2 Case study analysis

population health case study and need the explanation and answer to help me learn.

Please read the attached case studies and answer the attached framework questions for a total of 10 questions. Answer don’t have to be long. APA format
Requirements: N/A
Handout: Suggested Framework for Case Analysis

1. Procedure. Who are the parties? Who brought the action? In what court did the case originate? Who won at the trial-court level? What is the appellate history of the case?
2. Facts. What are the relevant facts as recited by this court? Are there any facts that you would like to know but that are not revealed in the opinion?
3. Issues. What are the precise issues being litigated, as stated by the court? Do you agree with the way the court has framed those issues?
4. Holding. What is the court’s precise holding (decision)? What is its rationale for that decision? Do you agree with that rationale?
5. Implications. What does the case mean for healthcare today? What were its implications when the decision was announced? How should healthcare administrators prepare to deal with these implications? What would be different today if the case had been decided differently?
rhe Court Decides á á Helling v. Careyá 83 Wash. 2d 514, 519 P.2d 981 (1974) Hunter, J. w find this to be a unique case. The tesU-In [another case,] Justice [Learned] Hand 111:ny of the medical expe~ts is undisputed stated:. concerning the standards of the profession [l]n most cases reasonable prudence is in for the specialty of. ophthalmology. ¥ ¥ ¥ The fact common prudence; but strictly it is never issue is whether the defendants’ compli-á its measure; a whole calling may have unduly ance with the standard of the profession á lagged in the adoption of new and available of ophthalmology, which does ~ot require devices. _It never may set its own tests, how-the giving of a routine pressure test to per-. ever persuasive be its usages. Courts must in sons under 40 years of age, should insula.te the end say which is required; there are pre-them from liability under the facts of this á cautions so imperative that even their univer-case. . ¥ ¥ . .. .¥. . . _ .. >: … sal disregard will not excuse their omission. [The court points to eviden,ce ,that the’.} <'.if:, Under the facts of this case reasonable incidence of glaucoma in persons under;;it:;,,;á:(. : prudence required the timely giving of the the age 0{40 was .about 1_in ,25,oqo~JJfo~;;: .{~"¥:~) .. pressure _test to this plaintiff. The precaution ever, that one person; the.plaintiff ifrthis}{::(:i?efgiving this test to detect the incidence of. instance, is entitled to the same protect'ion';{,E/'.'glaucomato patients under 40 years of age as afforded pers"ons over 40, essentialJ(),f)\:'t}~_is so Jmpe~ative that irrespáective of its disre-á timely detection of the ev.idence of glaáu/~:t\Já' ~;,ágard by thestandards of the ophthalmology coma where it can be arreste"d to avoid the')<<-,, profession, ifis the áduty of the courts to say á grave and devastating result of this dise'ase~ -. 'wh~t is "require,d to protect patie~ts under 40 . The test is a simple pressure test, rel~tiyely' á .. from the damaging results of glaucoma. inexpensive. There is no judgment fader, _ .W,~ t~erefore hold, -~s a matter of law, that involved, and there is no doubt thatby giv-.7 .. the reasonable standard that should ha_ve á á ing the test the evidence of glaucoma ácan, b(i-, been foll~,wed und~r the ~n?ispute~ fa~ts of detected -. . .. . _ á . ; . á ''./k/: this case was the timely g1vmg of this s,.mple, Justic; Hdlmes stated in Texas & Pac.' Ry.:-á \;l' harmless pressure test.to.this plaintiff and v. Behymer: á. á , ,. , á , á á _ thatl in. failin~ to do s?, the defendant~ were _ What ll ¥ d á b á ádenáce' of : > . negligent, which prox,m_ately resulted m the usu a y ,s one may e ev1 . . , á ¥ d b h 1 ¥ áff i á h. h What ou ht b ád b h t u ht to á _ blindness sustame . y t e p amt, or w ,c be to e one, ut w a o g . the defendants are liable. . -.á. done 1s fixed by a standard of reasonabl_e á á Th. J’udgment áof the trial court and Prudence h th á ll á mplied with e -á or . , w e er 1_t usua Y 1s co , the decision of the Court of Appeals [are]. á not. . _. . . á reversed ¥¥ ¥¥ á (continued)
