ethics Training and education Commitment by organization’s leadership Corporate Compliance Program (1 of 2) Appoint compliance officer. Develop standards of conduct. Assign duties, authority, and responsibility. Communication and education.

Implement monitoring and auditing systems. Corporate Compliance Program (2 of 2) Consistency in enforcement of policies and procedures. Reasonable steps in response to offenses. Annual audit of compliance program. Integrity and effectiveness.

Maintain management trust on all levels. Unprofessional Conduct Trust and integrity lacking False advertisements Concealing mistakes Surgical procedure cover-up Appearance may not be reality Truthfulness in Advertising Hospitals advertise their quality by how well a third party evaluates them. Often a brief and cursory 3- to 5-day visit Scores as high as 100 were often posted on billboards and/or in local newspapers. One young lady told me, “This hospital [in a small rural town] scored 100. they have the nerve to publish this. They killed my mom.

I wouldn’t take my dog there.†Corporate Negligence Occurs when a corporation fails to perform duties and responsibilities it owes directly patients, visitors, and staff. If a duty is breached and a patient is injured as a result of that breach, the corporation can be liable for a patient’s injuries under the theory of corporate negligence. Benchmark Darling Case In Darling v. Charleston Community Memorial Hospital, the court enunciated a “corporate negligence doctrine†under which hospitals have a duty, for example, to provide adequately trained medical and nursing staff. Respondeat Superior Legal doctrine holding employers liable for wrongful acts of their employees.

Doctrine also referred to as vicarious liability. For liability to be imputed to the employer: A master–servant relationship must exist between the employer and the employee. Wrongful act of the employee must have occurred within the scope of his or her employment. Independent Contractor Independent contractor is responsible for his or her own negligent acts. Relationship established when principal has no right of control over manner in which agent’s work is to be performed.

Corporate Duties and Responsibilities (1 of 5) Appointment of CEO CEO licensure CEO responsibilities and challenges CEO code of ethics Maintain moral integrity Screen job applicants Corporate Duties and Responsibilities (2 of 5) Credentialing, appointments, and privileging Ensure competency False statements Masquerading as a physician Discipline of physicians Physicians reluctant to discipline physicians Physician privileges suspended Don’t Let Hospitals Make You Sick The problem is not that we have an epidemic of negligent doctors. Rather, it’s that the health-care system has grown so complicated that there is a greater chance than ever of things falling through the cracks. . . . —Dr. Ranit Mishori, Parade Magazine, 2009 Corporate Duties and Responsibilities (3 of 5) Provide adequate staff.

Provide adequate supplies and equipment. Allocate scarce resources. Provide quality patient care. Comply with rules and regulations. Corporate Duties and Responsibilities (4 of 5) Comply with accreditation standards.

Accreditation and conflict of interest. Provide timely treatment. Avoid conflicts of interest. Situations where one has opportunity to promote self-interests that could have a detrimental effect on an organization. Corporate Duties and Responsibilities (5 of 5) Provide a safe environment.

Prevent surgical errors. Runaway elevator. Prevent of falls. Protect patients from sexual assault. Example: Sexual assault in the recovery room.

Decisions That Collide with Professional Ethics The principles of autonomy, beneficence, and justice and the ability to practice what is right according to such principles often collide when organizations have to, for example, ration scarce resources. Such rationing may require managers to cut costs at the expense of quality. Case 1: Financial Incentive Scheme (1 of 2) I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because in fact, what I did was I saved a company a half a million dollars for this. —Dr.

Linda Peeno, Congressional testimony Case 1: Financial Incentives Scheme (2 of 2) HMO failed to disclose financial incentive system it provided to its physicians to discourage referrals to specialists. Discuss the legal and ethical issues. Case 2: Letter of Recommendation A former employer who knew that an employee had committed offensive sexual acts gave a letter of recommendation that vouched for him without reservation. The employee after being hired by the new employer injured the student-plaintiff. Discuss the legal and ethical issues.

