Start by reading and following these instructions:
- Quickly skim the questions or assignment below and the assignment rubric to help you focus.
- Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
- Consider the discussion and the any insights you gained from it.
- Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.
Assignment:
This week students will complete an APA paper to address the following case study.
Mr. Corley Case Study:
Walter and Sheila Corley were married on January 20, 1984. At the time, they lived in Texarkana, Arkansas. Their son Jerry was born in July 1985. Later that year, the Corleys separated and were divorced. Sometime thereafter, the Corleys reconciled and resumed living together, holding themselves out to others as a married couple. In February 1988, the Corleys moved to Mr. Corley’s hometown of Ferriday, Louisiana. The Corleys were remarried in December 1988.
Neurofibromatosis, a disease of the peripheral nerves of the body, is a condition marked by the presence of numerous neurofibromas, which are tumors or growths arising from the Schwann cells which form the covering membrane or sheath of a nerve fiber. Persons with neurofibromatosis frequently have café au lait spots of varying sizes on their bodies as well. In addition, people afflicted with neurofibromatosis experience a significantly increased risk of developing cancer.
In 1978, Mr. Corley was diagnosed with neurofibromatosis and had four neurofibromas removed from his head, arm, hip and leg by a physician in Texarkana. Thereafter, a few months prior to his return to Louisiana in 1988, Mr. Corley, who had no other known health problems, began experiencing low back pain.
On February 11, 1988, Mr. Corley sought medical treatment from Dr. Maurice Gremillion, a family practitioner in Ferriday. On that date, Mr. Corley complained that he had been experiencing low back pain and abdominal discomfort for approximately four months. He also noted that he had intermittent right shoulder pain and trouble sleeping. At Mr. Corley’s request, Dr. Gremillion ordered a total work-up which included x-rays of the lower spine, chest, kidneys and gall bladder, as well as an upper GI series. Dr. Gremillion also prescribed Flexeril, a muscle relaxer, and Anaprox, an anti-inflammatory pain medication. Dr. Gremillion, feeling that Mr. Corley should be seen by a specialist, then gave him a written referral to E.A. Conway Medical Center in Monroe for an orthopedic evaluation.
E.A. Conway, which is part of the L.S.U. system, is a teaching facility staffed by permanent, full-time physicians as well as by doctors who are employed on a temporary, rotating basis as interns and residents following their graduation from medical school. The general operating procedure of E.A. Conway at the time of Mr. Corley’s presentment was that all new patients, even those who have referrals to a specific service or department, first go through the emergency room. At that time, a patient is charted and evaluated by an emergency room physician. From there, the patient is either treated or referred to a specific clinic for further follow-up. In most cases, patients see different doctors each time they report to the hospital or one of its clinics.
On March 2, 1988, Mr. Corley, accompanied by Sheila Corley, reported to the E.A. Conway Emergency Room. The Corleys presented admitting personnel with all of Mr. Corley’s records from Dr. Gremillion, including the x-rays and other test reports. Dr. Bruce Fuller, an emergency room physician, took a history from Mr. Corley and reviewed Dr. Gremillion’s notes and the x-ray reports. He also conducted a routine physical examination and had x-rays made of Mr. Corley’s low back. Notwithstanding the presence of several growths and café au lait spots on Mr. Corley’s back and torso, Dr. Fuller was unaware that his patient had neurofibromatosis.
Dr. Fuller found everything to be within normal limits and it was his impression that Mr. Corley was suffering from low back pain based on minimal subjective complaints of pain. Dr. Fuller continued Mr. Corley on the medication prescribed by Dr. Gremillion and made an appointment for him with the Orthopedic Clinic on March 16, 1988.
On that date, Mr. Corley was seen in the Orthopedic Clinic by fourth year resident McIntyre Bridges. Dr. Bridges does not recall looking at or reading the x-rays or reports from Mr. Corley’s previous examinations. Dr. Bridges conducted a physical exam, which was normal, and started Mr. Corley on a conservative course of treatment for low back pain. Dr. Bridges’ notes from this date indicate his awareness of Mr. Corley’s neurofibromatosis.
Mr. Corley was next seen on April 20, 1988 by Dr. David Mehta. At the time, Dr. Mehta was doing a surgical internship and was rotating through the Orthopedic Department. Dr. Mehta’s notes reflect that his physical exam of Mr. Corley was normal, but that he felt that Mr. Corley had a posture problem and referred him to physical therapy for correction of his posture. Again, the notes do not reflect whether Dr. Mehta reviewed any of Mr. Corley’s previous medical records, x-rays or reports.
On September 14, 1988, Mr. Corley was seen by fourth year surgical resident Keith White. On that date, Mr. Corley noted that his pain had worsened and was occasionally affecting his walking. Dr. White’s examination yielded no objective findings of low back pain, but he did notice several café au lait spots indicative of neurofibromatosis so he ordered a CT scan of Mr. Corley’s low back to rule out any neurofibroma changes in the nerve roots. Dr. Ellis, a radiologist at E.A. Conway, interpreted the CT scan as showing arthritis consistent with fibrosis or spinal stenosis and possible edema of the right L-5 nerve root, which, according to Dr. White, may or may not have been the cause of Mr. Corley’s back pain. As with Drs. Bridges and Mehta, Dr. White did not review any of the previous medical records, x-rays or reports. Mr. Corley’s last visit to E.A. Conway was September 21, 1988. On that date, Dr. White reviewed the results of the CT scan with Mr. Corley, continued him on an anti-inflammatory drug and encouraged him to continue his back exercises. Dr. White instructed Mr. Corley to return to the clinic in three months.
