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respond to four classmates below ( 2 separate classes so please read accordingly)

respond to classmate#1 in 455 words using scholarly and biblical references.( Masters level responses)

In the case of Sonja Fizer Hickson v. Commonwealth of Virginia, the Circuit Court of Bedford County, VA found Ms. Hickson guilty of involuntary manslaughter and felony child abuse of 13-month old Frances “Fran” Vermillion. Involuntary manslaughter is defined as accidentally killing a person, whether or not it was intentional, during the improper performance of a lawful act. In this case, the lawful act would be the supervision of a minor by Ms. Hickson. Felony child abuse is the charge for any abuse or assault of a child and can run concurrently with other charges. Ms. Hickson appealed on the grounds of insufficient evidence. The Court of Appeals of Virginia found that “the Commonwealth had proven beyond a reasonable doubt that the death of this child resulted accidentally, but as a result of criminal negligence” (Sonja Fizer Hickson v. Commonwealth of Virginia, 2002) and they upheld the verdict of the Circuit Court.

On February 12, 1998, Fran was dropped off at her daycare provider, Ms. Hickson’s house at around 8:00 am. She was in good health except for some congestion. At 8:05 am Ms. Hickson called Fran’s mother to report that Fran had fallen and now was not acting right. She then called 9-1-1 and told the dispatcher that Fran had fallen face-first from a chair. Fran was found unconscious with a small bump over her left ear by the paramedics and was taken to the hospital where she underwent emergency surgery to evacuate a subdural hematoma in her head. Despite the efforts of her medical team, Fran was determined to have an unsurvivable injury and was taken off life support and later died.

In the days that followed, Ms. Hickson was interviewed by several different people. On February 13, 1998 she told Lt. Gardner of the Sheriff’s Department that Fran had fallen from a small chair in the kitchen. On March 19, 1998 she told Anne Shupe of Child Protective Services that Fran was a little fussy after arriving that morning. She gave her some cough syrup because she was sick, and later heard her fall while she was putting the medicine away and doing some dishes. Ms. Hickson said she picked Fran up and Fran went limp in her arms. And on February 17, 1999 Ms. Hickson told Special Agent McDowell of the VA State Police two different stories of what happened. She first told him that Fran had fallen from a small chair, then she changed the story and said that Fran had hit her head on the floor 4 different times. Once when she threw herself on the floor after the medicine, again when she threw herself backward with a diaper change, another time when Hickson did not have a good hold on her and dropped her on the floor on accident, and last when she carried her into the kitchen and Fran just fell on the floor for no reason. Remember that the time between when Fran arrived and when Ms. Hickson made the call to her mother and 9-1-1 was only about 10 minutes after her arrival.

During the trial, medical experts reported that Fran’s injuries were not consistent with any of the stories provided by Ms. Hickson. Doctors stated that her injuries were consistent with a fall from at least 10 feet or a serious application of force, that the multiples stories appeared to be a cover-up for guilt, and that Ms. Hickson intentionally inflicted injuries to Fran. The evidence was sufficient to convict her of both charges and the judgement was affirmed by the court.

I agree that the evidence strongly suggests that Ms. Hickson intentionally harmed Fran, and that her death was a result of those injuries. Studies have suggested that the magnitude of fatal child abuse is underestimated, meaning that the abuser is not being convicted or the death is not ruled a homicide (Riggs & Hobbs, 2011). Being a pediatric nurse on an infant/preschool unit, I have seen cases very similar to this one. I have also seen the effect it has on the nurses in the form of secondary trauma. Studies have shown that staff who work with victims of abuse should have supervision, reflective practice, and emotional support available to them (Dean, 2017). Children have significance in God’s plan and in His Word. Jesus took the children in his arms, placed his hands on them, and blessed them with compassion. We can follow His example by showing a child that he has value and is loved by God. We should be showing children love, not hatred and violence.

Reference

Riggs, J. E., & Hobbs, G. R. (2011). Infant homicide and accidental death in the United States, 1940-2005: Ethics and epidemiological classification. Journal of Medical Ethics, 37(7), 445-448. doi:10.1136/jme.2010.041053

Dean, E. (n.d.). Child abuse and neglect. Retrieved September 24, 2018, from https://journals.rcni.com/mental-health-practice/child-abuse-and-neglect-mhp.21.4.12.s9

Sonja Fizer Hickson v. Commonwealth of Virginia (Court of Appeals of Virginia April 23, 2002).

respond to classmate in 455 words using scholarly and biblical sources

In the court case, Hickson vs. Commonwealth, 2002 Va. App. Lexis 243, the defendant was convicted of involuntary manslaughter and felony child abuse. The defendant, Sonja Hickson, appealed the court’s decision and argued that there was not enough evidence for this conviction; however, the court denied the appeal.