Case 2: Legal Issues Liability may be imposed Recommendation letter misrepresented truth Duty to care Breach of duty Injury incurred Causation Breach of duty was cause of injury Injury was foreseeable Case 2: Legal Issues (Foreseeability) Randi W. v. Muroc Joint Unified School Dist., 14 Cal.4th 1066, 929 P.2d ): Defendants could foresee, had they not recommended the employee, the new employer would not have hired him. Defendants could foresee that employer would read and rely on defendant's letters of recommendation and that employee after being hired by new employer might molest or injure a student such as the plaintiff in this case. Case 2: Ethical Issues First do no harm Truthfulness Case 3: Letter of Recommendation (1 of 2) Mr.

R’s supervisor had received several reports alleging misconduct between Mr. R and some of the female residents in the Lee Allan nursing home. The supervisor was unable to verify them. Mr. R applied for a supervisory position with Parke County Nursing Home.

Parke County was sent a preprinted reference form from Lee Allan. Form indicated Mr. R was eligible for rehire. Form reflected that Mr. R performed his job adequately.

Case 3: Letter of Recommendation (2 of 2) Parke County hired Mr. R in part on the basis of a favorable recommendation from Lee Alan. The claim here is that Mr. R assaulted a patient at Parke County. The plaintiff asserts that the former employer, Lee Allan, wrongly gave a favorable recommendation and thus should be liable for the injury.

Case 3: Legal Issues Summary judgment was granted in favor of Lee Alan. The facts did not reflect that Lee Alan had any substantial information indicating that Mr. R had committed sexual misconduct with residents at Lee Alan. Case 3: Human Resources Issues Passmore v. Multi-Management Svcs., Inc., 810 N.E.2d 1022 (Ind.

2004). Recommendations should not be filled with rumors and innuendo instead of facts. Without substantial evidence, employers would subject themselves to possible defamation litigation. Declaring employers liable for negligence in providing employment references will lead to employer reluctance to provide information. Case 3: Ethical Issues Beneficence Justice Fairness Case 4: Surgical Site Infection Operating room staff observe a 10-inch by 2-inch tear in a surgical table mattress.

It is 2:00 PM and the room has been prepared for Mrs. Smith’s surgery. A surgical sheet is placed on the table. The sheet is worn and has several tears in it. Mrs.

Smith is placed on the surgical table. (Note: Prior to Mrs. Smith’s surgery, a bowel resection was performed on the same table.) Discuss the legal and ethical concerns. Case 4: Legal Issues Legal issues Negligence? Consider the hospital’s responsibility. Torn mattress is a known infection-control concern.

Body fluids can seep into the mattress. Recurrent use of the mattress by various patients. Case 4: Ethical Issues Ethical Issues Nonmaleficience (first, do no harm) Professional codes of ethics Case 4: Professional Ethics Operating room staff recognized the mattress should have been taken out of service but failed to do so. It is common knowledge that body fluids can seep into a mattress pad and provide a breeding ground for infections. Describe how hospital policy should address this issue.

Case 5: Defrauding the Government In States v. Liveoak, 377 F.3d 859 (C.A. 8, Mo. 2004), the government filed an indictment against 11 individuals and 4 corporations. In the indictment, the government alleged a healthcare fraud scheme that involved several residential care facilities and thousands of claims.

The government alleged that over at least 5 years 15 defendants, in various conspiracies, defrauded the government by falsely certifying patients as homebound and submitting false claims to Medicare and Medicaid. Case 5: Defrauding the Government Joinder of Medicare fraud was proper where the charges here were linked not only by common conspiracy members, but also by an overall scheme in which each conspiracy member participated to fraudulently charge the government for healthcare costs. Case 5: Legal and Ethical Issues Legal issues Fraud Ethical issues Trustworthiness Restoring Trust Effective communication spawns trust and a harmonious organization. All the players must work together and understand the role each plays.

Better the teamwork, better the care. Results in satisfied patients, families, and staff. Improving Organizational Performance Board education Policies and procedures Search for best practices Reduce variation Ensure continuity of care Partner with the community Develop a culture of compassion and kindness Review Questions Discuss the governing body’s decision-making authority. Explain what an ultra varies act is. Describe the important aspects of a code of ethics for organizations.

