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Martha Duncan was scheduled for a magnetic resonance imaging (MRI) examination on June 19, 1998. Before her examination, she called Scottsdale Medical Imaging (SMI) to inform the medical staff that she needs to be sedated during the examination due to a back condition which would prohibit her from lying still during the MRI process if she is awake. In this regard, she specifically informed the nurse that she will not be taking any drug except for demerol or morphine. Duncan also informed the nurse that she is allergic to synthetic drugs. The nurse assured Duncan that they will be complying with her specifications.

When Duncan arrived at the Scottsdale Memorial Hospital North for the MRI examination, the attending nurse, Gary Fink, informed her that fentanyl, a synthetic drug similar to morphine and demerol will be used for her sedation. Duncan rejected the administration of fentanyl for her sedation instead she stressed the use of either demerol or morphine. Duncan repeated her specifications thrice and told Fink to consult her physician for her medications and reschedule her MRI examination if necessary. Fink later informed Duncan that the medication has been changed to morphine.

Duncan agreed to the administration of the drug, however, Fink, instead of giving morphine, actually gave fentanyl. The drug caused serious complications to Duncan specifically sever headache, post-traumatic stress disorder, projectile vomiting, difficulty in breathing and dysfunction of the vocal cord. Due to the difficulties that she experienced, Duncan decided to file three cases against SMI and Hospital Radiologists. Among the cases she filed were 1) medical malpractice, 2) lack of informed consent in the administration of drug, and 3) battery.

When the cases were set for trial, Duncan moved for the dismissal of the first two cases and retained only the battery case. SMI moved that the battery case be classified as medical malpractice. The latter crime requires the testimony of an expert witness who will be attesting or rebutting the claim that Duncan suffered difficulties due to medication given to her. The trial court ruled in favor of SMI on the justification that the case Duncan filed is not actually a battery case but a medical malpractice case. Duncan prayed for a special action relief in the Court of Appeals but the latter denied it.

Duncan moved for the trial court to allow her to proceed with the battery claim instead of considering it as falling under the medical malpractice act which requires the testimony of an expert delving on standard of care that should be given to her. SMI on the other hand contended that the battery claim is already barred by the medical malpractice act. Since Duncan did not present any expert testimony the case should be dismissed. The trial court dismissed the battery claim against all the defendants. Duncan again appealed the case to the Court of Appeals contending that the medical malpractice act is unconstitutional.

The said act violates the provision in the Arizona constitution dealing with the common law battery action against a health care provider. Without solving the constitutional issue, the court dismissed the appeal on the ground that there is no battery case because Duncan consented to the injection and failed to present expert testimony on the standard of care that should be imposed. Duncan raised the case to the Supreme Court. The issues involved are: whether or not the battery claim of Duncan can push through and whether or not the medical malpractice act is constitutional.

The Supreme Court held that the Court of Appeals erred in ruling that the battery claim of Duncan cannot push through due to the consent that she gave. The battery case should prosper and is not barred by the medical malpractice act. According to the Supreme Court, there is battery when the health care provider performs a medical procedure without the patient’s consent. A battery claim is defeated if the patient consents to the administration of the procedure or the drug. The Supreme Court held that the consent that Duncan gave is limited.

She only agreed to the administration of the drug which she specified to be injected to her and not any other drug. Duncan did not consent to the use of fentanyl as her sedative. The consent which the Court of Appeals referred to was obtained through misrepresentation. Duncan consented on the belief that the drug being given to her was morphine. She did not consent to the injection of the synthetic drug thus, there is no consent at all to speak of. On the issue of the constitutionality of the medical malpractice act, the Supreme Court said that it is unconstitutional.

Based on the language of the said law, the right of the patient to bring action against the health care provider is abolished. Article 18 of Section 6 of the Arizona constitution provides the non-abrogation clause. The clause specifically mandates that the right to recover damages arising from injuries should not be abolished or abrogated by any law. The medical malpractice act clearly violates this provision of the constitution (Duncan v. Scottsdale Medical Imaging, Ltd. , 70 P. 3d 435 [Ariz. 2003]). The decision rendered by the Supreme in Duncan vs.

Scottsdale Medical Imaging, Ltd. made a mark in history as it now serves as the basis for health care cases involving battery in the state of Arizona. Nurses and health care providers should be careful in dealing with patients and the medical procedures that are conducted on them. Patients seek medical attention to improve their health condition and not to make them worse. Health workers should be sensitive as to the needs and specifications of their patients. Health workers should not presume that they know everything about the client.

The patient knows his physical sensitivities more than the health workers. In addition, nurses should not insist on what they want if the client desires otherwise. In the given case, what Fink did was really out of bounds. It was unethical and medically improper. The option to insist on a medication is not for him to make. His job does not also include misrepresentation. In any field, honesty is important. Telling lies or making false claims, more often than not is frowned by law and ethics thus, it should be avoided.

There are many medical issues that the case clarified among these issues are the filing of cases of battery, status of the medical malpractice act, types of patient consent that should be considered by the court and heath care providers and the distinction between battery and negligence. In the given case, the court finally decided that the medical malpractice act infringes upon the constitution. Complaints which the said law prohibits are no longer prohibited. Patients may pose claims for damages under battery cases on instances where the patient did not consent to the medical procedure conducted.