Hickson was a daycare provider and the victim, Fran a 13-month-old child, was dropped off by her mother at Hickson’s house the morning of February 12, 1998. It was noted in the court documents that Fran had no health issues other than some congestion when the mother dropped her off at Hickson’s house at around 8am. At 8:05 am the mother received a phone call from Hickson stating that Fran was acting weird and that something was wrong. A 911 call was placed at 8:09 and Fran’s mother immediately returned to Hickson’s house where she found her daughter limp and unresponsive. The paramedics arrived at 8:23am and found Fran limp with a bump above the ear, but no other injuries were noted. Fran was transported to the hospital where she had surgery for a subdural hematoma with a poor prognosis. Fran was removed from life support shortly after and passed away.

“Traumatic brain injury (TBI) primarily refers to the brain dysfunction caused by external trauma” (Ahmed et al., 2017, p. 114). TBI normally happens when there is a significant hit to the head which results in brain damage (Ahmed et al., 2017). Hickson first argued that Fran fell off a child size chair and hit her head on the kitchen floor, which was vinyl. Expert witnesses testified that the brain injury that Fran sustained could not have been caused by a fall from a child size chair to a vinyl floor. Hickson later changed her statement and said that Fran fell four times banging her head each time resulting in the injury. She stated she first fell in the kitchen from the small child size chair, then later the child threw herself back on the floor during a diaper change, then claimed she picked Fran up and dropped her accidently, and then another time dropped Fran while carrying her to the kitchen. Fran’s treating physician stated that Fran’s injuries were consistent of blunt force trauma to the head and not consistent with what Hickson stated happened. The court did not have evidence that Hickson acted willingly but proved that the death of Fran resulted accidentally because of criminal negligence. Hickson was convicted of accidental involuntary manslaughter and sentenced to serve 5 years in prison.

I believe that the sentencing should have been more severe as Hickson’s statements on what happened to Fran changed in the middle of the trial which is evident that she was lying and trying cover up what really happened. Also, the short amount of time between Fran’s drop off at Hickson’s house to the time that Hickson called the mother of Fran’s injury is suspicious and concerning and doesn’t correlate to how Hickson said the injuries happened. Hickson was guilty of child abuse. “Child abuse, therefore, is when harm or threat of harm is made to a child by someone acting in the role of caretaker” (Kemoli & Mavindu, 2014, p. 256). I also believe that Hickson acted willingly and purposely, although there was not enough evidence to prove this. This is such a sad case and although Hickson did have to serve jail time, I don’t think she got the appropriate conviction she deserved.

References

Ahmed, S., Venigalla, H., Mekala, H. M., Dar, S., Hussan, M., & Ayub, S. (2017, March-April). Traumatic Brain Injury and Neuropsychiatric Complications. Indian Journal of Pychological Medicine, 39(2), 114-121. https://doi.org/https://dx.doi.org/10.4103%2F0253-…

Kemoli, A., & Mavindu, M. (2014, April-June). Child abuse: A classic case report with literature review. Contemporary Clinical Dentistry , 5(2), 256-259. https://doi.org/10.4103/0976-237X.132380

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respond to each classmate in 455 words using scholarly and biblical sources(Masters Level responses)

classmate #1

The U.S. health system faces challenges including inefficiencies, escalating costs and variations in health care quality, access and results. Health expenditures accounted for roughly 32 percent of the average state’s budget and State governments are often the largest health care purchaser. About 30 percent of health care spending is by State governments. Collaboration between State and Federal governments is paramount in reducing costs, reducing redundancy as well as implementation of policies (AHRQ).

Privacy and security are important for patients regarding how their health record is used, accessed, and disclosed. The mission of the Health Information Security and Privacy Collaboration (HISPC) is to address the privacy and security challenges that impede electronic health information exchanges. Thirty-four participating state and territorial teams assessed their laws, policies and practices with respect to health information privacy and security and developed implementation plans to address identified barriers (Public Health Data Standards Consortium).

