Discuss the ethical, financial, treatment, and additional issues that surround this case.

Helen, who is 92 years old, is admitted through the hospital emergency department (ED) following a fall from her bed in the assisted-living facility where she lives. This was the third time she came into the hospital with this complaint in the past 2 months. Although previous examinations and tests showed no fractures, the ED physician felt that because of her age and the bruises that are beginning to appear on her arms and face, she should be monitored and evaluated more closely. She has a supplementary private insurance and is covered under Medicare parts A and B with a supplement from a Medicaid Diversion Program in her state since she is living in an assisted-living facility and not in a skilled nursing facility. Helen seems a bit confused but reports that the paramedics who brought her to the hospital were nice and it was a “fun ride.” She is obese and requires major assistance to transfer to the ED stretcher, despite her residence in an assisted-living facility. She has one daughter who lives out of state and is caring for a spouse with a chronic illness. The daughter is available by phone but can only manage to visit her mother every 2 months and has been assured by the staff at the assisted-living facility that her mother is well and happy. Helen is taking an anti-hypertensive medication that controls her moderate hypertension and receives a narcotic analgesic for joint pain when she requests medication at the facility. When asked about her pain level, she states, “my knees and back are killing me.” After a complete physical examination, including several tests and administration of morphine sulfate, she is scheduled for return to the assisted living facility via ambulance. Total cost for this ED evaluation, including tests and transportation, is in excess of $10,000.

• Discuss the ethical, financial, treatment, and additional issues that surround this case.

• Relate the case to the principles of distributive justice.

• What are your concerns about the bruising?