Workplace Issues Archives - Brown Law Office

Do Peer Assistance Programs Support Nursing?

August 4, 2021 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

In a recent article on MedPage Today the question is asked, “Are peer assistance programs defective and harmful to nurses”?

The article specifically discussed recent issues regarding the recovery and monitoring program (“RAMP”) in New Jersey. RAMP discussed how nurses cannot work during the intake process, which can take up to 90 days, after which a decision is made when a nurse can return to work.

It also discussed how costly RAMP is in that those nurses must pay a monitoring fee as well as for the testing which can range from $250 to $2000 depending on the type of evaluation required such as psychological, neurological or substance use.

While the program boasts their high success rates, it is very concerning to me that these programs are designed for nurses to keep their licenses, yet their licenses are promptly suspended for 90 days while the evaluation is being conducted.

In Indiana, nurses are referred to INPRP or ISNAP when there is an irregularity in documentation such as failing to witness waste, sign out or sign the administration of medication. Fortunately, Indiana does not immediately suspend a nurse’s license unless there is a clear and immediate danger to the public, and such is done only after the nurse is afforded an opportunity to be heard on the matter.

With protocols such as RAMP, I’m sure it spreads a chilling effect to nurses who may want or need to enter the program. I don’t believe there is a nurse anywhere who wakes in the morning thinking, “I want to take drugs” or “drink alcohol.”

Unfortunately, such abuse is a disease. Nurses need all the help that they can get. Nursing is stressful and getting even more stressful every day. We need to support our nurses who fall into addiction by providing them with support in a safe haven so they can continue working if they can safely do so or return to the workforce quickly.

In addition, if the nurse cannot work, such as with RAMP in New Jersey, it can be financially devastating to them.

Meanwhile, in Indiana, there is a needs assistance program available to help cover the costs of drug screens and monitoring, but that needs assistance is not guaranteed.

At a time when nurses are so desperately needed, I am hopeful they will be able to get the help they need in a caring compassionate environment so eventually they are again able to re-enter the workforce in a safe and healthy way.

RADONDA VAUGHT LOSES HER LICENCE

July 29, 2021 by LORIE A BROWN, R.N., M.N., J.D. 12 Comments

As we have been following the story of RaDonda Vaught for some time, we’ve learned that she had her hearing before the Tennessee Board of Nursing. She made a medication error causing death.

Ms. Vaught did the right thing by admitting to the error and taking responsibility for it but she also pointed out contributing factors from Vanderbilt such as the computer system linking to the medication cabinet was slow and nurses were told via email to override the safeguards so they could get necessary medications quickly.

Normally, she would not have done that. However, given the problems with the computer system, this override was frequently done by all nurses. Therefore, the normal safeguards in place were not utilized by the facility’s nurses due to the computer problem.

Ms. Vaught’s case accentuates a very serious problem which is just how much we rely on technology. As nurses, we should never get complacent because technology is an assistance, not a replacement.

When I was practicing nursing, we did not have any such systems in place. We had to follow the good old fashioned “5 rights” which were: right patient, right route; right drug; right dose and right time.

Apparently, Ms. Vaught is currently working at a desk job for HCA Healthcare. I’m not sure what kind of position it is but she most likely will have to quit because when one’s license is revoked by a state Board of Nursing, that person is reported to the Office of the Inspector General and not allowed to work anyplace that takes care of Medicare or Medicaid patients.

In another event, this one from 2015, a nurse administered the wrong dose of a medication resulting in patient’s death. I believe it was a child in home care named Samuel. The legislature reacted by introducing legislation called Samuel’s law that would automatically revoke a nurse’s license if they over or under medicated a patient.

The American Association of Nurse Attorneys (TAANA) issued a position statement against that law stating that 1, this law violates due process by failing to give a licensee an opportunity to be heard; and 2, usurps the authority of the Board which is provided powers and duties to hear these types of issues.