@) The Court Decides , Perin v. Hoyne 210 N.W.2d 609 (Iowa 1973) McCormick, J. This is an appeal from a directed verdict for aá doctor in a malpractice action. We affirm. á The claim arose from an anterior approach cervical fusion performed on plaintiff Ilene Perin by defendant Robert A. Hayne …¥ The fusion was successful in eliminating pain, weakness and numbness in plaintiff’s back, neck, right arm and hand caused by two protruded cervical discs, but plaintiff alleged she suffered paralysis of a vocal chord [sic] because of injury to the right recurrent laryn-geal nerve during surgery ¥¥¥¥ The injury reduced her voice to a hoarse whisper. She sought damages on four theories: specific negligence, res ipsa loquitur, breach of express warranty and battery or trespass. After both parties had rested, the trial court sustained defendant’s motion for directed verdict, holding the evidence insufficient to support jury consideration of the case on any of the pleaded theories. Plaintiff assigns this ruling as error. We must review each of the pleaded bases for recovery in the light of applicable law and the evidence. I. Specific negligence. Plaintiff alleges there was sufficient evidence to support jury submission of her charge [that] defendant negligently cut or injured the recurrent laryngeal nerve. Plaintiff had protruded ¥ discs at the level of the fifth and sixth cerná cal interspaces. The purpose of surgery was to remove the protruded discs and fuse the vertebrae with bone dowels from her hip. -..,~
á–‘ ,,.,m previous page) ccontJnusu ,. -val of a disc ends the pinching of the Remo In the spinal column which causes the nerv;nt’s pain. The bone supplants the disc. patlThe procedure Involves an incision in the t of the neck at one side of the mid line rr:: level slightly below the “Adam’s apple.” 8 columns run through the neck. The four . d I h vertebrae and spinal cor are n t e axial or e column at the rear. In order to get to b:n axial column the surgeon must retract á the visceral column which lies in front of ~t ~he visceral column, like the vascular ~lumns on each side of it, is .covered with protective fibrous sheath, called fascia. It contains the esophagus and trachea. The recurrent laryngeal nerve, which supplies sensitivity to the muscles that move the vocal chord, is located between the esopha-gus and trachea. . . á á. á. á á The surgeon does not enter the visceral . column during the.cervical fusion procedure. The same pliancy which enables the neck to á be turned enables the visceral column to be retracted to one side to permit access to the. axial column.á The retraction is accomplished by using a gauze-padded retractor specifi-cally designed for retraction of the visceral column during this surgery. The record shows the defendant used this procedure in the present case. Plaintiff was under general anesthetic. The ane’sthesia record is normal, and there is no evidence . of any unusual occurrence during surgery. Defendant denied any possibility the laryn-geal nerve was severed. He said it could not be severed unless the visceral fascia was entered, and it was not. He also believed it Would be impossible to sever the nerve dur-ing such surgery without also severing the esophagus or trachea or both. á [An expert witness for the plaintiff testi-fied that it would be unusual to specifically encounter the laryngeal nerve during this surgery but that “the injury could occur Chapter 6: Negligence despite the exercise of all proper skill and care.¥/ á Defendant testified he did not know the cause of the injury but presumed it resulted from contusion of the nerve inci-dent to retraction of the visceral column. He thought plaintiff’s laryngeal nerve may have been peculiarly susceptible to such injury. He insisted the surgery was done just as it always was and if he were doing it again he would do it the same way. He said one study has shown the surgery will result in paralysis of a vocal chord in two-or three-tenths of one percent of cases in which it is used. He .also said there is no way to predict or prevent such instances. . In considering the propriety of the verdict directed for defendant we give the evidence supporting plaintiff’s claim the most favor-able construction it will reasonably bear. We recognize three possible means to establish specific negligence of a physician. á One is through expert testimony, the second through evidence showing [that] the physi-cian’s lack of care is so obvious as to be within comprehension of the layman, and the third (actually an extension of the second) evidence that the physician injured a part of the body not involved in the treatment. The first means is the rule and the others are exceptions to it.’ In this case plaintiff asserts [that} a jury question was generated by the first and third means. We do not agree. Plaintiff alleges the laryngeal nerve was negligently cut or injured. The record is devoid of any evidence the nerve was sev-ered during surgery ¥¥¥¥ The doctors agree the technique employed by defendant was proper. The sole basis for suggesting the expert testimony would support a finding of specific negli-gence is that the nerve was injured during retraction. Where an injury may occur despite (continued)
