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INTRODUCTION

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Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients.

Principle 2, APTA Code of Ethics

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CASE 2.1 A CEO's Generosity

Edward received early admission to his college of first choice on his birthday. As a double celebration, he and his brother Lyle took a skiing weekend. Around 4 p.m., Edward fell during the last ski run of the day and was seriously injured. He was airlifted to the local community hospital, where he was treated for a head injury. As soon as he was medically stable, although comatose, he was transferred to Westover Rehabilitation Hospital. There he began to regain consciousness. Within the first week of rehabilitation, he started to make progress, but his team of therapists predicted a prolonged rehabilitation process of up to a year. The HMO that carries his health insurance allows only 45 days of rehabilitation.

The CEO, George, was a physician and a rehabilitation specialist. He immediately began negotiations with the HMO to provide a longer stay, assuring their administrator that with intense and continuous rehabilitation Edward would probably return to a state similar to where he was prior to the accident. To discharge him at 45 days would severely limit his lifetime potential, although he would most likely be semi-independent in many daily living skills. The representatives of the HMO would not hear of it and stuck with the 45-day limit. The negotiations had taken nearly a month, and George realized that, in a matter of days, he had to make some decisions.

The family could not afford the extensive rehabilitation needed, without selling their modest home. George checked out all the nursing homes in the hospital's geographic area but could not find one offering the specialized therapy and team members needed to maximize Edward's recovery. There was a special fund at the hospital that could cover some of the expenses for an extended stay, but it was modest and did not come close to supporting the full time needed. The head of physical therapy and nursing believed they could rally support within the hospital to do fundraising, but it would be necessary to personalize the effort, and they were not sure the family would want their financial and medical histories on public display. Besides, in the past these efforts did not raise substantial money and served more to build community support for this very unusual private hospital with a commitment to the public good.

At this point George called a meeting of his advisors. Westover's administrative structure was nearly flat, with George having enormous power, thanks to a board of trustees’ confidence in him. He asked his risk management officer what kind of liability the hospital would incur if he discharged Edward at the end of 45 days, even though he had not reached his potential. The response was a confident “none.” At that point, without hesitation, George announced the hospital would pay the bill for ...

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