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The legal system within the United States of America functions to solve disputes and therefore acts as a truth seeking mechanism (United States Courts, n.d.).  Courts, judges, and lawyers share the common goal of determining the true causation of events and they apply liability accordingly (Doyle, 2005).  In terms of medicine, most medical professionals are aware of the increasing interaction between the medical and legal communities, usually in the form of legal challenges against healthcare providers.  Therefore, it is paramount to understand how legal regulations apply to medical professionals, including nurses.  A review of the liability and ethics is presented with reference to the Julio Ortis scenario. 

Potential Liability in Dr. Standahl's Absence

Julio Ortis' liability is complicated by different factors.  Consider the fact that the state in question has not granted immunity for co-workers of an employee injured on the job.  This is of extreme importance because Julio, an occupational health nurse, was treating an occupational health patient.  Presumably, they are both from the same place of employment and are technically coworkers.  This means that it is possible for the court to hold Julio directly liable (Jackson, 2008).  Practically speaking, however, this would be an unusual course of action for the plaintiff because Julio probably does not hold a malpractice insurance policy; therefore, attorneys are more inclined to go after physicians, who are required to have malpractice insurance (Jackson, 2008).  That being said, a good defense for the attending physician, Dr. Standahl, is that this case should be treated under a workers compensation lawsuit, not a malpractice lawsuit (Jackson, 2008).  Overall, it is not possible to make a firm conclusion regarding Julio's liability based upon the information that has been provided.  The only conclusion that can be drawn is that Julio could face liability for the negligent treatment from two separate angles: the plaintiff and the defense.


Dr. Standahl's liability is also complicated by different factors.  The scenario clearly states that Julio's work is regulated by a number of written protocols and standing orders.  Unfortunately, the scenario does not provide any details on the protocols or orders.  Therefore, there are two potential outcomes.  First, if the written protocols or standing orders support Julio's treatment, which was negligent, then Dr. Standahl could be held liable (Jackson, 2008).  Looking at who authored the protocols and standing orders further complicates this outcome.  If the protocols and standing orders were authored by a committee or by the organization's administrators, then the liability also transfers to those parties in addition to Dr. Standahl, thus spreading the liability over multiple parties (Jackson, 2008).  On the other hand, if the written protocols or standing orders do not support Julio's treatment, then Dr. Standahl could argue for less liability.  In this circumstance, the liability that Dr. Standahl faces is complicated by several factors.  If the written protocols or standing orders specifically stated that Julio should seek additional guidance if a situation arises that is not covered by the protocols or orders, then Dr. Standahl could mount a stronger defense.  In addition, if the negligent action was within the scope of knowledge of a nurse, then that might further enhance Dr. Standahl's defense by emphasizing Julio's incompetence.  Clearly, there are a number of different factors that affect Dr. Standahl's liability even though he was not present.

Lastly, it is important to understand the state medical board's viewpoint on the issue of direct versus indirect supervision (Jackson, 2008).  Since the scenario allows Julio to provide care in Dr. Standahl's absence, it is only fair to assume that the state medical board allows indirect supervision via written protocols and orders.  Based on this logic, Dr. Standahl is definitely liable for the negligent treatment.  Previous court cases in the state in question could be referenced to support or dispute this claim.  Nonetheless, as discussed thoroughly above, the degree of liability and consequent damages could be applied in many different ways (Jackson, 2008).  In my opinion, Dr. Standahl's defense would likely attempt to share the liability across providers and also with the organization.  In the end, Dr. Standahl would face some degree of liability and damages even though he was not present.

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Potential Liability in Dr. Standahl's Presence

In this section, Dr. Standahl's liability will be discussed assuming that he was present in the clinic but preoccupied with the injuries of a second worker.  Dr. Standahl's presence establishes a clear and direct doctor-nurse supervisory relationship between Dr. Standahl and Julio.  Even though Dr. Standahl was with a different patient, the treatment that Julio provided was under the supervision of Dr. Standahl (Jackson, 2008).  This means that, again, Dr. Standahl will likely face some degree of liability and damages.  However, as we discussed above, Dr. Standahl's defense will most definitely pursue any possible way to disperse this liability across providers, including Julio, or even with the plant itself (Jackson, 2008).  In my opinion, these efforts will be less effective when Dr. Standahl is present.

Let us suppose that Julio's negligent treatment was provided to the patient without Dr. Standahl's approval.  This would mean that Julio provided treatment that was unauthorized.  Although it may seem that in such a situation Dr. Standahl would face less liability whether he was present or not present, that is not the case.  The plaintiff would argue that Dr. Standahl's responsibilities require that he know what is going on within the clinic at all times and that Dr. Standahl was negligent in his supervisory duties, thereby exposing Dr. Standahl to liability once again (Jackson, 2008).

Ethical Violations, Ethical Justifications, and Ethical Advice

Based upon the nurse's code of ethics published by Nursing World, there are two key ethical violations that Julio might have committed.  First, consider the ethical code of professional boundaries (Nursing World, 2001).  This code requires nurses to understand the professional relationship with healthcare providers (Nursing World, 2001).  If Julio provided unauthorized care to his patient, then this code was violated.  Second, consider the ethical code of acting on questionable practice (Nursing World, 2001).  This code requires a nurse to protect the patient and take action against questionable practices or incompetent providers (Nursing World, 2001).  If Julio's incompetence itself was the source of the negligent care, then he has inherently violated this principle by not introspectively guarding himself.

Again, based upon the nurse's code of ethics published by Nursing World, there are several ethical standards that Julio has upheld.  First, consider the ethical code of the nature of health problems (Nursing World, 2001).  This code implies the inherent worth of an individual despite his or her health status.  Although Julio provided negligent treatment, he most likely had the patient's best intentions in mind.  Second, consider the ethical code of the right to self-determination (Nursing World, 2001).  This code states that all people have the right to control what happens to their body (Nursing World, 2001).  Assuming that Julio obtained informed consent for the negligent treatment, this code of conduct is upheld.  Third, consider the ethical code of collaboration (Nursing World, 2001).  This code requires that healthcare providers work together towards a common goal or objective (Nursing World, 2001).  Assuming that Julio worked effectively with Dr. Standahl in providing care to the patient, although it was negligent, this code is nonetheless upheld.

Lastly, it is important for Julio to reflect on and learn from the situation.  This is an important part of the learning process in preventing future mistakes (Austin, 2007 p. 86).  Personally, the best advice for Julio is to remain professional and dignified throughout this situation regardless of the outcome.  Doing so says a lot about him and about the nursing profession.  Second, other advice might focus on the complicated nature of ethics.  Clearly, Julio has violated some codes and upheld others.  The world of ethics is far from black and white (Austin, 2007 p. 83).  Julio should think more carefully and be perceptive about ethics to hopefully avoid a similar negative outcome in the future (Austin, 2007 p. 88).

Overall, the process of assigning liability to Julio and Dr. Standahl is complicated and fraught with many uncertainties for different reasons.  First, the scenario is open-ended and does not provide specifics.  Second, the legal world and liability is a complicated process.  Generally speaking, liability is often shared across different providers and legal entities, such as businesses or organizations.  Third, the absence or presence of Dr. Standahl does not affect whether he is liable or not.  Instead, it only affects the degree of liability and potentially the amount of damages.  Fourth, ethics play a vital role in the scenario.  Julio definitely violated some codes of conduct while simultaneously upholding other codes of conduct.  This is a good example of how complicated ethics are.

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