Fortunately, the Samuel’s Law was not passed. Ms. Vaught did have a hearing and an opportunity to be heard but the Board still chose to revoke her license.

Previously, the Board had reviewed Ms. Vaught’s matter and decided to take no action. But once criminal charges were filed, charges were also filed against her nursing license.

The nursing board is the appropriate venue for these types of issues. I do not believe that an inadvertent medication error should result in criminal charges.

RADONDA VAUGHT’S DAY IN COURT

July 7, 2021 by LORIE A BROWN, R.N., M.N., J.D. 6 Comments

In a previous article, I reported on RaDonda Vaught, a Tennessee nurse who was ordered to give versed to a patient undergoing a PET scan but instead administered vecuronium through a medication mix-up. As a result, she was arrested and has criminal charges pending for reckless homicide.

This matter has been concerning because this clearly is medical malpractice but, can it also be involuntary manslaughter? If a jury finds Radonda guilty of reckless homicide, wouldn’t you agree that it would have a chilling effect on nurses who then could be criminally prosecuted for a medical mistake?

First, let me point out her nursing board matter which initially was dropped thinking the incident was a medication error. The Tennessee Nursing Board decided to close Radonda’s matter after originally determining that she had not violated standards of nursing care. Then suddenly, they decided she was a threat to the public and reopened the case making her license subject to possible discipline. However, her nursing license is still currently free and clear in Tennessee.

The Tennessee Department of Health is planning on calling 16 witnesses, most of whom are medical professionals at Vanderbilt University as well as some of her former colleagues.

The Administrative Law Judge said the witnesses can testify remotely due to the COVID limitations; however, Radonda’s attorney petitioned a Davidson County judge to overrule that decision because the case hinges on the credibility of witnesses. By not having the witnesses physically before the Board, it would be more difficult to assess the weight of their testimonies, properly and fully. I do not know how the Judge ruled on this Motion.

Apparently, other than the criminal charges, there has been no filing of a medical malpractice action against Radonda or Vanderbilt. When asked her plea on the criminal charges, she pled “not guilty.”

Vanderbilt took several steps so the public would not learn about the incident and the error. They had the decedent’s family sign a non-disclosure agreement about the matter. The fatal error was not reported to the Tennessee government as required by that state’s law. Vanderbilt informed the Davidson County Medical Examiner that the patient succumbed to natural causes, failing to mention anything of the deadly medication error.

Apparently, an anonymous tip triggered a Center for Medicaid and Medicare Services investigation that subsequently revealed the mistake resulting in the patient’s death.

Radonda’s jury trial is scheduled to begin March 21, 2022. We have all heard of our right to a speedy trial however it seems that may only apply to defendants who are actually sitting in jail. Fortunately, Radonda is free on bond until her trial on March 21, 2022.

I am looking forward to learning what a jury of her peers will decide and am hopeful they will see that this matter should be one of medical malpractice and not a criminal matter.

Polarity Between Medical and Nursing Boards

June 17, 2021 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

In California, there was a proposed legislation that would add 2 seats so that a majority of members for the Medical Licensing Board would be consumers rather than doctors.

This is an interesting proposition. However, in my experience, the consumer Board member does not contribute as much because they haven’t worked in the nurses’ or the doctors’ shoes.

Evidently, the public is very suspicious of the Medical Board in California because of several complaints by patients against doctors that seemed substantial where the doctor received no disciplinary action.

In fact, one member of the public stated, “My husband lost his hands and feet, and this physician has a spotless record.”

Adding more public members or making a public member majority would, “Obtain more transparency and data with regard to the Board’s enforcement process, and how it makes decisions.”

However, I do not think that this legislation was enacted.

Apparently, the Board settles 84% of its cases and 54% of those stipulated settlements failed to meet the disciplinary guidelines, yet no action is taken.

There was also another allegation against a former chief pediatrician over some 20 years as the pediatrician allegedly had sexually abused boys. No action was taken against this physician.

