-Staff refusing treatment to patients without first confirming insurance coverage as well as requiring HIV clearances.
-Unauthorized pro bono treatment and installment payments on prescriptions.
-Unnecessary treatments being performed.
Second, get the facts. To some extent the facts speak for themselves. Staff is acting on their individual code of ethics without regard or possibly without knowledge of the hospital's code. With respect to the DNR issues, in all cases the family members were happy, but in this case, as administrator their happiness is not the issue. The legality however is. DNR orders are for the protection of the hospital and its staff. If they are not adhered to that protection is none existent.
What are the facts surrounding treatment or lack thereof? Investigation again reveals varied results. I have staff that fear for their personal safety, so they require HIV clearance before treatment. I have staff that is concerned for the welfare of the hospital, so they require insurance verification prior to treating. I have staff that care for the patients themselves so much they provide free service or payment on installments, both occurring without consent of administration. I also have staff the order treatment just for the sake of doing the procedure.
Third, evaluate the alternative actions from various moral perspectives. While the hospital mission "to promote the health and well-being of the people in the communities we serve" must remain a focal point, as administrator the overall health of the organization falls to me. The decision on what treatment should be given should be at the discretion of the physician. The physician must not abuse this authority by ordering those treatments that are not necessary for the welfare of the patient. Even though I can appreciate and even respect the values presented by the staff the truth of the situation is that not everyone is going to be happy.