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03/30/2016

BIOETHICSTV: Chicago Med 3/29

by Craig Klugman, Ph.D.

BioethicsTV is an occasional bioethics.net feature where we examine bioethical issues raised in televised medical dramas.

Tonight marked the mid-season premiere of Chicago Med, a freshman television show that seems to relish throwing professional and bioethical issues at its audience. This week, viewers saw no fewer than 4 ethical challenges.

1. Blood draws for DUI in the ED. The first story was about a young man who crashes his car into a house. He is brought to the ED and needs immediate surgery for internal bleeding. Before he is brought to the OR, a police officer demands a blood draw because if they wait until after surgery, they won’t be able to prove he was drunk. The surgeon asks the patient if he consents to a draw and the patient says ‘no.” The charge nurse supports her staff and is then arrested for impeding an investigation. The officer says that having a driver’s license is consent and the nurse states that hospital policy requires patient consent. In this brief exchange, the nurse says that the hospital is where they treat patients, not make arrests.

As this show takes place in Chicago, it might be useful to look at the laws in Illinois. Under 725 ILCS 5/11-501.2, blood can be drawn in a secure location for the purpose of testing blood for a blood alcohol level. Someone licensed and trained in this procedure must collect the blood and a police officer must also be present. However, this type of draw requires the suspected person’s consent. Thus, arresting the nurse for impeding an investigation is problematic because the hospital was following the law (and their own policy). On the other hand, under 725 ILCS 5/11-501.4, if blood is drawn in an ED to determine blood alcohol content for purposes of emergency medical treatment, then that finding is admissible for a DUI prosecution. Because this draw is part of emergency medical treatment, patient consent is not needed (implied consent under the reasonable person standard is at play). That the patient was able to answer the question means that implied consent under emergency treatment was likely not in effect. Under this second statute, the officer just needed to ask for a copy of the test result for her purposes.

Ethically, health care providers ought to help prevent illness and injury. Such efforts include education and helping people at risk, like helping to prevent driving under the influence. But the need for consent to perform any non-emergent medical procedure is a long established guide. And as the nurse states, the purpose of a hospital is to treat patients, not to aid in arrest and prosecution.

2. Required reporting of suspected child abuse. The second issue in this episode was that of a baby who presents with the symptoms of shaken baby syndrome. The physician notifies the department administrator who contacts child protective services. Later, the physician gets records from another hospital that includes a fetal scan after a car accident. The in utero scan shows the damage was a result of the accident and not abuse. This evidence is enough to stop the investigation and reunite mother with baby. Although the physician feels guilty for having begun the investigation, she was ethically and legally correct in doing so. In most states, health care providers (and educators) are required to report any suspicion of child abuse. The standard is suspicion, not proof. Ethically, the reason for this is that small children, especially infants, are vulnerable and unable to speak for themselves. Thus, they require this extra protection

3. Psych hold for suicide watch. A third issue surrounded a patient brought to the ED after being swiped by a car as he tried to cross the street. As someone who daily crosses Chicago streets, cars commonly do not stop for pedestrians. So such activity as walking is not without its danger. The patient, however, does not want any scans and has an extremely detailed story of how the accident happens. This raises red flags for the chief of psychiatry who puts the patient on a psych hold. As it turns out, the patient was depressed and since he lived a perfect life (great job, family, money) felt there was no justification for his feelings. He was if not consciously suicidal, unconsciously so. The hold is appropriate for people who pose a threat of harm to themselves or others. In Illinois, the involuntary hold can be up to 5 days (in other states it is only 2 days) and is not only for being a danger to oneself or others but also includes inability to take care of your own basic needs.

4.Borrowing access to medical records. The last issue in this episode was the continuing storyline of a physician who ignored a dying patient’s DNR and resuscitated her. He and the hospital are now subjects of a lawsuit. In one segment, the physician is being prepared by the hospital attorney for his testimony to say that the husband seemed to indicate wanting to keep his wife alive. As is made clear, the attorney’s task is to protect the hospital. What is unsaid is that the attorney is not there to represent the physician. He should have his own attorney and I suspect that this story line will follow shifting liability from the hospital to him. In another scene, he asks another physician to log into the electronic medical record so he can look up this patient, who is now enrolled in a clinical trial for a new cancer treatment. He knows that if his account shows up as having accessed the record that he will be in trouble. In an unethical, illegal, and violation of hospital policy move, the second physician logs into his account so that his colleague can check into the record without being flagged. In most hospitals, such an action is a violation of policy. Using someone else’s account may also be a HIPAA violation since part of that law is that patients may request a listing of who has seen their medical record. Ethically, this is a form of lying through deceit, which is not generally acceptable.

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