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By
Kirk S. Bond, Attorney for UFCW 141
I
recently represented a registered nurse who had been charged by the Nursing
Care
Quality Assurance Commission with patient abuse. The Commission alleged that my
client abused the patient by "striking the patient in the chest, knocking
the patient down into the bed, and by speaking to the patient in a disrespectful
manner." The evidence presented at hearing, however, did not support the
allegations.
Accordingly,
the Commission found that "insufficient evidence was presented to support
the allegation regarding striking and knocking [the patient] down into his bed,
and therefore those charges are dismissed." Rather than dismissing the
charges in their entirety, though, the Commission held that my client committed
"abuse of a patient" by speaking to the patient "in a
disrespectful manner."
The
patient to whom my client allegedly spoke in a disrespectful manner was an 87
year old male who had been admitted to the intensive care unit of the hospital
after suffering a subarachnoid hemorrhage and fractured hip during a fall. As
the Commission concluded, the patient was "frequently confused and
disoriented with periods of delirium and aggressiveness" and was "hard
of hearing." The patient had an IV line, a urine catheter, a cranial shunt
and his physician had ordered soft wrist restraints to protect him from harming
himself or others.
As
my client walked by the patient's room one day, he noticed the patient flailing
his arms and trying to sit up. Concerned that the patient would pull out a tube
or otherwise harm himself, my client approached the patient and tried to calm
him. Knowing that the patient was hard of hearing, my client yelled in a loud
voice, "stop it, stop it." Although the evidence on this next point
was contradictory, based on the testimony of one witness the Commission
concluded that my client yelled, "stop it, stop it, old man."
The
Commission determined that my client's supposed use of the term "old
man" was "very inappropriate and demeaning" to the patient and
that, even though the patient was hard of hearing, the tone and volume that my
client used was inappropriate. According to the Commission, my client should
have used "a gentler tone and volume to help the patient orient himself and
calm down." Because of its conclusion, the Commission suspended my client's
license for one year, but stayed the suspension upon his compliance with certain
terms and conditions.
The
Commission's Order in this case could have enormous impact upon the practice of
nursing. The Commission decided that talking to a patient in what it deems an
"inappropriate" or "disrespectful" manner is "abuse of
a patient."
If
this is the state of the law in Washington, it is conceivable that nurses
licensed here place their licenses at risk if they call a patient,
"honey," "dear," "grandpa," "young
lady," "buddy" or any other term that the Commission in a given
case unilaterally determines is inappropriate. Likewise, the Commission could
possibly take action against the license of a registered nurse who uses in an
emergency situation a tone or volume of voice that the Commission after the fact
determines was "inappropriate."
While
few would disagree with the view that all health care professionals should
aspire to treat patients appropriately and respectfully, the Commission's Order
in this case should frighten all registered nurses. Depending on the
circumstances, calling an 87 year old man an "old man" could be
considered "inappropriate." Inappropriate behavior, though, is not
patient abuse.
By
interchangeably using the terms "inappropriate" and
"abusive," the Commission has imposed a nebulous standard upon nurses
in which it is imaginable that a nurse places her license at risk if she fails
on a particularly bad morning to take the appropriate and respectful action of
greeting each patient with a warm smile.
On
behalf of my client, I have appealed the Commission's Order in this case to the
Superior Court for the state of Washington. I will update the status of this
case in a later issue of Vital Signs.
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