1. Describe the facts of the case? Secure a video of the case to be shown in the class.

Issue: Rectal Surgery Scandal References: http://onlinemindanao.com/news-updates/surgery-scandal.html http://www.philippinestoday.net/index.php?module=article&view=878 Date: May 7, 2008 Facts: The Office of the Ombudsman in the Visayas has recommended the filing of criminal and administrative charges against seven doctors, four nurses, two clinical instructors, and a nursing aide who were implicated in the operating room scandal at the government-run Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City. The medical personnel were caught on video laughing while conducting surgery of a 39-year-old gay florist to extract a perfume canister from his rectum last Jan.3. The video recording was made without the consent of the patient and was uploaded on YouTube. The Ombudsman identified the accused as Doctors Phillip Leo Arias, Marlowe Parreno, Angelo Linawagan, Alfred Joseph De Leon, Joanne Mae Merilles, Serapio Salazar and Max Joseph Montecillo, registered nurses Isabelita Remulta, Carmenia Sapio, Consuelo Tecling and Ida Sumayang, clinical instructors Ramon Pandaan and a certain A. Opado from Southwestern University, and nursing aide Rosemarie Villareal. The 39-year-old patient filed a complaint seeking the revocation of the licenses of those responsible and a civil suit for damages. In its recommendation, the Ombudsman-Visayas ruled that the medical staff committed misconduct for unlawful behavior and gross negligence as public officers. Findings and recommendations: Three doctors and a nurse will face administrative case for possible violation of conduct and ethical standards; A doctor and three nurse supervisors were sternly warned to be more cautious in the performance of their duties as supervisors; A clinical instructor alluded to by the staff who misbehaved has been banned from the hospital; The student allegedly responsible for uploading the video to video-sharing site YouTube should be endorsed to his or her school for disciplinary action; and SOPs of the operating room should be reviewed, revised and updated.

~~ 2. What ethical principles involved in the case?

a. Is there a violation of the ethical principle? Why? Yes, there were violations of numerous ethical principles. The act of taking a video, making jokes and jeering during the procedure are considered as malpractice or fails to follow generally accepted professional standards which cause humiliation or discrimination on the part of the patient. The following are ethical principles that were violated: First is Confidentiality. Nurses are privy to the most personal information about their patients, information that may also be embarrassing to the person if anyone else knew. Primarily, one of the roles of the nurse is to maintain confidentiality regarding the patients case. But what happened to the case of this 39 year old male, is confidentiality preserved? Evidently, no because of the health care providers acted contrary to the Hippocratic Oath : whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one. Instead of showing sympathy to the patient, the health care providers were the one who initiate the act of making fun of the procedure. Secondly, the principle of Bene?cence. This principle says that an individual must do only good and contribute to the welfare of others. With this case, exposing the body of the patient on an internet site without consent is not good. This act violates the principle of beneficence. It is not ethically good that the health care team which promotes health would make fun of the procedure being done to the patient through recording a video. Third is Nonmale?cence This principle refers to the moral obligation not to cause harm to patients. Surgery, with its necessary incision, could be seen to defy this principle. Indeed, all attempts to bene?t patients, whether through words, drugs, or procedures, carry risks of harm. It is in conjunction with the principle of beneficence and the act of the health care team causes humiliation and discrimination to the patient.

b. Do you think there is an intention to humiliate or discriminate the patient? What ethical standard is violated when there is humiliation and discrimination? We believe there was an intention to humiliate or discriminate the patient. Even non-professionals could say that the act of laughing, jeering and making the patient as the laughingstock was a sign of humiliation, discrimination and ridicule. Another factor to consider in the aspect of humiliation was the patients sexual orientation. Okay, it is safe and more factual to say, the patient is gay. In this slightly homophobic country, due to its Christian inclination and some peoples narrowmindedness, gays are placed on the inferior position because of their socially unacceptable activities. The patients bill of rights states that, The patient has the right to considerate and respectful care. In this case, it was really being violated as for the secrecy of a

