An Ethical Case Study: Jerry McCall
Heather Sewell
HCS335
November 4, 2013
Susan Kajfasz

An Ethical Case Study: Jerry McCall

The Jerry McCall case study involves a health care worker who is a medical assistant and LPN and b faces a legal and ethical decision when a patient insists on a prescription of Valium while Jerry is in the office alone. Jerry must decide how to provide the patient with what he needs while maintaining the law and his ethical values.
Jerry McCall, although he received professional training as a medical assistant and an LPN, is not qualified to refill a prescription for a patient. According to New York State Law, LPNs are not allowed to work independently. The law “requires LPNs to practice under the direction of a registered professional nurse, nurse practitioner, physician, dentist, physician assistant, specialist assistant, podiatrist, or midwife” (Office of the Professions, n.d.). Jerry is aware of the rules and regulations concerning prescriptions and should not be intimidated by a pushy patient. Rules and laws are in place to protect both patients from injury and health care workers from malpractice.
The law covers all medications because a patient can have an adverse reaction to even a common medication which is why all prescriptions must be ordered by licensed professionals. It does not matter whether the patient requests a daily medication such as a blood pressure medication or Valium as in Jerry’s case. The only legal way that Jerry could call in a refill for the patient is if the physician instructed him to because this would be within the scope of his duties. NYSNA, the New York State Nurses Association, prohibits medical assistant from performing any duties within the scope of nursing or the practice of medicine (NYSNA, n.d.). Although physicians reserve the right to train staff as they see fit, neither medical assistants nor LPNs are allowed to prescribe or refill prescriptions of any kind. A medical assistant or LPN could call in a refill on a prescription if the physician documented a need for refills in the patients chart or directly instructed them to call the pharmacy. Any other option leaves Jerry and the facility open to litigation.
The doctrine of respondent superior is a legal doctrine “that holds an employer or principal legally responsible for the wrongful acts of an employee or agent, if such acts occur within the scope of the employment or agency” (Legal Information Institute Cornell University Law School, 2010). According to the guidelines of respondent superior, Jerry is not protected during a malpractice lawsuit because prescribing medications is not within the scope of his job duties as an LPN or medical assistant. If the event that the physician documented a need for a refill in the patient’s chart and Jerry called it in to the pharmacy, Jerry would be protected by the physician’s malpractice insurance. In this case, Jerry would be liable for his actions because he acted outside of the scope of his job duties. If the patient had an adverse reaction, he would be able to sue Jerry for acting outside the scope of his position and illegally calling in a prescription.
Jerry should respectfully tell the patient the circumstances. He is alone in the office and legally cannot refill the patient’s prescription for Valium. Regardless of how irate the patient becomes, Jerry must act within the scope of his education and experience as a medical assistant and LPN. He must explore his options with two goals in mind – helping the patient and fulfilling his work obligations. He can explain to the patient that he is not licensed to prescribe medications even if it is for a refill. Jerry can tell the patient when the physician or nurse practitioner, if there is one in the office, will return to speak with the patient. Jerry can also recommend that the patient call the physician directly since the patient insists that they are personal friends. This option would completely remove Jerry from the situation. Another option would be for Jerry to refer the patient to another physician since the patient is leaving for the airport shortly. Deontologism holds ethics in a clear and concise view of right and wrong meaning there is no gray area. “The deontologist considers the rightness or wrongness of at least some acts to be independent of their consequences; that is, some acts are good or evil in and of themselves” (Garrett, Baillie & Garrett, 2009, para. 17).
Although Jerry could do some good for the patient by calling in a refill for Valium, he is prohibited from doing so by law. Jerry can immediately eliminate the option of calling in the prescription by utilizing the ethical theory of deontologism. Hicks (1999) outlines the following 7 step process for effective problem solving: (1) identify the issues, (2) understand everyone’s interests, (3) list the possible options, (4) evaluate the options, (5) select an option, (6) document the agreement, (7) agree of contingencies, monitoring, and evaluation (Hicks, 1999, para. 6). Utilization of this process can provide Jerry with a comprehensive view of the situation and all possible solutions. He must always keep in mind his training, position and responsibilities as a medical assistant and LPN.

References

Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2009). Health care ethics: Principles and problems (5th ed.). Upper Saddle River, NJ: Prentice-Hall.
Hicks, T. (1999, April). Seven steps for effective problem solving in the workplace. The
Business Journal of Sonoma/Marin, (), . Retrieved from http://www.mediate.com/articles/thicks.cfm
Legal Information Institute Cornell University Law School. (2010). Respondent Superior.
Retrieved from http://www.law.cornell.edu/wex/respondeat_superior
NYSNA. (n.d.). Scope of practice. Retrieved from http://www.nysna.org/practice/scope/med_assists.htm Office of the Professions. (n.d.). Frequently asked practice questions. Retrieved from
http://www.op.nysed.gov/prof/nurse/nursepracticefaq.htm