Ethical Challenges in Managed Care: A Casebook

By Karen Grandstrand Gervais; Reinhard Priester et al. | Go to book overview

8
Choice of Venue and
Provider Under Capitation

CASE STUDY

Enrollee Request to Change Primary Care Clinic

Six weeks ago, Chris Cataldo, a nineteen-year-old college student, was critically injured when a van running a red light broadsided the car she was riding in. The drivers of both vehicles were killed. Ms. Cataldo suffered severe head and neck injuries, including the fracture of two cervical vertebrae, and was taken by ambulance to Mercy Hospital, the closest trauma center.

The night of the accident Ms. Cataldo underwent six hours of emergency brain surgery and a shunt was placed to drain excess fluid in her skull. A large portion of her skull was removed, to be replaced as the swelling in her brain decreased. Four weeks after the accident, she was transferred to a skilled nursing facility that is adjacent to and a division of Mercy Hospital. Now, six weeks after the accident, she is awake but nonverbal and paralyzed on her right side but able to follow movement commands on her left side. Since she remains unable to swallow, she is fed through a jejunostomy tube. She receives intensive rehabilitation services, including physical therapy and speech therapy, twice daily for half-hour sessions. In the near future, she will need surgery to complete the cranioplasty.

Ms. Cataldo's family (parents and two younger sisters) lives twenty miles from Mercy Hospital. At least one family member visits her daily. Her mother reports that only in the past week has Ms. Cataldo been able to distinguish her family from her nurses and other caregivers. She notes that Ms. Cataldo is particularly responsive to and cooperative with her regular physical therapist and markedly less cooperative with the replacement staff on the therapist's days off. The family, too, has developed a rapport with Ms. Cataldo's caregivers, particularly the neurosurgi

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