human being was being unrespected by some of the medical personnels of that institution whom are being liable of the act that they have done. Article III, Section 10 of Board of Nursings Board Resolution No. 220 Series of 2004 states that, Registered Nurses are aware that their actions have professional, ethical, moral and legal dimensions. They strive to perform their work in the best interest of all concerned. This law was even violated, the nurses themselves should be aware of their responsibilities most especially when it comes to ethical conduct. Section 11 provides the guidelines that registered nurses must perform their duties in conformity with existing laws, rules and regulations, measures and generally accepted principles of moral conduct and proper decorum. This code was being violated that brought up humiliation and discrimination of the patients life and dignity in this rectal surgery scandal, as he was being laugh with by those medical personnels who conducted the procedure to remove a perfume canister from his rectum and it was being publicized by means of Youtube. c. Do the health practitioners violate the code of ethics or code of good governance? What particular provision? Why? In this Rectal Surgery Scandal, Yes the health practitioners really violated the code of ethics particularly the code of ethics Article III Section 8, Registered nurses are advocates of the patients: they shall take the appropriate steps to safeguard their rights and privileges and to respect Patients Bill of Rights. The code states that nurses should be patients advocate but in this incident it turns out that patients rights of privacy and confidentiality was being disrespected. It only reveals the misdemeanor of the nurses involved and other health care personnels liable for this case. Article 3 Section 10-11. It says: registered nurses are aware that their actions have professional, ethical, moral, and legal dimensions. They strive to perform their work in the best interest of all concerned sec. 10. perform their professional duties in conformity with the existing laws, rules, regulations, measures, and generally accepted principles of moral conduct and proper decorum sec.11a. As nurses, we are guided with code of ethics to become good professionals in our society. If this code of ethics were not followed accordingly, we become unethical. This code of ethics was being formulated to serve as a basis for the practice of our profession, we should always be aware of what we do in respect to human life and basically to the welfare our patients because we are health advocators and it is our primary responsibility to promote lifes secrecy.

3. Interview 10 OR nurses from different hospitals who has at least 3 years of experience. a. Is cheering and laughing among personnel a common situation in the OR? Why does it mean when there is cheering and laughing? Nurse1 (GSDH): Yes, it only shows we are enjoying our work.

Nurse2 (GSDH): Sometimes these things happen in the Operating Room. It means there is something to cheer about amongst the staff. Nurse3 (GSDH): If there were patients, cheering and laughing are refrain. Cheering and laughing only happen if personnel are not busy and it means they are happy at work but personnel know there limits. Personnel know when and where to laugh, this is to avoid quiet environment for patients and to provide privacy for them. Nurse4 (SCH): No. when there is cheering and laughing, it means that there is something funny happening. Nurse5 (SCH): Cheering No, but laughing can be, because sometimes doctors crack a joke while in the OR. When nurses/ personnel yell it is not common in the OR, it only reflects that there is unusual happening in the OR. Nurse6 (MMC): Cheering no; laughing yes; it means everybody is happy of the doctor/s crack/s some jokes. Nurse7 (MMC): Yes; simply because it means that the team is in relax state prior or after a critical phase. Nurse8 (GSCH): The OR policy of GSCH states that loud voice and improper decorum is strictly prohibited, in any situation. As professionals, cheering and laughing are only expressed outside the clinical area. Nurse9 (GSCH): It is not a common situation for personnel in the OR to cheer and laugh during a procedure. Laughing and cheering is only allowed when you are outside the OR room. Nurse10 (GSCH): Cheering and laughing is common. It only shows that while working, we enjoyed our work. b. What is the proper decorum of health personnel in the operating room? Nurse1 (GSDH): Respecting the patients dignity. Nurse2 (GSDH): A health personnel behaves as a professional. Do his/her job well. Socialize with others. Nurse3 (GSDH): Proper decorum includes; working with respect to each other, knows there limit, provides privacy especially to patients fooling and playing around is strictly not allowed; no shouting, voices are modulated and minimized. Nurse4 (SCH): The health personnel should maintain an environment that is respectful to the patients privacy beliefs and confidentiality. Nurse5 (SCH): The health personnel must maintain privacy and confidentiality. The health care team should follow the norms of a good professional. The nurses must

