Analyze the Health Insurance Portability and Accountability Act (HIPAA) violations in the scenario.
ROLE OF NURSING
As a staff nurse in an intensive care unit, you accompany Dr. K to assess the condition of a patient, Mr. E, currently in the emergency department. The nursing home where Mr. E resides has brought him to the hospital because of lung congestion. The medical notes indicate that Mr. E is a 67-year-old white male with diabetes, high blood pressure, poor vision, and hearing difficulties, and is mildly developmentally delayed.
After assessing Mr. E’s condition, Dr. K determines that Mr. E has pneumonia secondary to aspiration. Mr. E is dyspneic on exertion and is running a fever of 101o F. He has a blood oxygen saturation level (SpO2) of 88% on room air. Dr. K determines that Mr. E will need to be placed on a ventilator and admitted to the intensive care unit. When Dr. K explains the situation Mr. E shakes his head and says, “Go away! No! No! Take me home.” Knowing that Mr. E is developmentally delayed and hypoxic, Dr. K is concerned that Mr. E does not understand the situation.
Dr. K notes that without the ventilator Mr. E will continue to aspirate and likely die. Dr. K asks you to look at Mr. E’s file to determine whether there is anyone else who might have responsibility for Mr. E. The chart indicates that seven years ago Mr. E checked himself into the local nursing home. When he entered the nursing home a patient advocate helped him fill out an advance directive, which stated Mr. E’s medical wishes. Mr. E clearly indicated that he did not want a ventilator or cardiopulmonary resuscitation. No family member signed the advance directive and it is unclear if any family members were involved. Mr. E has also filled out a medical power of attorney, which states Mr. E wants his younger brother, Mr. Y, to make medical decisions for him in the event he is no longer able to do so.
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