Medical Ethics Case Study Who Can Prescribe

Medical Ethics Case Study

Who Can Prescribe Medicine?

Does Jerry's medical training qualify him to issue this refill order? Why or why not?

Generally, LPNs and medical assistants are qualified to dispense medication prescribed by a physician ("Medical assistant, 2011). A medical assistant is a trained medical professional who works under the supervision of a board-certified physician ("Medical assistant, 2011). Typically, a medical assistant's work is administrative, but it may also include clinical duties ("Medical assistant, 2011). The administrative duties performed by a medical assistant might include scheduling appointments, maintaining medical records, greeting patients, and such. Clinical duties that may be performed by a medical assistant include taking vital signs, preparing patients for exams, drawing blood, and administering medication ("Medical assistant, 2011)..

In Jerry's case, the medical office includes a receptionist who normally takes telephone calls. This tends to indicate that the office administrative duties may be delegated to the receptionist. But this is not necessarily the case. Regardless, the extent to which Jerry is expected to carry out clinical duties will be determined by the physician for whom he works and Jerry's training and certification. That said, writing a refill for a prescription can only be conducted by someone who has the authority to prescribe medication. Jerry's certification as an LPN and a medical assistant do not qualify him to refill a prescription -- even for a current patient of the supervising physician.

The Nature of Medical Care Provided

Would it make a difference if the medication requested were for control of high blood pressure that the patient critically needs on a daily basis? Why or why not?

Jerry would not be able to prescribe medication -- which is essentially what writing a refill does -- even if the medication being refilled was for a current patient and for medication that had been prescribed by the supervising physician on a long-standing basis. The same stipulations apply under both conditions. Jerry would not be privy to all the information that the physician has due to his training, even with the best kept medical records. A definitive risk to the patient exists whenever a medical transition occurs -- even between the best trained physicians -- because communication can never be absolute. Complex decision-making accompanies the act of prescribing medication -- whether it is for a chronic, acute, or functional purpose (as in the case of reducing flying anxiety). Such decision-making is rarely transparent. Most importantly, Jerry is not trained to prescribe medication.

Doctrine of Respondent Superior

If Jerry calls in the refill and the patient has an adverse reaction while flying, is Jerry protected from a lawsuit under the doctrine of respondent superior?

A legal relationship exists between an employee and an employer that is referred to as agency. An employee is considered an agent, and an employer is considered to be a principal. In an employee-employer relationship, there is an assumption that the principal regulates or controls to a degree the behavior of the agent. Based on this assumption, respondeat superior attributes some responsibility for the agent's actions to the principal. Certain qualifications are attached to the notion of respondent superior -- in particular, an agent is only partially entrusted with the business of the employer, and the employee is authorized to act for the employer to the degree that such authority has been granted. The quotidian logistics of carrying out duties and responsibilities -- such as the time, place, and methods of working -- are controlled by the employer. In a principal-agent relationship, an employer can be held liable for injuries caused by an employee during the course of employment. In very general terms, conduct of an employee is considered to be within the scope of employment if it bears some relationship to the work. In the field of medicine, appropriate employee work conduct is determined by circumstances and particular facts. When making decisions about the appropriateness or lawfulness of an employee's conduct, a court will consider such things as job description, licensing and certification, the purpose of actions, work expectations and demands, and the extent to which an occurrence of the employee's conduct could reasonably been expected.

Advice and Legal & Ethical Issues.

What is your advice to Jerry? Identify major legal and ethical issues that may affect Jerry's decision.

Legally, Jerry simply cannot respond to the patient's request to refill his prescription for Valium. However, Jerry can take a number of steps to see if the medication can be made available to the patient. First, if the prescriptions have been ordered as the patient claims, this information would be included in his medical records. If Jerry finds a record that Valium has been prescribed by the physician, then he can expediently try to reach his supervising physician to determine his course of action. If the prescribing physician -- or another doctor who might be on-call for the prescribing physician -- can be reached a call can be made to the pharmacy to refill the prescription. If this is a refill of an extant prescription, the medication could be ready in time for the patient to pick it up prior to his flight.

On the other hand, if no record of Valium prescriptions can be found in the patient's medical record, then Jerry must grapple with the fact that his supervising physician could very well be just handing over a controlled substance to his friend. This knowledge places Jerry in a very uncomfortable position which -- should he chose to act on his presumption or inquire for more details -- could very well put Jerry's employment at risk.

The patient is not acting ethically when making a request for a prescription for Valium to be filled by someone who does not have the authority to do so. The situation is complicated by the fact that the patient claims that the supervising physician is a personal friend. The patient says that the physician "gives" him the Valium -- the patient does not say that the physician "prescribes" Valium for him. Taking a slightly different tact, the patient has to assume responsibility for planning for anticipated needs in such a manner that permits others to respond within the legal bounds of their work and praxis. The physician and his office staff cannot be held responsible for the patient's inability or unwillingness to organize his affairs.