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TexLaw, Attorney
Category: Legal
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Experience:  Lead trial/International commercial attorney licensed 11 yrs
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I have been accused of patient abuse. Am on administrative

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I have been accused of patient abuse. Am on administrative leave pending investigation. To my knowledge patient did not complain was three hospital employees that were in the room. Patient had blood alcohol of 335 and had overdosed on 90 tabs of 50 mg amitryptyline and 750 ml of Vodka. Dr. order stomach to be washed out. I asked the EMT intermediate that was in the room if he wanted to do the procedure of putting down the ewald tube, at first he said yes than said no.. He said no after I was trying to explain to him that he would feel the nose "break" that this causes a broken nose, what I meant was he would feel the cartilage inside the nose give away when he passed the tube. I also told him that 20 years ago doctors felt this would "teach the patient a lesson, not to overdose again and that in fact it never did do that". I just meant the statement as a bit of history as this procedure is not done often anymore. This happened in Cortez Colorado on 12/2/12. On 12/3/12 I was placed on administrative leave without explanation. Yesterday was called in for a meeting to investigate, was asked if I disliked overdose patients, where I went to school, if I had ever done this procedure before and how often. Was told this hospital has never inserted the tube through the nose. I was told that this has been reported as patient abuse to the Department of Health and the local police department that gave a CAD number. Was told that HR director wasn't so concerned about how the tube was placed as he was with what I said that he considers patient abuse. He said the write ups through the hospital system spoke of my "demeanor" and what I said and that it was written up by 3 separate employees. He said my answers about what I said was not what three employees wrote and why would three long time employees lie. I told him I did not know. He continued the administrative leave, told me he would let me know if I was terminated or not after he finished his investigation. He said the police here to a CAD number not a case number ***** if I was terminated he would call them back and they would issue a case number ***** they would come to my house, talk to me and arrest me. He said at that point the Dept. of Health would turn this over to the state board. I am very frightened and terrified. I have never been in any legal trouble and am 56 years old. I have several dogs that I need to get safe to a no kill shelter so they do not go to the kill pound here. The shelter is 48 miles away in Colorado. I interviewed for a different job today and pending background check have been hired by a local nursing home. I have never been accused of anything have a Masters degree in nursing Education and HR director told me I would lose my Colorado and California license. I am sitting in my house scared that I will be arrested any minute. I haven't even eaten since Sunday. I have not been told I can not leave and have considered leaving and writing a letter of resignation. I did go today and obtain a complete copy of my personnel file, the three write ups he had in his hand yesterday and three pages of notes he took on yellow legal paper were not in my file. Please advise me what to do , what I can do, and what to expect, I am so very scared. Thank-you

Hi, Thank you for your question. I'm very sorry to hear about your situation. Patient abuse can be prosecuted as an assault or under the following statute: 5 Colo. Rev. Stat. § 12-38-217(1)(c), (f), and (h) provides as follows that the board has the power to revoke, suspend, or refuse to renew any license or to place on probation a licensee upon proof that such person: (c) Has negligently or willfully acted in a manner inconsistent with the health or safety of persons under his care; (f) Has negligently or willfully performed nursing services in a manner which fails to meet generally accepted standards for such nursing services; (h) Has falsified or in a repeatedly negligent manner made incorrect entries or failed to make essential entries on essential patient records. The phrase "generally accepted standards" is a common legal concept that refers to norms of conduct applicable to similar persons in like circumstances. In the case of a medical Expert, such as a nurse, compliance with "generally accepted standards" requires the person to exercise that degree of knowledge, skill, and care exercised by other like Experts in the same or a similar community. From what I understand from your statement, you did not actually force the tube through the nose, you only spoke about it, in what seems to be a joking manner. It was neither a threat nor an attempt to abuse the patient. As that is the case, unless some other facts arise that are not in your statement here, it is unlikely that you could have your license revoked. However, there could be some sort of disciplinary action taken potentially. That the administrator told you that you would be arrested is ridiculous and abusive in and of itself. You are not going to be arrested for making a light hearted comment about past medical practice procedures. However, you should expect that a full investigation will be conducted. It makes sense that an investigation needs to go forward on any sort of allegation of patient abuse. This is to protect the hospital and the patient. Nevertheless, the threat of criminal prosecution by the hospital brings up your rights to get a lawyer to attend all investigative hearings with you and to assert advise you on your fifth amendment rights. You do not have to ever admit to doing any kind of thing that might be considered criminal. I don't think you did anything, but if a prosecutorial investigator were trying to make you say something to implicate yourself in criminal behavior, you have the right to not answer the question. If you have the means you might want to contact a local criminal defense attorney and see about hiring him/her to accompany you to an sort of investigative hearing with the hospital or the state nursing board. But you can relax and stop worrying about being arrested. I think you should cooperate with the investigation and be prepared to answer questions if asked. I also think it would be wise to make some inquiries on how long the investigation will go on so that you will know how much longer you are going to be on administrative leave. If it is for too long, it might be in your best interests to submit your letter of resignation and take the alternative job you found.