Health Information Security and Privacy Collaboration (HISPC) was established in 2006 (Nelson & Staggers, 2018). The HISPC project was designed to examine privacy and security laws and business practices that affect the ability of every state and territory to exchange electronic health information within its borders and with other states. It had three phases called projects. “Each project was designed to develop common, replicable multistate solutions for reducing variation in and harmonizing privacy and security practices, policies and laws” (Nelson & Staggers, 2018, p. 443). That first phase concluded in May 2007 with a report that got the issues onto the table and recommended ways forward. In phase 2, which ran from June 2007 to January 2008, state groups began implementing their phase 1 recommendations through state-specific improvement projects. The focus shifted to regional collaboration in phase 3, and the project grew to include groups in 42 states and territories. State groups broke into seven regional collaborative groups, with each group focused on a different barrier or issue identified in the earlier phases (AHRQ).

The Agency for Healthcare Research and Quality (AHRQ) and the Office of the National Coordinator for Health Information Technology (ONC) launched the Privacy and Security Solutions for Interoperable Health Information Exchange project. One purpose of the project was to assess variation in organization-level business practices, policies, and state laws, to help policymakers identify common practices and reduce variation. The HISPC project found that health information is protected by a patchwork of practices, policies, and state laws that has evolved over time, state by state and organization by organization, without a comprehensive plan or approach. This has resulted in state privacy and security laws that are scattered throughout many chapters of code and that sometimes conflict with one another. Most of these laws were written for paper-based systems, and many have failed to anticipate electronic HIE.

A major collaboration in North Carolina is the Health Information Exchanges (HIE). The North Carolina Healthcare Information and Communications Alliance (NCHICA) was awarded the contract to represent North Carolina in April 2006. Their job in conjunction with stakeholders was to work collaboratively through a process of consensus to identify, assess, and develop plans to address variations in organizational-level business policies and state laws that affect privacy and security practices that may pose challenges to health information exchange (HIE). AHRQ additionally indicated that the purposes of the North Carolina HISPC project are to address variations in organizational-level business policies and state laws that affect privacy and security practices which, in turn, may pose challenges to interoperable HIE; to recommend solutions and implementation plans to reduce or eliminate these challenges; and to increase the level of expertise in and compliance with privacy protections within the health care community. They stated that the goals of North Carolina HISPC’s goals are to:

1. identify current health care practices and challenges regarding the release and exchange of health information, Privacy and Security Solutions for Interoperable Health Information Exchange

2. develop consensus-based solutions for interoperable electronic HIE that protect the privacy and security of health information, and

3. recommend high-level plans to implement recommended solutions.

In healthcare, multiple disciplines need to work more effectively as a team to help improve patient outcomes. Collaborating in patient care and overall healthcare delivery is very important. There is a significant amount of research to show that patient outcomes, quality of care and cost of care delivery are all optimized when disciplines work together toward a shared goal that focuses on the patient. With clinical care becoming more complex and specialized, medical staffs must be flexible and be willing to work in complicated health services and quickly learn new methods. Aging populations, the increase of chronic diseases like diabetes, cancer, and heart disease have forced medical staffs to take a multidisciplinary approach to health care (Thomas, 2011). Informatics tools and applications have enhanced many aspects of healthcare delivery. Kuziemsky & Reeves (2012) described how informatics applications can provide patient, service delivery and administrative benefits in hospital and community settings. These benefits included improved administrative decision-making about resource scheduling, the ability to provide patient-centered care and the linkage of patient records over time to support continuity of care.

A Bible verse that comes to mind is about teamwork and collaboration. “Two are better than one, because they have a good reward for their toil. For if they fall, one will lift his fellow. But woe to him who is alone when he falls and has not another to lift him up! Again, if two lie together, they keep warm, but how can one keep warm alone? And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken.” ~ Ecclesiastes 4:9-12

References

Agency for Healthcare Research and Quality. (n.d.). Privacy and Security Solutions for Interoperable Health Information, Exchange Assessment of Variation and Analysis of Solutions. Retrieved September 23, 2018, from https://healthit.ahrq.gov/sites/default/files/docs…

Agency for Healthcare Research and Quality. (n.d.). North Carolina Team Description. Retrieved September 23, 2018, from https://healthit.ahrq.gov/ahrq-funded-projects/pas…

Institute of Medicine of the National Academies, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America” (Washington, D.C., 2012), https://iom.nationalacademies.org/~/media/ Files/Report%20Files/2012/Best‑Care/ BestCareReportBrief.pdf.

