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Approaches to Ethical Dilemmas

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The case study I chose is that of six-year-old Tavion Robinson who was taken to Methodist Hospital by his father for a broken arm and abrasions. There were a couple of things in this case that could insinuate that the broken arm and abrasions were not an accident. The father being hesitant to leave Tavion alone with hospital staff was the first red flag that something could be wrong. Secondly, Mr. Robinson’s request that he be notified prior to releasing Tavion’s records to anyone. Thirdly, informing the Emergency Department that Tavion’s parents are divorced and that the mother the non-custodial parent may not access Tavion’s records without his consent. In retrospect not leaving him alone with staff could be the actions of very concerned father, releasing his information to just anyone is also understandable to protect his son’s privacy but to not allow the mother to access his records without his consent sends up a red flag immediately.

When asked by the triage nurse how Tavion sustained his injuries the father informed the nurse that he fell from the jungle gym in the park. When Tavion was taken to the x-ray room his father was not allowed and the staff took the time to question Tavion about what happened in which he verified his father’s explanation. Although Tavion and his father gave the same story there seemed to be some inconsistencies due to the abrasions being clean and they would not have been if he truly fallen from the jungle gym and brought in right afterwards. Due to there still being some inconsistencies in the story to the hospital staff they also question Tavion about ever being afraid of being hurt by anyone at home while he was in the x-ray room in which he denied abuse or fear of being abused. The father request that the medical records not be released to anyone unless he was contacted even his child’s mother makes it seem as if he has something to hide.

The following weekend Tavion’s mother requested documents from the Emergency Department visit. She suspects the father was physically abusing him and wanted to view documentation. I do believe that Tavion’s mother has the right to view his records especially if she suspects abuse. Along with the inconsistencies of the finding of the injuries and the suspicions of the mother I feel that this is enough reason to investigate the suspicion of child abuse. The concerns of the mother is valid and she also is aware of how the father handles his son on a day to day basis she isn’t suspicious for no reason at all. There is history amongst the adults before they divorced she knows how he was disciplined as a kid and he could be using the same discipline as that in which his parents used on him.

The mother has several avenues that she can take on her suspicions she could talk to the social worker at the hospital, the Department of Family Protective Services or contact the police. The ethical issue we are dealing with is the mother wanting the hospital documents of her son’s visit and the father denying her access without him being consulted. Also the injuries not matching up to the father’s story. Confidentially will be the legal issue in this case regarding Tavion’s medical records. Of course the father’s request of being contact if there is a request to view the files makes him look suspicious and makes it appear he is hiding something. However, if the hospital staff suspects that there is abuse they are mandated to report it.

Discussion Questions

1. Is Tavion’s mother’s statement of concern of abuse sufficient to warrant further investigation by the hospital?

Tavion’s mother’s statement of concern of abuse is sufficient to warrant further investigation by the hospital. I believe that Tavion’s mother’s concern tells us that from her history with the father maybe in the time she was married to him she has witnessed some form of abuse or a form of discipline that is legally considered abuse.

2. Should Tavion’s mother be directed to a different department of the hospital or another organization regarding her concern of abuse?

She should be directed to the social workers office of the hospital to alert them of her suspicions and if the hospital doesn’t agree with her and are not willing to have a case opened then she should see an organization outside of the hospital.

3. What internal and external forces impact this case?

Internal would be the staff in the hospital the external forces would be law enforcement and department of child and protective services

4. What are the legal issues addressed in this case? How do your state laws address access to health records by noncustodial parents?

The legal issue would be going against the father’s request to grant the mother access to the son’s records. However not giving the mother access to the child’s record is going against the right that the noncustodial parent has to view the child’s record.

I live in the state of Texas and in Texas the non-custodial parent has permission to access to medical records without going through the other parent.

5. What are the ethical issues addressed in this case?

The ethical issue is the mother wanting the records and the father not wanting the records to be given without his consent

6. How would you respond to Tavion’s mother if you were the Release of Information Clerk?

If I were the release of information clerk I would have to follow the rules of following the father’s request. I would tell the mother to bring in information stating that she is a parent of the child and her court documents saying she can obtain access to his records. Once she brings the
information back I would consult my supervisor on the steps we would need to take to get her the information needed.

7. Using the case method, evaluate possible actions that should be taken and determine the best option.

I would hold a counseling session with the mother, father, and child each separately. I would ask all similar questions to each individual and compare notes. If I find flaws in the father and feel like Tavion is in danger I would report my findings. I would ask the mother in her session why she believes that there is child abuse. I would also find out why the father would go so far as requesting the mother has to get permission to get her son’s medical records. I will like by the end of the sessions all issues can be addressed and if there is abuse I would report my findings.

Grebner, L. A. (2009). Ethics case studies for health information management. Clifton Park, NY: Cengage.

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