How Does Policy Influence Your Decision?

You  are the evening house supervisor of a small, private, rural hospital.  In your role as house supervisor, you are responsible for staffing the  upcoming shift and for troubleshooting any and all problems that cannot  be handled at the unit level.  Tonight, you receive a call to come to the emergency department (ED) to  handle a “patient complaint.” When you arrive, you find a Hispanic woman  in her mid-20s arguing vehemently with the ED charge nurse and  physician. When you intercede, the patient introduces herself as Teresa  Garcia and states, “There is something wrong with my father, and they  won’t help him because we only have Medicaid insurance. If we had  private insurance, you would be willing to do something.” The charge  nurse intercedes by saying, “Teresa’s father began vomiting about 2  hours ago and blacked out approximately 45 minutes ago, following a  14-hour drinking binge.” The ED physician added, “Mr. Garcia’s blood  alcohol level is 0.25 [2.5 times the level required to be declared  legally intoxicated], and my baseline physical examination would  indicate nothing other than he is drunk and needs to sleep it off.  Besides, I have seen Mr. Garcia in the ED before, and it’s always for  the same thing. He does not need further treatment.”  Teresa persists in her pleas to you that “there is something different  this time” and that she believes this hospital should evaluate her  father further. She intuitively feels that something terrible will  happen to her father if he is not cared for immediately. The ED  physician becomes even angrier after this comment and states to you, “I  am not going to waste my time and energy on someone who is just drunk,  and I refuse to order any more expensive lab tests or X-rays on this  patient. I’ve met the legal requirements for care. If you want something  else done, you will have to find someone else to order it.” With that,  he walks off and returns to the examination room, where other patients  are waiting to be seen. The ED nurse turns to look at you and is waiting  for further directions.  ASSIGNMENT:     How will you handle this situation? Would your decision be any easier if  there were no limitations in resource allocation? Are your values to  act as an agent for the patient or for the agency more strongly  developed?