There are three kinds of consent: general, limited and informed consent. General consent may either be explicit or implied. There is explicit consent when the patient expressly tells (orally or in writing) that he agrees to the medical procedure that will be conducted on her. There is an implied consent when the patient performs or agrees to perform the instruction of the physician or the health worker. Implied consent can be illustrated in cases where the health worker instructs the patient to turn his head so that he can examine the ear.

The turning of the head impliedly allows the health worker to examine the ear. In both cases, the health worker cannot do any medical procedure to the patient if the patient fails to give them his consent (Miller, n. d. ). There is limited consent when the patient agrees to the performance of a medical procedure but with certain specifications or limitations. If the health worker does not follow the specification or limitations, then it can be said that the patient did not consent to the performance of such an act and a battery case can be filed.

In the given case, the court held that there was no general consent because the patient made specific instructions on the medication that should be used for her sedation. The nurse failed to comply with the specific orders of the patient which made him liable (Miller, n. d. ). The patient provides an informed consent when he agrees to the performance of a medical procedure after being informed on the possible risks and consequences of the procedure and non-performance of the procedure, alternatives of the treatment, and other information that would give the patient a full understanding of what is going to happen.

This kind of consent protects the right of the client to self-determination in making health care related decisions. The execution of nursing actions requires an informed consent before they can be performed (Craven ; Hirnle, 2006). In the case of Duncan, the court gave due emphasis to the kind of consent that the client gives to the health workers. The kind of consent provided will determine the case that the patient can file if there are irregularities that happen.

The court discussed in the said case that there are two theories of liability for the conduct of unauthorized treatment and therapy: battery and negligence. Battery is an intentional tort claim which springs from the lack of consent of the patient. In illustration, if the physician informs the patient that he will be performing a specific procedure but undertakes a different one then the physician is liable for battery. On the other hand, there is negligence if the physician fails to disclose to the client information which will allow him to have a full understanding of the treatment that is undertaken to him.

The patient must be fully informed of the medical procedures that health workers are performing so that he can properly decide whether or not to go through with such procedure. The case of Duncan implies the necessity for health workers never to disregard the consent of the patient. The primary ethical responsibility of a nurse is to make sure that the wishes and specifications of the client are followed and respected. Physicians and nurses should make sure that they properly inform their patients of the medications as well as the treatments and other medical procedures that they undertake.

They should not mislead their patients just to get their consent. It is important that the client understands what will happen because he will be the one suffering the consequences of the medication or the treatment and not the health worker. A life can never be replaced anything, not even money. The Code of Ethics for Nurses provision 2 states that the nurse’s primary commitment is to the patient, whether an individual, family, group or community. Any nursing plan that should be employed upon the patient should reflect the uniqueness of the individual patient.

The nurse should strive to provide their patients the opportunity to take part in the planning process so that they can have the assurance that their needs and specifications are met. When there are conflicts between the wishes of the patient and that pf others such as the physicians’ orders or medical intervention prescribed, the nurse should strive to help resolve the conflict. However, in case conflict persists, the commitment of the nurse should remain with the patient.

From the language of the Code of Ethics formulated by the American Nurses Association, the nurse is expected to respect the wishes of the patient and all means must be exerted to meet these wishes. The commitment of the nurse is to the patient. The Code of the Ethics does not say that the nurse should insist on what he wants or that he mislead the patient just to administer the drug that he initially told the patient to be administered to him. Nurse Fink clearly violated his profession’s code of ethics.

The obligation of the nurse to give primary commitment to the desires of the patient should be stressed. Nurses are not given the leeway to do as they desire without relaying the proper information to the patient and/ or his family. If nurses are given such freedom then patients’ lives will be subjected to the whims of health workers which is totally improper and unjust. QUESTIONS: 1. What is a battery case and how it is different from medical malpractice? What are the elements of a battery case? 2. What is the possible defense of a health worker who is subjected to a battery case?

3. What are the different kinds of consent that a health worker should acquire from the patient? 4. What are the consequences if a particular consent is not achieved by the health worker from the patient? 5. Based on the Code of Ethics of the American Nurses Association, to whom should the nurses’ primary be commitment be given and why? References “Code of Ethics for Nurses”(n. d. ). Nursing World. Retrieved 10 September 2008 from http://nursingworld. org/ethics/code/protected_nwcoe813. htm#2. 1 Craven, R. F. ; Hirnle, C.

J. (2006). Fundamentals of Nursing. Philadelphia: Lippincott Williams ; Wilkins. Duncan v. Scottsdale Medical Imaging, Ltd. (2003). Supreme Court of Arizona 70 P. 3d 435 Miller, T. (n. d. ). What Every Physician and PA Needs to Know About Consent. Arizona Regulatory Board of Physician Assistants. Retrieved 10 September 2008, from www. azpa. gov/Alerts/Need%20to%20Know%20About%20Consent. pdf – “Nurse Switched Patient’s Medication: Court Says Patient can sue for Battery”. (2003). Legal Eagle Eye Newsletter. (11), 8, 1.

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