:::¥;;::::~::::~:e:ligence cannot be~3~~ the usual case the basis of PiSI~ predicated solely on the fact it did occur. ence from which this conclusion~ ) .J Plaintiff also maintains there is evidence drawn is common to the commu111ty, and of negligence from the fact this is a case of a matter of general_knowledge, which injury to a part of the body not involved in . court recognizes on much the same the treatment. However, that is not so. The á when it takes judicial notice of facts surgical procedure did include retraction of everyone knows: It may, however, be á the visceral column. It was very much in the á plied by the evidence of _the parties; and surgical field. á expert testimony that such an event US1f-Trial court did not err in directing aver-á ally does not occur without negligence diet for defendant on the issue of specific afford a sufficient basis for the inference. negligence. á á .. Thuswe disagree with defendant’s co. II. Res ipsa loquitur. Plaintiff also alleges the applicability of the doctrine of-res ipsa. loquitur. Our most recent statement of the . doctrine appears in [a 1973 case]: tention [that] the second foundation fact mus~ be based exclusively on the common’ knowledge of laymen. á á . In this case, ho\Vever, even considering á the ~xpert testimony, th~ record at bestoidf Under the doctrine of res ipsa ioquitur,. supports an inference [that] plaintiff sllf’felt!( where (1) injury or damage is_ caused by an . . an extremely rare injury’in anterior ap~ instrumentality under the exclusive control .. cervicalfusion surgery which may occur.¥ of defendant and (2) the occurrenceá is $UCh á .. even wheri d1,1e’care is ‘exercised; Rarity of as in the ordinary course of things would’./;., “the occurrence is not a ‘sufficient predicate not happen ifreasonable care had been” ;’ :. for’ applkatiori of res ipsa loquitur ¥¥ ;; There ¥ ¥ -á-¥ , ,’ . ‘.> \.-\_ v_ , . _ ,, , ¥ ¥ ‘á ¥ ¥ ¥ ,, -¥ c’ á –,. ‘. .. ¥’ … used, the happening of the i_~jury permits; . isá no b~sis iná the P.resent case, in_~pl!rt: : but does not compel, an inference ~efen-.. . , testimony orá otherwise:lor sayin.gpla~ dant was negl_igent._ . ::: á .. ,á -:\’ ᥠinjury is more likely the result of negUg’ -~f~,.;j . The contest in this case concerns pres~;._.á á :. than some c_ause for ~hk~ .. the d_~fend_~~ ence of the second foundation fad [from the :á n?t responsible. _ á, á _ á. á: á: -:, . > quoted paragraph]. á . á á .. , . , . , . . .. á á á We do not believe there was any ~aslS Defendant argues the second foundationá… . . this case for submission of res ipsa toq~ fact for res ipsa loquitur is absent because it. , Trial court did not err in refusing to SU . does riot _lie in the common knowledge of lay-á . ¥ . : . .. . . á . . . . ¥ . ¥ , . men to say injury to the laryngeal nerve does. á 111: ~p!ess ~arranty. [The co~rt dtsm~ not occur if due care is exercised in ante’rior’. á ‘ this, count, saying that the evidence. approach cervical fusion surgery. . á .á ., ing her argument that the physici~n_g . We must init_ially decide what has previ-á. á ~;ed a ~ood result ~as equivocal ,n ,; ously been an open question in this jurisdic-. á There come~ a pomt when a questlo the tion: may the common experience to estab-áá fact may be generated as to whet~e~ li~h ~he second foundation fact for res ipsa . á tor has w~rranted a cure or a spe~ á . á loqu1tur be shown by expert testimony? However, m the present case the . , [The court proceeds to review cases from does not rise to that level.”} á á . Wisconsin, California, Oregon, and Washing-. á á á áá:..-1’ ¥ t’ff cont~ ton, plus three l~gal treatises on the subject. IV. Battery or trespass. Plain 1 . It quotes with favor the following from the . there was also sufficient evidence~ á Restatement of Torts:} the case to the jury on the theory 0
Chapter 6: Negligence r trespass. In effect, she alleges she con-circumstances when a doctor performs an :ented to fusion of two vertebrae (removal operation to which the patient has not con-of only one protruded disc) thinking there sented. When the patient gives permission to would be a separate operation if additional perform one type of treatment and the doctor vertebrae had to be fused. She asserts the performs another, the requisite element of fact four vertebrae were fused combined with deliberate intent to deviate from the consent . defendant’s assurances and failure to warn given is present. However, when the patient her of specific hazards vitiated her consent consents to certain treatment and the doctor and makes the paralyzed vocal chord the . performs that treatment but an undisclosed result of battery or trespass for which defen-inherent complication with a low probability dant is liable even without negligence. There occurs, no intentional deviation from the was no evidence or contention by her in the áconsent given appears; rather, the doctor in trial court nor is there any assertion here that obtain.ing consent may have failed to meet she would not have consented to the surgery á his due care duty to disclose pertinent infor-had she known those things she says were. mation. In that situation the action should be withheld from her prior to surgery.