Introduction
The case under consideration concerns a medical assistant acting beyond the scope of practice. The situation occurred in a primary care office, which employs one physician, three nurse practitioners, and eight medical assistants. One of the assistants, Stephanie, who has worked in the office for ten years, issued amoxicillin to a patient without the consultation of the physician or nurse practitioners. Furthermore, the medication was issued under the name of a nurse practitioner as the prescriber, who had no knowledge that the patient called the practice with concerns about a cold or that any medicine was issued to them. The situation is highly unethical and leaves the practice vulnerable to legal action. This case study will address the event and discuss ethical and legal implications for all provider stakeholders involved. In addition, it will consider strategies to prevent illegal behavior in the workplace as well as leadership qualities needed to foster positive change.
Ethical and Legal Applications
Medical Assistant
Medical assistants greatly help and support other health care professionals, including nursing practitioners and physicians. It should be noted that the scope of practice of medical assistants differs from those of nurses and medical doctors. Their duty is to assist in different procedures, collect patient information, set appointments, and deal with billing (Med Assisting, 2022). In addition, medical assistants may administer medication under supervision but are prohibited from diagnosing and treating patients, as well as prescribing medication and refilling prescriptions (Med Assisting, 2022). Therefore, the medical assistant, Stephanie, committed a considerable legal error by acting beyond her scope of practice.
Moreover, the issue is ethical in nature, as Stephanie knowingly prescribed amoxicillin under the wrong prescriber’s name. In addition, although she might be familiar with the history of the patient in question, they might have an adverse reaction to amoxicillin. Oral amoxicillin is associated with severe side effects, including nausea, diarrhea, bloody stool, skin blisters, swelling, and difficulties breathing and swallowing (American Society of Health-System Pharmacists, 2022). Sousa and Raimundo (2020) note that in rare cases, amoxicillin can induce aseptic meningitis in patients. Therefore, it can be argued that by prescribing amoxicillin Stephanie disregarded such fundamental ethical principles of health care as beneficence and nonmaleficence (Varkey, 2020). Overall, the deception of the patient and the wrongful use of the colleague’s name are ethically indefensible and can be considered fraud from a legal standpoint.
Nurse Practitioner
Although the nurse practitioner under whose name the medication was issued was unaware of the prescription being made, they are at risk of legal and disciplinary action. Any prescription is legally binding, and the prescriber becomes liable if patients experience adverse effects. Disciplinary hearings can be held against them by their place of work and lead to suspension or loss of license. Moreover, as they were made aware of the transgression by the patient after the fact, they duffer an additional ethical and moral obligation. As the act was incompatible with the law, the ethical principle of justice demands it is reported (Varkey, 2020). If the nurse practitioner fails to report it, they become liable for it, although to a lesser degree than the medical assistant.
Medical Director and the Practice
The medical director of the practice, the position held by a physician, is responsible for the supervision of their office. Thus, they are legally and morally compelled to ensure all health care workers act with consideration of the law and within their scope of duties and responsibilities. The failure to ensure lawful and ethical behavior of the medical professional in their charge signifies a failure in leadership. It should be emphasized that the medical practice is a legal entity with the medical director serving as its owner and partner. Therefore, the illegal behavior of employees puts the medical director and the practice at risk of legal action and loss of license, negatively impacting the employment of other workers.
Illegal Behavior Prevention Strategies
In order to prevent illegal prescribing, several strategies can be put in place in the primary care office. However, before any approaches can be devised, it is vital to determine the causes of the behavior of the medical assistant. It can be assumed that Stephanie did not act with malice and prescribed the medication out of care for the patient and due to parties with prescribing authority being otherwise unavailable. Thus, a private conversation should be held with Stephani, during which it should be established if she prescribed medications to patients before and whether it is a common practice among medical assistants in the office. If this practice is widespread and embedded in the company’s culture, the prevention strategy needs to be designed to address it thoroughly. In particular, specific measures should be introduced to increase the risks of the behavior, reduce provocations, and remove potential excuses for illegal prescribing (Moreto et al., 2019). For example, a new protocol for taking phone calls from clients can be developed and distributed to medical assistants. In addition, additional training on workplace ethics and legal and safety aspects of prescribing errors should be held.
Moreover, some positive measures should be implemented to maintain workplace culture. It can be presumed that Stephanie made the decision to prescribe amoxicillin to the patient due to her experience and accumulated medical knowledge. Therefore, although she acted unethically and illegally, a conversation should be held about her future in health care. It should be made clear that her actions are inexcusable and will not be tolerated if repeated. However, opportunities should be sought for her to secure a nursing practitioner certificate if she would prefer to grow professionally.
Leadership Qualities to Effect Positive Change
The event under review proves the necessity for change in the discussed primary care office. For such change to take place, it is crucial that the nurse in charge exhibits such leadership qualities as open communication, integrity, ability to inspire others, and enthusiasm (Clavelle & Prado-Inzerillo, 2018). Transformational leadership facilitates change in the workplace, including changes in the workplace culture, by promoting practices and behaviors that improve such outcomes as job satisfaction, commitment, and productivity among employees (Clavelle & Prado-Inzerillo, 2018). Thus, for the discussed illegal behavior strategies to be efficient, the lead nurse practitioner should enable and inspire other employees to act accordingly and model the new way by setting an example for other employees to follow (Clavelle & Prado-Inzerillo, 2018). Furthermore, emotional intelligence and the ability to control own emotions are expected in nurse leaders (Apore & Asamoah, 2019). In this case, it is paramount to focus and think clearly as to what caused the behavior of the medical assistant and not be disruptive not to damage the existing relationship. Overall, several leadership qualities are required to address the event effectively.
Conclusion
In summary, the behavior of the medical assistant in the case study can be viewed as both illegal and unethical, as they acted beyond the scope of their duties and forged the prescriber’s name in a legally binding document. Disciplinary action and strategies to increase the risk of illicit behavior are required, with new protocols for phone conversations with patients being established to prevent the repetition of the situation.
References
American Society of Health-System Pharmacists. (2022). Amoxicillin. Medline Plus. Web.
Apore, G. N., & Asamoah, E. S. (2019). Emotional intelligence, gender and transformational leadership among nurses in emerging economies. Leadership in Health Services, 32(4), 600–619. Web.
Clavelle, J. T., & Prado-Inzerillo, M. (2018). Inspire others through transformational leadership. American Nurse Today, 13(11), 39–41.
Med Assisting. (2022). What are the duties and responsibilities of a medical assistant? Med Assisting – Education for Medical Assistants. Web.
Moreto, W. D., Gau, J. M., & Brooke, E. J. (2019). Pill mills, occupational offending, and situational crime prevention: A framework for analyzing offender behavior and adaptation. Security Journal, 33(2), 161–178. Web.
Sousa, D., & Raimundo, P. (2020). Amoxicillin-induced aseptic meningitis. European Journal of Case Reports in Internal Medicine, 7(6), 1–2. Web.
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. Web.
