CHAPTER 12: ETHICAL AND SOCIAL ISSUES IN INFORMATION SYSTEMS

•       What concepts in the chapter are illustrated in this case? What ethical issues are raised by radiation technology?

There are three basic concepts that can be applied in ethics in an information society that is responsibility, accountability, and liability. The concept that illustrated in this case is accountability. Accountability can be defined as the responsibility to someone or for some activity. In this case hospital need to find the mechanism to identify the responsible parties for the radiation therapy kills. The research of New York City hospitals found that the key of this problem cause by the combination of the malfunctions and user error that cause the patient were exposed to excessive dosages of radiation in his body.

One of the ethical issues that raised by radiation technology is machine malfunction. Machine malfunction happens when technician was coding certain code of treating their patient; the machine was doing the other things. Moreover, human error is one of the ethical issues that rose by radiation technology. The technician had failed to notice error massage on the machine screen indicate that there is an error regards on the radiation therapy treatment.

Moreover, human error also is one of the ethical issues. This is because when technician wrongly setting the machine, it will affect the patients health. For example, as a result of the careless of the technician, Mr. Jerome-Parks receives an overdose radiation that make him experiences deafness and near-blindness, ulcers in his mouth and throat, persistent nausea, and severe pain. This will make the patient suffer because of the carelessness of the staff who in charge the machine.

Besides that, eethical issues that are raised by radiation technology is when scientist is finding ways to use radiation therapy to destroy cancerous cells while making sure that healthy cells are not being harmed. An incident occurred where Mr. Jerome-Parks “experienced deafness and near-blindness, ulcers in his mouth and throat, persistent nausea, and severe pain.” 

Organizations did not take the time to properly train doctors and medical technicians therefore incidents like Jerome-Parks happens. The machines that are used to ‘cure’ patients are not being appropriately updated and watch carefully. In this case study we can see that the technicians are not being fully responsible and being careless, and doctors that are not getting the full training for operating the machine. His concepts of ethics are illustrated in this chapter. Ethics is a concern of humans who have freedom of choice.

In this case we see that the carelessness or laziness of the medical technician, the lack of training in the handling of the equipment (software), also of the maintenance of the updates of the software can cause the life a person. These errors cause by humans or machines can be prevented: if software had some type of safeguards that control the amount of radiation that they can deliver, if the technician or machine operators were more aware of the message errors, that appear on the screen, and if the hospitals had given the proper training to their staff. Technicians, hospital and the software manufacturer all need to collaborated with each other to create a common set of safety procedures, software features in order to prevent this to happen, all of them are responsible. Each of them had the capacity to prevent this type of things to happen and they all decide to blame each other for their own mistakes.

The use of a central reporting agency could reduce the numbers of radiation therapy errors in the future because this enables the state to identify trends and exposures that may create safety concerns. If I were to design electronic software for a linear acceleration, I will certainly put some type of safeguards that control the amount of radiation that they can deliver, by this way trying to prevent the overdose of radiation.

•           What people, organization, and technology factors were responsible for the problems           detailed in this case? Explain the role of each.

People factors responsible for the problems detailed in this case are they lack of training of the staff. They failed to provide extensive training for doctors, technicians, and machine operations as well as insufficient staffs. The hospitals rarely able to adjust their staffing to handle those workloads or increase the amount of training technician receive before using newer machines. Medical technicians incorrectly assume that the new systems and software are going to work correctly, but in reality they have not have not been tested over long periods of time. They should have thought of creating a mandatory checklist for employees each time the machine was being used.

Next are organization factors. The organization doesn’t have the implementation an internal incident reporting system. The complicating issue is the fact that total number of radiation-related accidents each year is essentially unknown. There is no national medical patient medical record system, and doctor does not know how much radiation their patient has received in the past. No single agency exists to collect data across the country on these accidents, and many states don't even require that accident be reported.

The lack of knowledge on the machines, the lack of reporting these incidents for future references instead the doctors and technicians do not troubleshoot the problem unless it is serious and by that time the patient(s) is already injured.