Thereafter, on October 26, 1988, Mr. Corley, plagued by constant back pain and beginning to experience difficulty breathing, consulted Dr. Rick Maxwell, a chiropractor, who did a full spinal x-ray which revealed a markedly diminished right lung area. Dr. Maxwell sent Mr. Corley to his father, also a chiropractor, who confirmed that there was a potential problem with Mr. Corley’s right lung and recommended that he see a pulmonary specialist.
On October 31, 1988, Mr. Corley presented to Dr. Gremillion complaining of chest congestion and shortness of breath. Dr. Gremillion diagnosed him with bronchitis and implemented treatment accordingly. Mr. Corley returned to Dr. Gremillion on November 14, 1988, with complaints of shortness of breath and marked weight loss. Subsequent diagnostic testing confirmed the presence of a very large mass in Mr. Corley’s right chest.
Prior to his death on January 23, 1990, Mr. Corley received radiation and chemotherapy treatment at LSU Medical Center in Shreveport.
Corley v. State Department of Health Hospitals. should address the following questions regarding this case in an APA paper
- What are the facts of the case? This should include: what do we need to know, who is involved in the situation, where does the ethical situation take place, and when does it occur?
- What is the precise ethical issue in regards to autonomy, nonmaleficence, beneficence, fidelity, and justice?
- Identify the major principles, rules, and values of the case. Values are sets of beliefs about good and bad, right and wrong, and about many other aspects of living and interacting in society with others. A principle is a personal rule that governs personal behavior. A rule is generally imposed by a figure of authority and used to guide and govern people.
- Is there legal ground for this case, if so what? Who is at fault? What legal action should be taken?
- Are there alternatives to the actions completed in this case by both the patient and the healthcare facility? Do you feel the physicians were following hospital protocol?
- If you were a member of the ethics committee at this facility, what actions or changes would you recommend changing? Why?
For the case study, an APA formatted paper should be used and needs to include a title page, level headings, references, and citations. This assignment should include at least 2 references and should be at least five pages in length. Students should address the proposed questions providing ample detail, examples, and additional support.
Assignment Expectations:
- Length: answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 5-6 pages
- Structure: reference page required
- address each question in a numbered list
- References: Two references required
- Format: save your assignment as a Microsoft Word (.doc or .docx), Open Office (.odt) or rich text format (.rtf) file type
Expert Solution Preview
Introduction:
This case study involves the medical treatment and management of a patient with neurofibromatosis who presented with low back pain and was seen by several physicians and residents at E.A. Conway Medical Center. The case raises ethical issues related to autonomy, nonmaleficence, beneficence, fidelity, and justice, as well as issues related to the principles, rules, and values involved in medical care.
Facts of the Case:
The case involves Walter Corley, who was diagnosed with neurofibromatosis and presented with low back pain to Dr. Maurice Gremillion, a family practitioner in Ferriday, Louisiana, on February 11, 1988. Dr. Gremillion referred Mr. Corley to E.A. Conway Medical Center for an orthopedic evaluation. At E.A. Conway, Mr. Corley was evaluated by several physicians and residents, who conducted physical exams, ordered x-rays and CT scans, and prescribed medications and physical therapy. Despite the presence of several growths and café au lait spots indicative of neurofibromatosis on Mr. Corley’s back and torso, some of the physicians and residents were unaware of his condition. Mr. Corley was eventually diagnosed with a very large mass in his right chest, and received radiation and chemotherapy treatment, but ultimately died on January 23, 1990.
Ethical Issues:
The precise ethical issue in this case is related to the duty of care and informed consent owed to patients with neurofibromatosis presenting with low back pain. The physicians and residents involved had a duty to provide Mr. Corley with appropriate medical care that was consistent with professional standards and the best interests of the patient. However, some of the physicians and residents may have failed to adequately consider Mr. Corley’s neurofibromatosis in their evaluation and treatment of his low back pain, which may have contributed to a delay in diagnosis and treatment of his chest mass. As such, issues related to autonomy, nonmaleficence, beneficence, fidelity, and justice may be involved.
Principles, Rules, and Values:
The major principles, rules, and values of this case include the duty of care owed to patients, the obligation to obtain informed consent, the importance of thorough medical evaluation and record keeping, the need to respect patient autonomy and preferences, the duty to avoid harm and promote beneficence, and the obligation to practice medicine in a manner that is fair and just, and that is consistent with professional standards and ethical guidelines. The values involved in this case include the importance of honesty, integrity, competence, compassion, and respect for patients and their families. The rules that were applicable in this case include the need to follow professional standards and ethical guidelines, and to provide care that is consistent with the best interests of the patient.