á á pleaded in negligence. Defendant testified plaintiff was fully á . . .. , . : . From our approval of this analysis it advised as to the nature of her problem and : ._ should be clear we believe the battery or the scop~ of corrective surgery. He acknowl-” á ‘trespasás theory pleaded by plaintiff in this edges he did not advise her of the hazardof case is limiteád in its applicability to surgery vocal chord paralysis. ~e believed the P?Sá1/ tc>.’whichthe patient has not consented. sibility of such occurrence was negligible and :: á There must be a substantial difference outweighed by the danger of undue a:ppre~_ . : á between the surgery consented to and the hension if warning of the risk was given. á,á surgery which is done. Plaintiff asserts she á [The court next begins a discussion of theá .á consented toá only one fusion rather than two. distinction between consent and informecf .á . á Assuming this is true, t~e most that could consent, quoting with approval from its own ¥á. áábe argued i’s [that] the second fusion was a landmark case Cobbs v. Grant.J, á battery or trespass. But she does not claim Where a doctor obtains consent of the. damages for a second fusion. She asks dam-patient to perform one type of treatment ages because of injury to the laryngeal nerve . and subsequently performs a substantially. . during surgery. The eviden~e is undisputed different treatment for which consent was á. á that whether one or two fusions were to be not obtained there is a clear case of battery. done the path to the axial column had to be However, wh~n an undisclosed potential “cleared by retraction of the visceral column. complication results, the occurrence of which: . Hence, any injury ca_used by such retrac-Was not an integral part of the treatment ; consent had been given. Retraction of the tion occurred during a procedure to which Procedure but merely a known risk, the .á á I h courts are divided on the issue of whether : visceral column dur ng t e surgery was not a this should be deemed to be a battery or á .. battery or trespass.á.á á we have no occasion to reach the ques-negligence. á á l ¥ ‘ff f h … ~e agree With the majority trend. The bat-~ry theory should be reserved for those á á tion whether failure to. advise p amt, o t e isk of laryngeal nerve injury would in the ~ircumstances of th!s case have generat~d a jury Issue on negligence, but we do point á á (continued)
(continued from previous page) out that recovery on such basis is precluded unless a plaintiff also establishes he would á not have submitted to the procedure if he had been advised of the risk ¥¥¥¥ There is no evidence plaintiff would have with& consent In this case. á á á. . … á Affirmed. Discussion Questions 1. Has due care been shown? Need it be? 2. What is the “second foundation fact,” and how does “common experience” matter relation to it? á á á á , 3. The opinion states, “There must be a substantial difference between the surgery consented to and the surgery which is done [for a battery case to be made).” Whatá would amount to a “substantial difference” in your mind? What if throat cancer had been discovered and cleanly removed with noá aftereffects? Would that procedure bff substantial difference justifying damages for battery even though_ no other injury (a fact, a benefit) had resulted? -á á áá á á . 4. Why did the court “have no occasion’~ to d.ecide wh~ther failifre to advise the.plainti the risk of nerve injury raised a negligence issue?. á :::@i.t,á; :?á ~. ¥, Notes 1. Pederson v. Dumouchel, 431 P.2d 973, 978 (Wash. 1967). 2. Baldor v. Rogers, 81 So. 2d 658 (Fla. 1954), rehg denied, 81 So. 2d 661 (Fla. 1955); ANGELA R. HOLDER, MEDICAL MALPRACilCE LAw47 (2d ed. 1978). 3. Defilippo v. Preston, 53 Del. 539, 173 A.2d 333 (1961). 4. Miller v. Toles, 183 Mich. 252, 150 N.W. 118 (1914). 5. Fiorentino v. Wenger, 272 N.Y.S.2d 557, 26 A.D.2d 693 (1966), m’d on other grounds, 19 N.Y.2d 407,227 N.E.2d 296 (1967). 6. Faulkner v. Pezeshki, 44 Ohio App. 2d 186, 337 N.E.2d 158 (1975)á d 7. Small v. Howard, 128 Mass. 131, 35 Am. R. 363 (1880) was overrule by Brune v. Belinkoff, 235 N.E.2d 793 (Mass. 1968). 8. Zills v. Brown, 382 So. 2d 528, 532 (Ala. 1980). 9. 382 So. 2d at 532. See also Morrison v. MacNamara, 407 A.2d 555 (D.C. 1979). (A'” d 254 … 10. Drs. Lane, Bryant, Eubanks & Dulaney v. Otts, 412 So. 2 1982). 54 (1971)á 11. ]ON R. WALTZ & FREDE. INBAU, MEDICAL JURISPRUDENCE

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