Last but not least, technology is a factor that responsible for the problems detailed in this case. Technology factors are another responsible for the problems detailed in this case that is software glitches. The machines were not well designed, there was software glitch and “the complexity of new Linear accelerator technology has not been accompanied by with appropriate updates in software”.

•     Do you feel that any of the groups involved with this issue (hospital administrators, technicians, medical equipment, and software manufacturers) should accept the majority of the blame for these incidents?

I feel only the groups that involved with this issue there are machinery, hospital administration, technicians, government agencies should accept majority of the blame for these incidents. First errors caused by machinery complexity. When these highly complex machines used to treat cancers go awry, it results in suffering worse than the ailments radiation aims to cure.

Second is a hospital administration error. Medical machinery and software manufacturers claims that hospital that provide with radiation treatment should be responsible for training their staff to correctly operate radiological equipment.

Third is a technician. Technicians claim that they are understaffed and overworked and that there are no procedures in place that would check accuracy of their work.

Next is medical equipment. Hospitals on the other hand, claim that manufacturers should be doing better job providing radiation equipment with fail-safe mechanisms.

Last is a government agency. State government as a regulator and controller of groups involved in radiation therapy and the one who is majorly responsible for medical errors associated with radiological mistreatment. Industry Response: ASRT (American Society of Radiologic Technologists) members believe solution lies in the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE S. 3737) bill before the          House. FDA (Food and Drug Administration) sent a letter in 2010 to manufacturers recommending they attend Public Workshops concerning these matters.
Timothy E. Guertin, Varian’s president and chief executive, said in an interview that after the accident, the company warned users to be especially careful when using their equipment, and then distributed new software, with a fail-safe provision.

•        How would a central reporting agency that gathered data on radiation-related accidents help reduce the number of radiation therapy errors in the future?

In the study case as we known the U.S. does not have a Central Reporting and Regulatory agency to report radiation technology errors. But, with using Utilize raw data like reporting techniques and consultation services they can make report radiation technology errors. Using the reporting techniques the hospitals can record the data about total number of radiation-related accident each year, national medical patient and the doctor know how much radiation their patients have received in the past. For consultation service the hospitals can get data about their patients and errors machines, from the National Radiology Data Registry (NRDR).Using the both of technique it will aid to change policy and procedures Managers within the MIS Complying with federal & state reporting mandates R&D of unique techniques that reduces personnel time and related costs in processing data, personnel, including mid-level management, senior to junior programmer analysts, provides 24-hour, 7-day support for communications network that will reap the benefits of technological change by building an economical, efficient, and salable and integrated computer system.

•       If you were in charge of designing electronic software for a linear accelerator, what are   some features you would include? Are there any features you would avoid?

If I were in charge of designing electronic software for a linear accelerator, the electronic software that I will include is check list on screen, fail-safe mechanism and program the system that need to be able to simultaneously include the technicians so they are aware of what is happening at all times. First, I would include is a check list on the screen. The check list on the screen that allows the technicians to double check and guarantee they would monitor the screen when necessary.

Second, a fail-safe mechanism should be put in place. Include an automatic alert that allows the system to shut down when it exceeds a radiation level that can cause harm to the human body.

Last but not least, program the system to have every crash sent back to the manufacturing/management firm. As we known in the case of Scott Jerome-Parks and Alexandra Jn-Charles, both patients in NYC hospitals, suffered terrible deaths due to carelessness of technicians, complex use of software, faulty machines, and poor state regulations. Mr. Jerome-Parks was treated for tongue cancer by using a newer linear accelerator which was the multi-leaf collimator. Due to the software's crashes, the medical physicist thought the saved radiation treatment plan was updated when it fact it was not. Mr. Jerome-Parks had 7x the prescribed amount of radiation and the multi-leaf collimator was wide open, exposing his whole neck.

Mrs. Jn-Charles was treated for breast cancer and had 28 sessions with a device known as a "wedge." For the first 27 sessions, technicians failed to notice an error message that the wedge was missing, which lead to radiation overdose.Using the check list on screen, fail-safe mechanism and program the system can avoid this problem in features.