Negligence: An Ethical and Legal Issue in Psychiatric Healthcare Setting
Seeking holistic care in a hospital setting is the basic need of every patient and providing such care is the ultimate goal of each health care provider, but errors are part of human nature. Some errors are done intentionally but most of them are unintentional errors in health care. These unintentional errors come under the umbrella of negligence. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), negligence is a “failure to use such care as a reasonably prudent and careful person would use under similar circumstances” (Croke, 2003).
In health care setting, negligence is marked as a legal and ethical issue. In legal terms, negligence “is a civil tort that occurs when a person breaches their duty of care owed to another and as a result, that person suffers an injury or a loss” (“Contact law: finding,” 2012). Such errors have severe complications on the patient’s health. There are many reasons for highlighting this issue. Firstly, the highly increasing cases of negligence in medical field throughout the world highlighted by Shiwani and Gadith (2011) which surmised that there is an alarming number of cases of death and other injuries which are the result of medical errors.
This study was done in New York State which revealed that 27.6% of the adverse cases were due to negligence. In another study done in UK, every year there are about 90,000 adverse cases due to the medical error of negligence out of which 13,500 patients died (Oyebode, 2013). Secondly, such mistakes made by the staff members develop mistrust between them and clients. Trust builds a bond between patient and staff, breaking this bond can affect the recovery of patient.
Lastly, these cases of negligence and other errors are not reported. According to a study if any case of negligence is reported, it is not supported by the court unless there is any physical injury to the client (Reich & Maldonado, 2011). Due to this reason working on such circumstances is not easy for the higher authorities.
Reflecting upon an incident, a patient got admission in the psychiatric unit with the complaints of aggressive behaviour and suicidal ideations. These suicidal ideations were due to depression caused as a side effect of interferon given to patient for the treatment of Hepatitis C. Usually anti-depressant are also prescribed with interferon but in this case doctors forgot to consult with psychiatrist regarding this issue. This depression was the result of negligence done by the team of doctors. Due to the negligence of doctor, patient was suffering from a psychiatric issue which resulted in conflicts with family and suicide attempts.
In order to prove the legal issue of negligence, American Medical Association (AMA) describes the concept of negligence and its relation with the accountability of health care professional in four D’s i.e. duty, derelict, direct cause and damage (McGraw-Hill, n.d.). Firstly, patient should be certain that the specific doctor on duty is taking care of him. In this case scenario a gastroenterologist was assigned and taking care for the issue of hepatitis C. Secondly, patient must certify that the health care professional was unable to meet the standards of health care which shows derelict of the health care provider. The gastroenterologist was unable to consult the psychiatrist for anti-depressants.
This was the main error done by the doctor. Thirdly, patient must show that the error was a direct cause of any serious harm to the patient. Client had conflicts in his family; he physically abused his wife and attempted suicide along with harming his children. This is directly caused due to the error of the doctor because patient developed depression and aggressive behaviour.
Lastly, patient must show that there is serious injury or damage due to that harm which can be a proof to verify the negligence of health care professional. In the scenario, patient was not directly suffering from any physical injury but there was an origin of mental issue which led to suicide attempt and now he is seeking care for psychiatric issue. This shows the bad effects of negligence on the patient. Relation of the case scenario with the theory of AMA proves the negligence of doctors due to which the patient was suffering badly.
According to the study, every year 45,000 to 98,000 fatalities occur due to medical workers’ mistakes in the US (Shiwani & Gadit, 2011). Negligence impacts both physical and mental health. These errors, done by the staff members, sometimes worsen the patient’s condition and lead them to face the consequences in life and have an impact on their family relationships. Mostly, stress is the biggest complication of each and every medical error.
In the case scenario, negligence had a direct impact on the mental health as the patient got depressive symptoms due to which he started fighting with his family and attempted suicide. This shows how faults of health care providers can harm patients. Now the patient also had a fear of continuing his job due to stigmatization of being a psychiatric patient.
These errors and negligence can lead to harmful consequences; for instance, the patient may get harmed physically and mentally. Due to depression, patient may get aggressive and can harm himself or any other person. If the symptoms get worse, patient may lead to suicidal or homicidal ideation as this patient attempted.
After these psychiatric symptoms patient’s physical health also suffered and there was a marked delay in physical recovery. Facing such incidents, patient got stressed for being called a psychiatric patient which is a big stigma of our society. This can also lead to delay in treatment.
Errors cannot be completely removed from the nature of human being but they can be minimized to the level by which the patient would not get harmed. In order to lessen errors like negligence, doctors and other health care providers should be competent so that they can provide good quality care to the patients for their safety. Coordination among the doctors should be so strong that patient can get complete treatment. Policies and laws should be made at hospital level in order to evaluate the errors done by the health care providers.
If in any case any error is done by staff members, legal action should be taken against them for harming the patient. As the mistake is the result of health care professional there should be proper treatment of the patient after the error of health care provider is claimed and proved. It should be the duty of staff members to give clear information about the side effects of the medicine which patient is using.
All in all, negligence is one of the basic ethical and legal principles which should be followed in health care setting. To prove the medical error of negligence as a legal issue, patient has to prove all the four components of framework of American Medical Association. To overcome the issue of negligence is the duty of the staff members, by giving complete information regarding the disease process and the treatment of patient to patient and his family so that they are well aware of all the conditions. Doctors should consult each other for the treatment of the client so that they are able to completely meet the standards of health care.
About the Author: Ameen Asif is a registered nurse in Pediatric Intensive Care Unit. She can be reached at [email protected]
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