Discuss the various forms of professional misconduct discussed. Describe corporate negligence, respondeat superior, and independent contractor. Describe the duties and responsibilities of healthcare organizations and how the failure to adhere to those duties and responsibilities can result in both legal and ethical issues. Discuss how an organization’s decisions can collide with professional ethics. Discuss importance of effective communications in building trust in the healthcare setting.

Review Questions Hemorrhagic Fever with Renal Syndrome – Russia (07): Tatarstan Archive Number .3106 Published Date 02-Oct-2008 The Republic of Tatarstan in Russia has experienced an increased incidence in Hemorrhagic Fever with Renal Syndrome (HFRS) for this year. The current report states the incidence for 2008 is seven times greater than reported for 2007. Between September 19 and 25, 2008, 29 confirmed or suspected cases were reported (International Society for Infectious Diseases [ISID], 2008a). This is in addition to outbreaks reported earlier this year. According to the Russian Epidemiological Surveillance System, there were 165 cases reported as of July.

Cases increased from 65 on July 4 to 165 by July 22 (ISID, 2008b). Only one fatality has been reported at this time; generally, case fatality rates for HFRS range from 1% to 15%. Approximately 11% of total cases reported so far in 2008 have occurred in the capital city of Kazan. The majority of other cases have occurred in rural, forest areas of Tatarstan. The most recent outbreak of 29 cases has occurred in the following cities: Kazan (10), Naberezhnye Chenly (8), Nizhnekamiskiy (3), Almetievskiy (3), Sabinskiy (2), Kukmorshiy (1), and Bavlinskiy (1) (ISID, 2008a).

The Republic of Tatarstan is located in eastern Russia, about 800 kilometers southeast of Moscow (Department of Foreign Affairs to the President of the Republic of Tatarstan, 2008). As of 2002, the population of Tatarstan was 3,779,265, with an urban/rural population of 2,790,661 and 988,604, respectively. HFRS is endemic to Tatarstan and surrounding republics in eastern Russia (ISID, 2008a). Other geographic areas with endemic HFRS include Scandinavia, Western Europe, and the Balkans. The Puumala virus spread by the bank vole is the likely cause of the disease in Russia, Western Europe and Scandinavia.

The Dobrava virus is found in the Balkans and the Seoul virus may occur worldwide. All viruses are part of the Hantavirus classification. Hantavirus is transmitted to humans by vector rodents such as voles and field mice (Centers for Disease Control and Prevention [CDC], 2005). According to research conducted by Alla Bernshtein and colleagues of the Chunakov Institute in Moscow, natural increases and decreases of the bank vole population occur every three to four years. In years of higher vole populations, the incidence of human HFRS increases (ISID, 2008c).

Experts speculate a number of factors have contributed to the rise above endemic levels of human HFRS in Tatarstan and surrounding regions. First, an increase in the bank vole population may be a result of climate changes. Less harsh winters and warmer summers allow for better access to food sources for the rodents. Second, the new capitalistic Russia has resulted in increased construction of homes in rural forest areas. Humans have invaded the natural habitat of forest rodents.

This has increased the potential for contact between the habitats of bank voles and humans. City dwellers tend to visit their countryside homes during the summer months of June through August. The majority of HFRS cases are reported during these summer vacation months (ISID, 2008b). As mentioned previously, Hantavirus is spread to humans by rodents. As reported by the CDC (2005), infection occurs when humans encounter “aerosolized urine, droppings, saliva of infected rodents or after exposure to dust from their nests.†Infection may also occur through open wounds, mucous membranes, rodent bites, and in rare cases through person-to-person contact.

Most cases occur in individuals older than 15 years old, as children under the age of 15 often only show subclinical symptoms of HFRS. The incubation period of HFRS is one to two weeks. The CDC (2005) lists the following symptoms: severe headaches, back and abdominal pain, fever, chills, nausea and blurred vision. Fever, hemorrhage, and renal insufficiency are hallmarks of advanced disease. The disease generally progresses through five stages: 1) fever lasting four to six days, 2) low blood pressure lasting a few hours to 2 days, 3) decreased production of urine for three to six days, 4) diuretic stage lasting two to three weeks, and 5) recovery that may take three to six months.

