04 Jul Ass4

Conduct a case study analysis.  Unapproved Treatments:Honey on the WoundDale BuchbinderDr. Keene was making rounds at Old Town Nursing Home (OTNH). The Director of Nursing asked Dr. Keene to see Mr. Leroy, a new patient. Members of the nursing staff were concerned and quite agitated over an unusual family demand. She needed his expert opinion.Mr. Leroy, an 80-year-old white male, had several strokes and was not able to make decisions for himself. He arrived at OTNH with a large open wound on his left foot. After Mr. Leroy’s arrival, the patient’s son insisted that the nursing staff should place sterile honey and maggots on the wound. Mr. Leroy’s son, a veterinarian, felt this was a good treatment for cleaning up his father’s extremely necrotic and odorous wound. The nursing staff questioned this mode of treatment and also expressed concern that nothing had been done for the patient while he was at home. In fact, the wound had not been attended to at all. Why was the veterinarian just now insisting on this unapproved therapy?Dr. Keene called Mr. Leroy’s son and the two of them had an extensive discussion about the pros and cons of using honey and maggots on a human wound in a nursing home facility. Dr. Keene informed the son that since this was not an approved treatment, the nursing home could not administer it. Furthermore, Mr. Leroy needed a circulation check to assess whether he had adequate circulation to heal his wound, as well as a thorough medical evaluation for comorbidities, i.e., underlying medical conditions, which needed to be addressed.Unsatisfied with Dr. Keene’s responses, the patient’s son called the Nursing Home Administrator. The veterinarian again insisted the nursing staff should administer the honey and maggot treatment. After a lengthy discussion with the Nursing Home Administrator, Dr. Keene refused to allow the unapproved treatment. That day, Mr. Leroy’s son signed the patient out of the nursing home without allowing any circulatory or medical assessments. He told the staff he was taking his father home so he could perform the honey and maggot treatment.Discussion Questions1.    What are the facts in this situation?2.    Autonomy, nonmaleficence, beneficence, and justice are the cornerstones of ethical decision making. Are there ethical issues involved in using unapproved treatments for standard conditions? What ethical dilemmas does this case illustrate?3.    Have any principles of ethical decision making been violated in this case? What ones have been supported? Provide rationales for your responses.4.    Based on what you know from this short case, why do you think Mr. Leroy’s son is so insistent on using this treatment approach?5.    Were there alternatives that Dr. Keene or the nursing home should have attempted? Is this a case of elder abuse and neglect? Should the nursing home have called Adult Protective Services? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.ADDITIONAL RESOURCESAdult Protective Services in your stateBorkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA: Jones and Bartlett.Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.Läuchli, S., & Hafner, J. (2012). 13th symposium on modern wound therapy. EWMA Journal, 12(1), 68–69.Lighter, D. E. (2011). Advanced performance improvement in health care: Principles and methods. Sudbury, MA: Jones and Bartlett.Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.Mosqueda, L., Burnight, K., Liao, S., & Kemp, B. (2004). Advancing the field of elder mistreatment: A new model for integration of social and medical services. The Gerontologist, 44(5), 703–708.National Center on Elder Abuse. http://www.ncea.aoa.gov/Niles-Yokum, K., & Wagner, D. (2011). The aging networks: A guide to programs and services (7th ed.). New York, NY: Springer.Renner, R., Treudler, R., & Simon, J. (2008). Maggots do not survive in pyoderma gangrenosum. Dermatology (Basel, Switzerland), 217(3), 241–243.U.S. Food and Drug Administration (FDA). (2010, April 23). How drugs are developed and approved. Retrieved from http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/default.htmU.S. Food and Drug Administration (FDA), Inspections, Compliance, Enforcement, and Criminal Investigations. (2011, November 9). Warning letter to Monarch Labs regarding medical maggots. Retrieved from http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2010/ucm246466.htm?utm_campaign=Google2&utm_source=fdaSearch&utm_medium=website&utm_term=wound%20therapy%20and%20maggots&utm_content=5Wollina, U., Karte, K., Herold, C., & Looks, A. (2000). Biosurgery in wound healing: The renaissance of maggot therapy. Journal of the European Academy of Dermatology and Venereology, 14, 285–289.