What is so interesting is the California Board of Registered Nursing and the Medical Board are polar opposites. The Medical Board is “the good old boys’ club” whereas the BRN is eating their young.

It would be interesting to see in the states that have medical boards oversee nurse practitioners, if it would make a difference in the outcomes. Would nurse practitioners be part of the medical board’s good old boys’ club or treated just as harshly as they are by many of the nursing boards?

I suspect this issue is not over in California.

There was a shakeup in California several years ago when Arnold Schwarzenegger was Governor, where the California Board of Registered Nursing delayed taking action against nurses accused of misconduct. The then Governor Schwarzenegger replaced most of the BRN members. The BRN has been much more aggressive because they don’t want to be removed as in the Schwarzenegger era. Yet recently the former director of the BRN, Joseph Morris, resigned after there were allegations of sexual harassment from state employees.

What else is new? It’s California!

NURSES’ REFUSAL OF COVID VACCINES

June 9, 2021 by LORIE A BROWN, R.N., M.N., J.D. 20 Comments

I had great trepidation to write this article because it is so controversial among many nurses. However, in my desire to share with you real world happenings, I chose to go ahead to write about this subject.

Houston Methodist Hospital’s Jennifer Bridges, R.N., has worked with COVID patients since the pandemic began. She would assist patients to a window to see family members and at times hold a phone to their faces while family members spoke with them, many for the last time. She suffered numbness in her arms from holding up iPhones or iPads for hours. She risked infection, experienced the psychological toll of witnessing firsthand families in trauma.

She a times would find herself drenched in sweat and light-headed at the end of shifts. Helping her patients was a task in which she went above and beyond.

Last month, her hospital became the first hospital in the country to require mandatory COVID vaccinations for all employees. Those employees who did not comply and failed to provide proof of vaccination by this past Monday, June 7^th, were suspended without pay for 2 weeks. After that, they would be subject to termination.

Nurse Bridges, by no means an anti-vaxxer, received her annual flu inoculations as well as all the other recommended vaccines. However, she did have concerns about taking the CV-19 vaccines because they were rushed onto the public with Federal Drug Administration (FDA) “emergency use authorization” rather having gone through the normal prescribed testing protocols previously required for vaccines prior to it going to the public. Essentially, rather than the vaccines first being tested on animals, the public itself became the testing subjects.

She since has encountered dozens upon dozens of patients who experienced adverse reactions to the vaccines such as blood clots, heart arrhythmia, swollen appendages, etc.

Altogether, she does not feel comfortable at this point with the vaccines but maybe after they have been evaluated more in depth or even properly tested by the FDA, she would be more agreeable to accepting the vaccines.

In her home state of Texas, apparently only 33% of the residents are fully vaccinated meaning that two-thirds of the population has not received the full vaccination treatments.

That may reflect how the vaccine issues have split our nation into an “us vs. them” society. I’ve seen the opinions and responses on social media of the 2 camps: those who believe in protecting themselves and others with the vaccines and those who are hesitant or even refuse to participate in the vaccination programs. Most believers shun those that don’t want to get vaccinated but, interestingly, I have not seen many non-vaccinated who choose to shun their inoculated counterparts.

This is typical of the profession where “nurses eat their young” … shunning your brothers and sisters for choosing what they would like or not like to put in their bodies.

Ms. Bridges said, “This is supposed to be America! You’re supposed to have civil rights and constitution rights, your freedom of choice. … Nobody should be forced to put anything into their body if they are not okay with it.”

While many health care facilities have mandatory flu vaccines, if one chooses not to take the inoculation, you can wear a mask. But this is not so with the COVID vaccines.

According to the Health Law & Policy Institute at the University of Houston Law Center, an at-will employee of a private institution which has medical and religious exemptions in place, is not forcing her to take the vaccine.

With the support of other nurses, receiving signatures of more than a hundred co-workers, Ms. Bridges has filed suit against the hospital. Will the courts allow her to have a choice of what goes in her body or err on the side of public health? We shall see.

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