Sally Doe Case Summary

Case Review Introduction

Sally Doe is a 40-year-old Hispanic female diagnosed with a substance abuse disorder, Human Immunodeficiency Virus (HIV), diabetes and Post-Traumatic Stress Disorder (PTSD). Sally was diagnosed with HIV when she was 30 years old. She contracted the disease during a visit to India where she received blood transfusion due to a virus infection. Sally has a history of abusing opioids and alcohol receives Medication Assisted Treatment (MAT). Sally takes Zidovudine and Enfuvirtide which are anti-retroviral regimens (ARVs) to help suppress her HIV progression. Sally’s boyfriend of 20 years recently ended their relationship. Sally became upset, went to the bar and got drunk. While driving home that night she got into an

accident which resulted in a broken leg. Sally was treated at Tombstone University Hospital with opioids. The use of opioid during Sally’s recovery led to her relapse.
Ethical, Legal, and/or Professional Dilemma
Sally requested her Integrated Care Team which comprises of the Primary Care Provider (PCP), Counselor and MAT Therapist provide telemedicine services to her due to her inability to drive to the clinic. The Clinic does not have a true telemedicine video conferencing software, but the Integrated Care Team agreed to use the IMO video chat application on the Smart Television (TV) in the PCP’s office. Sally was excited about the telemedicine services and invited her new boyfriend to attend. The first telemedicine session was with the MAT Counselor. Sally’s new boyfriend expressed his disapproval that she was receiving MAT services. The next session was Sally’s Counselor, she discussed her anxiety and requested the Counselor email her immunologist last five (5) psychotherapy, MAT and HIV progress notes, which the Counselor completed without a written consent. The final session of the telemedicine appointment was with the PCP. The PCP discussed and prescribed Sally’s an HIV antiviral medication. Sally’s boyfriend became upset during the session because Sally did not disclose her HIV diagnosis to him prior to her appointment. He broke up with Sally immediately and she threaten to sue the clinic for releasing her health information without her written consent.
Ethical, Legal, and/or Professional Dilemma
The patient across the hall and the patient in the room next to the PCP’s office reported to the Clinic Administrator, Sally’s telemedicine sessions disrupted their appointment because they Smart TV was loud, and they overheard the conversations between Sally and the three providers.

The PCP also notified the Clinic Board and Administration about Sally’s threat to sue the clinic for releasing her information without prior consent. The Clinic Board and Administration conducted an internal investigation which reveal several ethical and legal standards were violated.
These violations include, (1). The Providers did not follow the State technical, clinical and administrative telemedicine guidelines (Association for Addiction Professionals, 2013). (2). Sally was not provided the necessary privacy because the walls of the PCP’s office was thin which resulted in other patients overhearing Sally’s sessions. (3). Sally did not sign a consent form for telemedicine and a release of information to her new boyfriend and immunologist. (4) The Clinic is not licensed to practice telemedicine.
Autonomy, Beneficence, Nonmaleficence, and

Justice
Autonomy. Although Sally has the right to request for telemedicine services, the Providers should have declined her request because the clinic does not have the license or appropriate software to provide telemedicine services.
Beneficence and Nonmaleficence. The PCP, Counselor and MAT Therapist’s goal was to help
Sally by approving and providing telemedicine services. They however caused harm to her
relationship and violated her privacy and confidentiality.
Justice. The telemedicine session disrupted the medical services of two other patients, as a result these two patients did not receive the same fair attention they required at their provider visit.
Integrated Care Dilemma
The Integrated Care Team did not adhere to Health Insurance Portability and Accountability Act of (HIPAA) and 42 Code of Federal Regulation (CFR) part 2 requirements by faxing Sally’s substance abuse, HIV and psychotherapy notes to her immunologist.
Differing Perspectives of the Integrated Care Team Members
Traditional approach to care for the Integrated Care Team is to accommodate the needs of the patient, adhere to HIPAA and 42 CFR part 2 and their individual respective professional code of ethics.

Health care providers adhere to different ethical principles depending on area of expertise (Botes, 2000). The MAT Therapist needed to comply with the Association for Addiction Professionals ethics, the Counselor should have adhered to the American Psychological Association ethical principles and the PCP needed to comply with the American Medical Association code of ethics. In a traditional setting these providers who have handled Sally’s request differently. The PCP and MAT would have bridged Sally’s medication while the counselor would resume counseling when Sally retuned to the clinic. The Integrated Care Team did not adhere to HIPAA laws and 42 CFR part 2 standards regarding information sharing, privacy and

confidentiality.
Optimum Team-Based and Shared-Decision Making.
The PCP, MAT therapist and Counselor collectively made the decision to provide to provide telemedicine services to Sally without following the appropriate protocols. They collectively
took responsibility for violating the telemedicine technical, clinical, and administrative
guidelines of their State and the Standard ethical protocols of their individual professional ethics.