Chapter 11 Case Study
Complete Chapter 11 Case Study (pages 213-214). This should be submitted as a Word document.
Derek Johnson, MD, has been an anesthesiologist at Community Hospital of the West for 15 years. He is 45 years old. The physician is board certified to perform all kinds of anesthesia procedures, including every type of surgical procedure and obstetrical anesthetic procedure. His colleagues have noticed for some time that he has become more and more haggard looking, but they ascribe this to the hectic work schedule that anesthesiologists often must maintain.
One day, Dr. Johnson was admitted to the intensive care unit at Community Hospital of the West. The news quickly spread through the organization. He was suffering from a compromised immune system and was close to dying from septicemia that had developed from abscesses in his arm as a result of injections. Some of the OR nurses discussed the situation on their dinner break and speculated that Dr. Johnson was a drug addict. The current policy of the hospital was that anesthesiologists were not required to account for the narcotics that they administered to patients post-operatively. Some of the OR nurses had noticed over the past six months to a year that Dr. Johnson’s patients had morphine for pain prescribed and that Dr. Johnson would administer this himself, even for patients who were not complaining of pain. Some of Dr. Johnson’s patients who were experiencing high levels of pain experienced little pain relief after supposedly receiving morphine administered by Dr. Johnson.
One of the nurses reported that three months earlier she had cornered the chief of the anesthesia service and told him of Dr. Johnson’s narcotics irregularities. Not wanting to challenge or accuse a fellow physician, the chief said indignantly that there must be some other explanation and terminated the conversation. The nurse did not discuss the problem with anyone else—not the director of surgical services, the chief of surgery, the director of nursing, or an administrator.
The possibility of personal addiction among healthcare workers is a job-related issue. Individuals who have access to pain medication and who frequently medicate others to help relieve pain can become caught in an addictive cycle themselves, especially when system processes fail to hold professionals accountable for narcotic use or abuse in the provision of patient care. Most agencies offer employees access to confidential counseling. Unfortunately, many times those who have problems with alcohol or drugs are unable to see their problem and justify their use in a variety of ways. It is unfortunate that the facility did not have a mechanism in place for confidentially reporting the suspected abuse. It may have been possible to offer the physician a professional intervention that could have saved him physically and mentally from such severe trauma.
Deliverables:
Case Study Questions
1. What observations were made or what evidence was there to indicate that Dr. Johnson had a narcotics problem?
2. Does Community Hospital of the West bear any responsibility for Dr. Johnson’s predicament? Why or why not?
3. What are the root causes of this situation? Build a cause-and-effect diagram on the basis of the findings in this case study.
4. What are the costs to the organization in terms of reputation, patient safety, marketing, and organizational culture? What would you recommend Community Hospital of the West do to mitigate the impact of these costs?