Customer: replied 4 years ago.
I did ask how long and was told he did not know, depended on how long it took to speak with the other three people. I have NSO malpractice insurance which covers legal expenses. I found an attorney Cathy Klein in Denver that I spoke with very briefly today and did what she told me to do by going for interview and getting copy of my complete personnel file. However it does not have the three write ups that were done in Midas nor the three or four pages of notes the HR director took yesterday when I went in and answered questions. He did not tell me I could have a lawyer present only that if and when they terminate me I will be reported to the state board by the dept. of health and that I will be arrested. He said if they do not terminate me and it was up to the manager and director of nurses than nothing would be reported to the board. He asked me where I graduated from, I told him, why I disliked the patient, told him I didn't, what I said and I told him and the context it was meant and why three people stated in their write up it was said in an abusive manner with an abusive demeanor. I told him I didn't know. He also asked me what my demeanor was and I told him one of urgency that the procedure took 30 minutes and the patient tolerated it well, there was perhaps less than a teaspoon of blood from the nose when tube was taken out and that there was charcoal in end of tube that also came out the nose which normally happens and patient started spitting I told him not to spit that was nasty and was holding a basin under his chin told him to spit in basin and gave him wash cloths told him to blow his nose in the wash clothes. What will happen to my license?
I'm sorry, I guess I misunderstood you. So the tube was inserted through the nose?
Since this is a procedural violation, you could be disciplined. The fact that the three witnesses are saying you were acting with an abusive demeanor is troubling. The board will review the circumstances and determine what needs to happen. The punishment could range from an admonishment, a fine, a suspension of your license, or a revocation of your license (worst case scenario). I do not believe that you would be facing any criminal charges for this, as it arguably does not rise to the level of an assault. I would expect that since there is no other indication of patient abuse or other failures that this will not result in a revocation or suspension.
Customer: replied 4 years ago.
Thank you I was taught in 1992 to place the tube through the nose when I went to nursing school in California and that is the method we always used. I found on webbsites it could be done either way? Did not know that practice had changed, I truly did not try nor want to assault , injure or intend to abuse this patient. I only wanted to help him. Other nurses that I worked with in California said yes that is how we always did this procedure. I told the manager and HR director that if procedure and practice had changed I was not aware of it and to please offer education. I also told them I was sorry. Was told they were not bothered so much by placement as they were by what the people that wrote me up said my demeanor was which they would not show nor tell me and by my two statements which I told you, now I am scared again that my license is in jeapordy of suspension and I may not be able to work, I am widowed and my sole support. Do you think in your experience it will go that far? I know this is not meant for advise but please can you tell me your gut feeling? I am so very scared again now.
My gut feeling is that this will not go very far in regard to your license. I also don't think you will lose your job.
Do you known why the other three witnesses are hostile towards you?
Customer: replied 4 years ago.
No sir I do not, but sure wish I did. Thinking resignation and nursing home job looking pretty good. I just don't want to do anything to make me look guilty more. That masters degree and all the research on evidence base that did not include this tube sure did not do anything for me did it? Can I do anything at all about the abusive statements of being arrested that the HR director made to me? He used to be a law officer in this town.
Customer: replied 4 years ago.
I have only been working here for 3 weeks.
You are going to be more educated on what is allowed in nursing than I am for sure. I think if you were taught in nursing school that through the nose is an acceptable practice, and that the practice is allowed in other states, then you are not in breach of the nursing standard of care and should not be worried about losing your license.
The threat from the HR director is something which you should file a complaint about with the hospital administration, but not until the investigation is over and final. There is not any legal remedies which come up from his abusive statements though.
I don't think you should resign at this point. I would ride it out and see what happens.
Customer: replied 4 years ago.
Thank you again. This is the way we did the procedure for many years in california and my colleague here signed off on my orientation packet that I was competent and no one that night told me to change how I was inserting the tube. If you go to a search engine and type in ewald placement and scroll down to procedure it comes up that it can be placed through the nose. I so appreciate you. If practice has changed and I did not know will they revoke my license?
