Hospital Has This Dilemma That,

¶ … hospital has this dilemma that, on the one hand, the patient obviously needs help. On the other hand, helping him will bring the healthcare system into a situation where it feels that it will not be reimbursed for the care that it will provide the man for the remainder of his life.

Identified and explained risks of not providing care The risks involved in not providing care are the following: not providing the patient with care may almost certainly kill him, if not now, then, with secondary traumatic brain injury occurring several days or weeks after the event. If not treated instantly, hemorrhaging can occur, as well as lesions that may develop inside the brain tissue itself or outside the brain in one of the three maters surrounding it. Tissues may be cut or torn as well as bruising of brain tissue.

Diffuse injuries that may have happened to the man may consist of edema (swelling) and widespread damage to axons that are responsible for transmitting messages that connect to cortex (Hardman & Manoukian, 2002). True it is that the hospital cannot correct the damage, all that they can do is prevent it from spreading and staunch it, but even this is very important given the emergency situation of the case. In fact, immediate care (within the so-called 'golden hour' following the accident) is crucial.

Although it is true that emergency care may not result in the instant death of the patient, - after all a large percentage of people who are killed by brain trauma do not die right away but rather days to weeks after the event -- instant hospitalization is, nonetheless, required because of the potentially fateful effects that would occur to the man were he not accorded emergency treatment.

The treatment that the healthcare system has the ability to provide may well prevent secondary injury from occurring which, at its worst, causes brain death because of the pressure from within the skull becoming too intense. Aside from brain death, other negative factors caused by secondary injury that emergency treatment may forestall are substances flooding into the brain such as the excessive release of neurotransmitter glutamate (excitotoxicity), influx of sodium and calcium into neurons, and dysfunction of the mitochondria all of which causes damage to the blood-brain barrier.

There may also be changes to the blood flow; axons may be severed from their roots; there may be insufficient blood flow (ischemia) and insufficient oxygen in the brain (cerebral hypoxia). Finally, the brain may experience swelling (cerebral edema) or a raised pressure within the skull (intracranial pressure). For all of these reasons, it is crucial that the man receive emergency care to prevent him, a few days later from being irreparably disabled, or, likely, possibly dead. On the other hand, this is an expensive situation.

A mild brain injury can run to as much as $85,000 in costs, whilst a severe brain injury requiring lifetime treatment can exceed $3 million for treatment, rehabilitation, and ongoing care (Holder, 2008). With the family unwilling to foot the man's bill, is the hospital care system required to be so generous, at the cost of its system that it should provide the service for gratis? There are the physicians involved, and the nurses and staff, as well as equipment, ventilator, procedures, laboratory tests, and radiographic studies.

These are just some of the expenses. Treating this man for free, more so, may open the door for more 'deserving cases', and then where does one draw the line. And a further ethical dilemma: if the care system agrees to treat the man for free, its debt may be so steep that it will be the paying customers who will, eventually, have to pay the price. Identified alternative courses of action and explained expected consequences.

The health care system could return the man to Mexico and to his family, but this would aggravate the man's station. In terms of traumatic brain injury, any lapse in treatment spells crucial damage to the patient's brain. Another option is that once danger to life is over, the patient could be moved to an ordinary hospital ward where his care would be less expensive and he could spend time recuperating.

This, nonetheless, would pose problems since, firstly, this too carries some element of expense, and, secondly, the patient should spend this time progressing to rehabilitation programs so that what he has left of his neuronal capacities should receive optimum attention. Receiving these rehabilitation services from the healthcare system would force the system to dole out millions on what could transpire to be ongoing care. Recommended one course of action, giving rationale. The health care system seems to feel that its responsibility to the patient is ongoing and throughout his life.

I do not see why this is the case. Hospitalization and emergency intervention is an obligation in order to save the man, but treatment for brain trauma, generally devolves along two levels: emergency intervention where the hospital's primary aim is to stabilize the patient and to prevent further injuries, since little if anything can be done to reverse existent damage, and follow-yup care where the patient would hopefully receive programs such as physical.