HFRS infection is confirmed by clinical symptoms, serological testing, microscopic inspection for Hantavirus antigen, or presence of Hantavirus RNA in blood and tissue samples. Depending on the patient’s fluid and electrolyte status, renal dialysis may be warranted. Patients may be required to follow sodium and fluid restricted diet during the oliguric stage followed by a liberal fluid intake during the diuretic stage. In addition, the administration of the intravenous antiviral drug, Ribavirin, lessens the disease severity and improves survival (Bhimma, Sairam, & Travis, 2008). The Puumula virus carried by the bank vole is implicated in the current outbreak of HFRS described above.

Bhimma et al. (2008) contend that prevention of HFRS starts with environmental control of rodent populations near human housing communities and structures. Recommendations for prevention include taking precautions such as wearing rubber gloves while cleaning areas contaminated with rodent droppings or urine, avoid stirring up dust in rodent areas, and using a bleach solution with disposable cleaning towels. Storing food and disposing of trash properly may also prevent rodents from interacting with human habitats. Humans should take precautions if sleeping outdoors, working on farm areas or handling hay where rodents may have built nests (Bhimma et al., 2008). In summary, the Puumula virus is a vector carried virus that falls within the Hantavirus family.

It is endemic to eastern Russia where rodent populations thrive in rural forest areas. Infection leads to HFRS in humans. Symptoms take one to two weeks to appear, with initial symptoms of headaches and back pain that may progress to acute renal failure. The survival rate is high for infected populations although recovery may take several months. The Puumula virus is recognized as one of the less severe forms in the Hantavirus family.

Controlling rodent populations and public education of risks are keys to the prevention of HFRS. References Bhimma, R., Sairam, V. K., & Travis, L. (2008). Hemorrhagic fever with renal failure syndrome. Retrieved from Centers for Disease Control and Prevention. (2005).

Hemorrhagic fever with renal syndrome. Retrieved from Department of Foreign Affairs to the President of the Republic of Tatarstan. (2008). Official web-site republic of Tatarstan: Geographical location. Retrieved from =797 International Society for Infectious Diseases. (2008a). Hemorrhagic fever with renal syndrome – Russia (07): (Tatarstan) .

Retrieved from International Society for Infectious Diseases. (2008b). Hemorrhagic fever with renal syndrome – Russia (04): (Tatarstan) . Retrieved from BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:10 01,.2226,Y International Society for Infectious Diseases. (2008c). Hemorrhagic fever with renal syndrome – Russia (05): (Tatarstan, Udmurtia) . Retrieved from BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:10 01,.2337,Y

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Organizational Ethics and the Law: Understanding Key Concepts

Introduction
The intersection of organizational ethics and law is essential in guiding healthcare institutions to fulfill their responsibilities towards patients, staff, and the communities they serve. This paper delves into various critical concepts related to corporate structure, the code of ethics, misconduct, respondeat superior, corporate negligence, and corporate duties. It also evaluates strategies to restore trust in organizations, especially in healthcare, where ethics and morals play a significant role in service delivery.

Corporate Structure and Ethical Governance

Corporate structure in healthcare organizations typically includes different levels of authority, such as the governing body, Chief Executive Officer (CEO), and various departments. The governing body is responsible for overarching decision-making and is empowered by the corporation's articles of incorporation (Buchanan & Wilkins, 2018). The CEO, appointed by the governing body, manages day-to-day operations and upholds fiduciary responsibilities—acting in the best interest of the organization and ensuring ethical practices.
A crucial aspect of corporate ethics involves developing a code of ethics that outlines organizational values, guiding staff behavior and decision-making (Paine, 1994). Codes of ethics serve as foundational documents that establish expectations regarding honesty, integrity, and professional conduct.