No. The change of practice must be accepted across the US and/or made a law in CO before it could be considered malpractice on your part.
Customer: replied 4 years ago.
I can learn, just need educated. My goodness I just graduated in August this year with a Masters in Nursing Education, I surely can learn. Have been in nursing since 1975 first LPN than RN in 1992 now a Master degree. This is all I know and I love my job and my patients. Have been told that is my gift to medicine, my patient and family care and caring attitude. So from what I think this is across United States now to go through the mouth I committed malpractice? Without knowing? And therefore abuse and will lose my license?
Relax! My gut says this is going to blow over and will not affect your license.
Customer: replied 4 years ago.
Oh my lord, thank you so very much. This county is known for going for the jugular and this hospital according to the town people have done this many times to many people. Is a small cowboy town, good ol boy so if they don't like you, they don't need a reason and they go after you according to the town folk.
Customer: replied 4 years ago.
perhaps those three do not like my black and white matter of fact German Irish demeanor
Customer: replied 4 years ago.
Yes it seems that new practice is to insert orally, I have been looking on line. So does this mean my license will be revoked for malpractice, I truly did not know. Are you still out there?
Sorry, I was on another response. I still think that while this may be the new practice, it has to be a matter of general consensus that inserting nasally is unacceptable, and the hospital would be responsible for making sure everyone knows that.
I think you are going to be ok.
Small towns can be like that. Just keep your head down, cooperate with the investigation and I'm betting it will blow over.
Customer: replied 4 years ago.
Thank you, ***** ***** cooperating and I sure want this to be okay. I love my job and patients even those that make me consciously remind my self to smile and be sweet. I sure want to get out of here as fast as possible though. The hospital never told me that I could not put it down the nose and that is all I have ever done. Wish I had known and that the nurse that signed off the skills checklist had said something.
Customer: replied 4 years ago.
Well seems that the new practice is to insert orally in all states. I did not know. Not retirement age yet but maybe is time to work at McDonalds or Walmart. Lord I am so sorry. Hope you are right and it blows over but for some reason I do not think so. I am supposed to work Saturday night, bet that they call tomorrow terminating me and than is on to state board and police is what they said. I am still scared.
Please remember to rate my answer positively so that I might receive payment from the website for my work with you today. Rating my answer does not prevent us from continuing our discussion and I certainly want to hear back from you on what happens.
Customer: replied 4 years ago.
Yes I will you have been so very nice to continue the conversation and try to make me feel better, about not going to jail I feel better but if this is and does seem to be the wrong method of inserting that I did because of years ago than I think you are saying is malpractice and I may lose my license so I am petrified and so very tired right now. I hope you are right that it blows over and I do not have licensed suspended or revoked, if that happens my life is over I am a widow with no other source of income. Did I understand that for malpractice and demeanor I may lose my license?
Yes, the worst case scenario would be a revocation of your license. But I cannot stress how very unlikely I think that is to happen.
Customer: replied 4 years ago.
Thank you, ***** ***** that still means I can not live I have no money in the bank do you also truly think that is unlikely? Seems from my re reading the statute you sent that other nurses in this community always have inserted orally, never nasally Also where do I rate this as excellent
Customer: replied 4 years ago.
from look on department managers face am sure I will be terminated prior to Saturday which would be tomorrow as I am due to work night shift Saturday
I think that it is unlikely you will be suspended as well. But you may be reprimanded for not following the local procedures.
The rating system should show up somewhere on your page as soon as you see my response.
Customer: replied 4 years ago.
Thank you I sure hope you are right, I will take a reprimand that will not hurt my license or my California license. This has sure taught me a valuable lesson. I need to find a new way to make a living, am to old to be a nurse anymore. Do not to ever want to hurt any patient
I think I did the rating?
It doesn't appear that you have done the rating yet. try again :-)
I can tell by talking to you that you did not intend to hurt anyone or break any rules.
Customer: replied 4 years ago.
That is so very true, I was only concerned that amitriptyline is the worst overdose anyone can take, it will kill you and only antidote is gastric lavage and giving sodium bicarbonate IV 1 meq per kilogram and patient was 400 lbs or 181 kg. I certainly hope that the board investigators will be able to understand and tell the same thing you do, as I am sure hospital manager can not tell. Evident from her demeanor. Did rating go through? If not will try again, I rolled over the stars.
Rating hasn't gone through yet. Sorry!
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