Public Health Data Standards Consortium. (n.d.). Health Information Security and Privacy Collaboration (HISPC). Retrieved September 16, 2018, from http://www.phdsc.org/privacy_security/hispc.asphtt…

Reeves, S., & Kuziemsky, C. (2012, October). The intersection of informatics and interprofessional collaboration. Retrieved September 23, 2018, from https://www.researchgate.net/profile/Scott_Reeves/…

Thomas, E. J. (2011). Improving teamwork in healthcare: Current approaches and the path forward. BMJ Quality & Safety, 20(8), 647-650. http://dx.doi.org/10.1136/bmjqs-2011-000117

respond to classmate #2


It is imperative and a fundamental right for the privacy and confidentiality to be protected. The Virginia Department of Health suggest that “Confidential information includes Protected Health Information (PHI) and Personal Information (PI) regarding employees, clients/patients, and the public as well as other forms of confidential information related to proprietary and/or business information” (2015). Nelson and Staggers (2018) additionally state that this is a duty of health care personnel and this information should be kept at the strictest secret. “The importance of protecting and safeguarding protected health information (PHI) has grown exponentially as health-related device use has expanded for mobile devices, electronic health records (EHRs), sensors, biomedical devices, telehealth, personal health records, personal health devices, and health information exchanges (HIEs)” (Nelson & Staggers, 2018, p 436).

Personnel are obligated to be extremely cautious with patient information to ensure their confidentiality. Confidential information is generally encountered with giving direct patient care, directing public health surveys, handling human resources records, and accessing governmental classified data (“Confidentiality,” 2015). According to the Virginia Department of Health, there are significant elements of the confidentiality policy that they discussion. Some of these include restricted collection of confidential material, regulate the use and admission to confidential information, restrain disclosure of confidential information, data integrity and destruction, and security.

Nelson and Staggers (2018) suggests that The Health Information Security and Privacy Collaboration (HISPC) was recognized in 2006. In 2008, HISPC reported the privacy and security encounters offered by electronic health information exchange through multistate partnership. 42 states and territories were included in this and this was considered to be the third and concluding phase. Phase 3 projects included the following:

  • Studying intrastate and interstate consent policies
  • Developing tools to help harmonize state privacy laws
  • Developing tools and strategies to educate and engage consumers
  • Developing a toolkit to educate healthcare providers
  • Recommending basic security policy requirements
  • Developing interorganizational agreements (Nelson & Staggers, 2018, p. 443).

All of these are very important in ensuring privacy. These decrease disparity and synchronize privacy and security between the 42 states (Nelson & Staggers, 2018).

“In late 2013, three key health IT issues came to light in the Commonwealth of Virginia resulting in a synergistic partnership between public and private health care entities that now uses ConnectVirginia, Virginia’s Statewide Health Information Exchange (HIE), for public health reporting” (Abbey, Condrey, Lynch, & McCleaf, 2014, para 1). Nowadays, ConnectVirginia backs the Virginia Department of Health (VDH) in meeting the purpose or goal to “promote and protect the health of all Virginians” (Abbey et al., 2014). This is done by offering a free portal run by the state health information exchange known as The Public Health Reporting Pathway; this enables the electronic statement of certain health-associated information (Abbey et al., 2014).

Safeguarding patient privacy and confidentiality is providing them protection. This is a right of each and every patient. This should be a top priority for every person in the health care field. As health care professionals we need to be diligent in making sure this is done. Proverbs 2:11 states, “Discretion will protect you, and understanding will guard you.” Furthermore, Proverbs 4:6 states, “Do not forsake wisdom, and she will protect you; love her, and she will watch over you.” Both of these Bible verses discuss protection and that is what need to be provided for each patient within our care.

References

Abbey, R., Condrey, D., Lynch, K., McCleaf, S. (2014). Virginia Department of Health and

ConnectVirginia Build a Pathway to Meet Public Health Measures. Retrieved from

https://www.healthit.gov/buzz-blog/health-information-exchange-2/virginia-health

connectvirginia-pathway-meet-public-health-measures/

“Confidentiality” (2015). Virginia Department of Health. Retrieved from

http://www.vdh.virginia.gov/qihr/documents/2015/pd…

Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2nd ed.).

St. Louis: MO. Elsevier.

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