avoid laughing, shouting, and cheering in the OR if there is ongoing operation. The health personnel should follow the code of ethics. Nurse6 (MMC): A health care personnel should maintain professionalism in all kinds of situation. Nurse7 (MMC): Proper decorum dictates all personnel inside the OR should maintain a professional behavior. Nurse8 (GSCH): As GSCH OR personnel, I believe that proper decorum is having a pleasant conversation with exposing others privacy whether our clients or our coworkers and adhering to its hospital rules and regulations and the nursing code of ethics. Nurse9 (GSCH): As a health personnel in OR, secure patients safety and patients privacy and confidentiality especially in his/her information and case. Nurse10 (GSCH): Maintain sterility for safety of patient and maintain privacy and confidentiality of information of the patient.

c. What do you think are present practices that can violate patient privacy and confidentiality according you your experience? Nurse1 (GSDH): I think gossiping among co-workers. Nurse2 (GSDH): Probably talking about the patient outside of the hospital or giving information or talking about the patients situation; or what happened in the hospital. Nurse3 (GSDH): I cant say it as a practice but then sometimes personnel tend to forget that there are patients so voices are not that minimized, as to privacy I couldnt think of any because as much as possible female staffs are assigned to OB cases and if there are situations that patients request for staff to assist them we ask for other staffs help. Nurse4 (SCH): In my 3 years of practice as Or nurse, I have not experienced any practices that can violate privacy and confidentiality. I do not think doctors and the hospital itself tolerate such things. Nurse5 (SCH): I never experienced violating the privacy and confidentiality of the patient since we follow the protocol of our institution and I think the institution will not allow it to happen, it may affect the integrity of the hospital. Nurse6 (MMC): Presence of non-hospital OR staffs (e.g. Nursing students, Midwifery students, etc.) that brings camera/cellphone with camera inside the OR. Nurse7 (MMC): The presence of affiliating institutions rotating inside the OR in some training hospitals.

Nurse8 (GSCH): As a senior OR nurse of GSCH, we adhere to the practice of quality care such as following the patients rights and responsibility. I am strict to implement in our department the nursing code of ethics and proper sanctions to those who violates the practices. Nurse9 (GSCH): I dont have any practices that violate patients privacy and confidentiality according to my experience. I see to it that patients privacy and confidentiality are well secured especially on his medical conditions. Nurse10 (GSCH): According to my experience, there is no practice that violates the privacy and confidentiality of the patient.

d. What are specific strategies that you can suggest in order to protect patients privacy and confidentiality (can be improvement in policy or improvement in nurses attitudes)? Nurse1 (GSDH): All information about the patient must be kept within the OR (Operating Room) complex and gossiping between co-workers must be lessened. Nurse2 (GSDH): I cant think of any. Maybe its in the attitude not to talk about things which regards to patient. Nurse3 (GSDH): There should be a clear policy about proper decorum and it should be emphasized and reiterated so that everyone will be aware and refresh attitudes of personnel at work should be appropriate if there are those who acts inappropriately. Nurse4 (SCH): Avoid talking about patients history, illness and personal matter in the operating rooms is one way of protecting patient privacy and confidentiality. As an operating room nurse, I believe that there are things that should not talk about inside the OR, even if the patient was sedated or not. Nurse5 (SCH): Cell phone inside the OR is prohibited while there is ongoing operation. Avoid unnecessary talking about patients condition. Nurse6 (MMC): Strict compliance to hospital policy (e.g. no electronic gadgets allowed inside the OR) Nurse7 (MMC): Strict implementation of hospital guidelines, observance of proper etiquette, strict implementation of boundaries and limits of all affiliating individuals. Nurse8 (GSCH): Proper gowning. Draping of patients body parts, incidental reports, oral/verbal reprimand to those personnel who violates code of ethics, suspension of personnel caught spreading hearsay to other people. Nurse9 (GSCH): Dont tell to just anybody about the patients information especially patients case or medical condition.

Nurse10 (GSCH): Strict implementation of sanctions to those who violates the rules and regulations according to the hospitals policy and according to nursing code of ethics.