Ethics Case Study
Ranacia Alford
HCS/335
Ruby Wesley Shadow

In order to make ethical decisions in the medical office setting, everyone should have a clear understanding of their role in the practice. Knowing the scope of their work allows employees to perform their jobs better and to keep from making mistakes that could reflect badly on the liable provider. In the case study that will be discussed, Jerry, the office assistant, is asked to refill a prescription for Valium, a controlled substance, without the doctor’s presence or authorization based on the word of the patient.
Does Jerry’s Medical Training Qualify Him to Issue This Refill Order? Why or Why Not?
According to the case study, Jerry’s job title is Office Assistant. He has professional training as a medical assistant and a licensed practical nurse. Technically, Jerry’s medical training does qualify him to refill this order. Unfortunately, his current job title disqualifies since the doctor has neither authorized this prescription nor hired him as a nurse. Since Valium is a controlled substance and the patient stated that the doctor calls it in from time to time, there likely are no refills at the pharmacy, thus Jerry would be calling in a new prescription which is completed outside of the scope of his position.
Would It Make A Difference If the Medication Was For Controlling High Blood Pressure That the Patient Critically Needs on a Daily Basis? Why or Why Not?
As previously stated, Jerry’s current position does not allow for him to refill any prescriptions. If he was hired as a nurse, he would be allowed to do so under the provider’s direction. The primary point is that any prescription requested by a patient must be cleared and authorized by a licensed health care provider. In some organizations, certain prescriptions that are standing orders, such as hypertension medication, may be refilled by the nurse as this order has been signed off by a provider. In essence, it makes absolutely no difference whatsoever the kind of medication that is requested. Jerry cannot call in a prescription without the direction of the doctor.
If Jerry Calls in the Refill and the Patient Has an Adverse Reaction While Flying, Is Jerry Protected From Lawsuit Under the Doctrine of Respondent Superior?
The doctrine of respondent superior simply states that “an employer is liable for acts of the employee within the scope of employment. What this means for physicians is that they are liable for negligent actions of the employees working for them even though the employer’s conduct may be without fault” (Fremgen, 2009). At first glance, one may assume that Jerry is protected if the patient has an adverse reaction while flying. The doctrine goes on to specify that, in order for the employee to be protected, the mistake must be within the scope of their employment. In Jerry’s case, he was hired as an office assistant, not a nurse or a medical assistant. Calling in prescription refills is outside of his duties and responsibilities. Dr. Williams, his boss, can still be held liable if Jerry’s job scope was not clearly communicated to him.
Advice to Jerry
My advice to Jerry would be to not call in the prescription. He cannot take the patient’s word that the doctor is a personal friend and does him the favor. That is not Jerry’s problem. He should adhere to his training as a nurse and as a medical assistant which taught him that all prescriptions must be authorized by a licensed health care provider. He should also be aware of his job title as office assistant and stay within the scope of his job. His role is to kindly inform the patient that he has to contact the doctor for that request then reach out to either Dr. Williams or the on-call doctor.
Major Legal and Ethical Issues that May Affect Jerry’s Decision
In calling in the prescription, Jerry faces several legal and ethical issues. Legally, Jerry would be breaking the law by calling in the prescription because he has taken on the role of a doctor when, in fact, he is not licensed to do so. Also it is against the law for a licensed practical nurse (LPN) or medical assistant to prescribe medications: this function lies only within the domain of a physician, nurse practitioner, or physician assistant” (Fregmen, 2009). If the patient has a reaction to the medication, the impending lawsuit against Jerry would likely hold up in court due to his performing duties outside of his scope of practice. Ethically, Jerry knows that he should not call in the prescription just because the patient told him a nice story. He has the choice to either stand his ground against the patient or succumb to the patient’s request. In a critical situation, Jerry may be inclined to call in a emergency prescription with intent to benefit the patient but both legally and ethically, it is still wrong because he’d be breaking man’s law and going against his clinical training.
Problem-Solving Methods to Assist in Making an Ethical Decision
In order to make an ethical decision in this case study, Jerry can use Blanchard and Peale’s three step ethics model (Evers, 2009). This model asks three questions. Is it legal? Is it balanced? How does it make one feel? Jerry would need to consider if his decision is breaking the law. He has to consider who will his decision affect and identify the stakeholders in his decision. He has to figure out if harm will come to any one of the stakeholders. Finally Jerry has to do some personal reflection determine if the decision is right in his own mind. This simple model will enable Jerry to make the right decision with the least amount of damage.
Conclusion
Jerry the office assistant has a hard choice to make. Do or do not do. If he prescribes the medication and the patient is harmed, he has done harm to the patient, his employer and himself. If he does not prescribe the medication, the patient may be upset with him but Jerry will have done the right thing from a legal and ethical standpoint. Understanding and carrying out his role rather than superseding his own authority is also a road that Jerry should stay on in order to perform his job ethically.

References
Fremgen, B. F. (2009). Medical law and ethics (3rd ed.). Retrieved from The University of Phoenix eBook Collection database.
Pamela S. Evers. (2009). Business ethics and social responsibility [PowerPoint slides]. Retrieved from http://www.csb.uncw.edu/people/eversp/classes/BLA361/PowerPoint/361-4a.Ethics.pdf.