Running head: NU 502 ADV PRACTICING NURSING ETHICS: INTERVIEW
Stephanee Evers MD
Stephanie M. Kimbrel, BSN
Washburn University
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NU 502 ADV PRACTICING NURSING ETHICS: INTERVIEW
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Stephanee Evers MD
Stephanee Evers practices Emergency Medicine in Olathe, Kansas at Olathe Medical
Center (OMC). She has been at OMC in the emergency department for the past ten years. She is
the only female physician out of the fourteen physicians in her group. She is a University of
Missouri-Kansas City (UMKC) Kangaroo graduate. She went through the six year program at
UMKC that includes your undergraduate degree. She did her residency at Indiana University
Hospital for three years. She did participate in urban search and rescue and disaster medicine
through FEMA, where she assisted in 9/11 search and recovery. She was trained to do confine
space rescue, weather disasters, and chemical war. She was raised as Lutheran here in Kansas.
She now is currently married with two young children.
She discussed multiple ethical responsibilities that she has as an emergency department
physician. She discussed end of life, minor consent, drug and alcohol abuse, treating pain with
narcotic pain medication, various treatments such as the morning after pill, her issues with
HIPPA, and psyche patients. She states, “I think how I make decisions would vary from other
physicians in my group, this is because we are all individuals with different experiences,
backgrounds and beliefs. For example I would give the morning after pill where as Dr. Gould a
devote catholic probably would not.” She states that HIPPA can actually hinder care versus
always protecting them. Her example for this is a patient who has a dependency problem, if they
invoke HIPPA, this is very frustrating for her that she cannot contact family members or friends
that could help support the patient in getting the appropriate treatment. She has a very hard time
with letting a drunken patient or a patient who has received narcotic pain medicine leave against
medical advice. “What happens if this patient walks out and drives home and kills a family of
four.” To solve her dilemma, she discussed with the legal department at OMC, they verified for
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her that it is not a HIPPA violation to call the police if a patient is under the influence and drives
away.
When making a decision she always puts the patient first over anyone and everyone else
including family. She takes all information about the situation, what has brought this patient
here, their current life and environment. What are the expressed wishes of the patient, prior
events, illnesses, surgeries, and there outcomes. What are the potential outcomes for this current
situation with the various possible interventions? She believes that any physician should lay out
the facts and only give their opinions if requested.
A fourteen year old female patient is brought into the emergency department by her
mother after running away this weekend. Her mother states in triage that she wants to know if
her daughter had sex this weekend. The patient denies any complaints, states “I didn’t do
anything!!” Patient is alert and orientated to person, place, situation, and time. Heart rate of 85,
strong and regular; blood pressure of 115/65, respirations 16, unlabored; temperature is 98.5
orally. She is cooperative with you, angry and disrespectful with her mother. No known drug or
environmental allergies, she takes no prescription medication, has no previous chronic medical
illnesses, she had her tonsils removed at the age of 8 without difficulty. She denies pain other
than her mother. The patient is brought back to ER room 10 to be seen by the Dr. Evers. Pelvic
bed is placed in room.
The mother is requested to step out of room during evaluation by Dr. Evers, patient is
found to be in good physical health. She has never had a pelvic exam, denies being sexually
active. The patient reports that her mother and she got into a fight, so she left and went to a
friend’s house in Kansas City, KS without her mother’s knowledge. Her mother does not know
this family. Her friend’s mother convinced her to return home Sunday afternoon. Upon arriving
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back home, her mother is acting crazy, accusing her of doing things like drugs and having sex.
Patient is visibly agitated when discussing relationship with mother and situation. The patient
reports that she did not do drugs, drink alcohol, or have sex while being gone this weekend. She
states that she will not have a pelvic exam, “You will have to hold me down, tie me to the bed
before I will let you do that to me!!”
Dr. Evers steps out of the room and takes mother into the consult room to discuss
situation. Mother is adamant that she wants to know what she did this weekend. I want drug tests
and a pelvic exam so I will know if she had sex. I don’t believe she just sat over at some friend’s
house this weekend. “She will do it!!”
After gathering the relevant information regarding this situation, Dr. Evers finds herself
in an ethical dilemma: does a minor have the right to refuse if mother is demanding to have a
pelvic exam done? Do we force this fourteen year old to have a pelvic exam even if we have to
hold her down? What rights does a fourteen year old have in regards to their body? Is this
necessary? Is there indication that a pelvic exam should be done?
By law the mother has the right to dictate medical care of the fourteen year old. For Dr.
Evers though she feels the patient has a right to refuse. There is no indication medically that a
pelvic exam should be done, i.e. pelvic pain, vaginal bleeding. A pelvic exam is not a diagnostic
tool for whether or not sexual intercourse has occurred. She could identify trauma if it were
present or culture any fluid/discharge present, however she could not definitively state whether
intercourse occurred or not. She could possibly cause trauma physically and emotionally by
performing a vaginal pelvic exam. She feels that the best answer is to educate the mother about
this and encourage family counseling. She states that there is no medical reason to perform an
exam. Mother initially is very upset threatens to involve law enforcement to have it done. Dr.
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Evers gives her this option, states she is more than welcome to have law enforcement to come up
here. Mother eventually calms down. Patient is discharged to home with referral to Johnson
County Mental Health. The nurse reports patient to CFS as a child in need of care due to running
away and verbally abusive relationship with mother.
Dr. Evers believes that every case is unique and she must weigh all options for each
situation. In this case, she believed that even though the mother has the right to request and
dictate medical care of her minor child, the child’s rights were going to be violated and would
cause more damage.
NU 502 ADV PRACTICING NURSING ETHICS: INTERVIEW
References
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