Reference no: EM132242761

The Case of the Dishonest Employee

Dale Buchbinder

Dr. Jonas was examining a patient in the office who needed a dialysis access procedure performed on one of her arms. Dr. Jones reviewed the vital signs done by Ms. Smith, a med tech/secretary. Her documentation in the medical record clearly stated the blood pressure was equal in both arms. Dr. Jonas performed his own examination and realized that the radial pulse in the left arm felt diminished as compared to the right. After completing a thorough examination, he was still somewhat concerned by the discrepancy between the physical exams and the vital signs placed on the chart by Ms. Smith. He repeated the blood pressures himself. Sure enough, the systolic blood pressure in the left arm was 60 mm/hg less than the right. The patient’s left arm would have been the preferred site to perform an access procedure because the patient was right-handed. Now it was clear only the right arm would be suitable unless another intervention was performed first. If Dr. Jonas had relied on the information placed in the chart he would have conducted an access procedure in the left arm. With a low systolic blood pressure in the left arm, the access would have been doomed to either failure, or given the patient’s physical status, a severe complication such as steal.* Since he was trying to sort through the facts and what happened, Dr. Jonas asked the patient if blood pressure readings were performed in both arms. The patient replied the pressure had only been taken in the right arm. Dr. Jonas confronted his employee and told her that her blood pressures were not correct, and, in fact, the patient had stated that they had not been taken in the left arm. Ms. Smith stated that she was quite busy and felt that these pressures were never different. With her response, she admitted to having falsified the data.

Discussion Questions

1. Summarize the important aspects of this case.

2. Which theory or theories do you believe best explain Ms. Smith’s behaviors?

3. What actions would be appropriate in dealing with such falsification of patient data?

4. Should Ms. Smith be terminated, counseled, or disciplined in some other fashion?

5. What are the clinical implications of Ms. Smith’s actions?

6. What are the legal implications of Ms. Smith’s actions?

7. What should Dr. Jonas do in the future to make sure that this set of events does not recur?