Organizational Misconduct and Accountability

Organizational misconduct undermines trust and can manifest in various ways, including false advertising, concealing mistakes, or unethical financial practices. One infamous case is that of Darling v. Charleston Community Memorial Hospital, which established the doctrine of corporate negligence—where a healthcare institution is held liable for failing to provide safe and competent care (Stratton, 2006). Such negligence may result in significant harm to patients and can trigger legal and ethical consequences for the organization.
The principle of respondeat superior holds employers accountable for the acts of employees performed within the scope of their employment. This legal doctrine supports the notion of vicarious liability, asserting that an employer can be held liable for an employee's actions if a master-servant relationship exists at the time of the offense (Sullivan, 2019).

Corporate Duties and Responsibilities

Healthcare organizations must uphold several duties and responsibilities, including:
1. Providing Adequate Staff and Resources: Organizations have a duty to hire qualified personnel and maintain sufficient staffing levels to deliver quality care (Gaba, 2000).
2. Compliance with Regulations: They must adhere to legal and accreditation standards set by governmental bodies and healthcare associations (Buchanan & Wilkins, 2018).
3. Maintaining Ethical Practices: Avoiding conflicts of interest and deception in advertising is paramount. For instance, unethical practices such as concealing adverse outcomes while publicizing success rates can lead to legal liabilities and loss of community trust.
4. Enhancing Patient Safety: Ensuring a safe physical environment, minimizing risks of accidents, and implementing infection control measures are core duties (Pettker et al., 2014).
Failure to meet these responsibilities can lead to significant repercussions, including legal penalties and reputational damage.

Intersecting Legal and Ethical Issues

The decision-making processes in organizations often lead to ethical dilemmas. For example, financial incentive schemes in healthcare can sometimes induce practitioners to prioritize cost-saving over patient welfare (Peeno, 1999). Such examples highlight the potential for collision between corporate interests and professional ethics, necessitating stringent oversight and compliance programs.

Strategies for Restoring Trust

When trust is broken within an organization, especially a healthcare institution, it is vital to undertake comprehensive strategies for rebuilding that trust (Ferguson, 2013). Effective communication is the cornerstone of such efforts. This involves transparency in operations, open acknowledgment of mistakes, and prompt corrective actions.
1. Implementing a Corporate Compliance Program: This includes appointing a compliance officer, developing standards of conduct, and educating staff about ethical behaviors (Buchanan & Wilkins, 2018).
2. Regular Auditing and Monitoring: Conduct annual audits to ensure adherence to policies and the effectiveness of ethical programs (Paine, 1994).
3. Training and Education: Ongoing staff education regarding ethical practices can prevent misconduct and foster a culture of integrity (Ferguson, 2013).
4. Engaging Stakeholders: Including patients, staff, and community members in discussions about ethical practices helps rebuild trust and transparency.

Conclusion

The relationship between organizational ethics and law is complex, particularly in healthcare settings, where the consequences of unethical conduct can be dire. By fostering a robust corporate structure and focusing on ethical governance, organizations can effectively mitigate risks associated with misconduct. Comprehensive compliance programs and proactive strategies for restoring trust are essential in promoting a culture of responsibility and integrity, ultimately enhancing patient care and community wellness.

References

1. Bhimma, R., Sairam, V. K., & Travis, L. (2008). Hemorrhagic fever with renal failure syndrome.
2. Buchanan, L. & Wilkins, S. M. (2018). Ethics and health policy: An overview of key concepts.
3. Centers for Disease Control and Prevention. (2005). Hemorrhagic fever with renal syndrome.
4. Ferguson, R. (2013). Building trust through effective healthcare communication.
5. Gaba, D. M. (2000). Human factors and patient safety: Current challenges in the field.
6. Paine, L. S. (1994). Managing for organizational integrity. Harvard Business Review.
7. Peeno, L. (1999). Congressional testimony on health insurance practices.
8. Pettker, C. M., et al. (2014). Protocol-based labor management: Implementation and outcomes.
9. Stratton, T. (2006). The corporate negligence doctrine: Update on Darling.
10. Sullivan, P. (2019). Respondeat Superior: An overview of employer liability.
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This paper incorporates the essential concepts related to organizational ethics and the law with extensive references for further reading. It highlights the importance of a robust ethical framework in healthcare to protect the interests of both patients and organizations.