You work in a gynecological office, and your office has been asked to participate in a women’s health fair. The focus of the fair is health promotion.
for female reproductive disorders is vital to identify and treat rapidly to produce the best patient outcomes. Preventative screening includes mammogram and Pap smear and should be performed based on recommended age and associated risk factors. To promote preventative screening, your office will be creating brochures to distribute at the health fair.
Design a women’s health brochure by choosing one of the female reproductive disorders covered in this module. In the brochure, include the following:
please give References
The fifteen year-old patient was scheduled for surgery on the right
side of his brain to remove a right tem-
poral lobe lesion that was believed to be
causing his epileptic seizures.
The surgery began with the sur-
geon making an incision on the left
side, opening the skull, penetrating the
dura and removing significant portions
of the left amygdala, hippocampus and
other left-side brain tissue before it was
discovered that they were working on
the wrong side.
The left-side wound was closed,
the right side was opened and the pro-
cedure went ahead on the right, correct
The error in the O.R. was revealed
to the parents shortly after the surgery,
but only as if it was a minor and incon-
The patient recuperated, left the
hospital, returned to his regular activi-
ties and graduated from high school
before his parents could no longer deny
he was not all right. After a thorough
neurological assessment he had to be
placed in an assisted living facility for
brain damaged individuals.
When the full magnitude of the
consequences came to light a lawsuit
was filed which resulted in a $11 mil-
lion judgment which was affirmed by
the Supreme Court of Arkansas.
A circulating nurse has a le-
gal duty to see that surgery
does not take place on the
wrong side of the body.
The preoperative documents
failed to identify on which side
the surgery was to be done.
It was below the standard of
care for the circulating nurse
not to notice that fact and not
to seek out the correct infor-
SUPREME COURT OF ARKANSAS
December 13, 2012
Operating Room: Surgical Error Blamed, In
Part, On Circulating Nurse’s Negligence.
Surgical Error Blamed, In Part, On
Circulating Nurse’s Negligence
The Court accepted the testimony
of the family’s nursing expert that a
circulating nurse has a fundamental
responsibility as a member of the surgi-
cal team to make sure that surgery is
done on the correct anatomical site,
especially when it is brain surgery.
The circulating nurse is supposed
to understand imposing terms like se-
lective amygdala hippocampectomy
and know the basics of how it is sup-
posed to be done.
Hospital policy called for the sur-
geon, the anesthesiologist, the circulat-
ing nurse and the scrub nurse or tech to
take a “timeout” prior to starting a sur-
gical case for final verification of the
correct anatomical site.
The circulating nurse should have
available three essential documents, the
surgical consent form, the preoperative
history and the O.R. schedule.
The full extent of the error, that is,
a full list of the parts of the brain that
were removed from the healthy side,
should have been documented by the
circulating nurse, and failure to do so
was a factor that adversely affected the
patient’s later medical course, the pa-
tient’s nursing expert said. Proassur-
ance v. Metheny, __ S.W. 3d __, 2012 WL
6204231 (Ark., December 13, 2012).
January 2013 Volume 21 Number 1
Inside this month’s
See Page 3
Operating Room/Circulating Nurse – Nursing Home Admission
Labor & Delivery Nursing/Pitocin/Fetal Monitor
Labor & Delivery Nursing/High Risk Patient/Fetal Monitor
Medication Error/Nursing Negligence – Correctional Nursing
Age Discrimination – Race Discrimination/Minority Nurses
Skilled Nursing/Blood Draws/PT/INR/Reporting To Physician
Flu Immunization/Public Health Emergency – Nursing Assessment
Nurse Practitioner/Pre-Signed Prescriptions – Threat Of Violence
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 2
Labor & Delivery, Pitocin, Fetal
Monitors: Court Finds Evidence
Of Nursing Negligence.
T he mother was admitted to the labor and delivery unit at 10:10 p.m. for
induction of labor.
The baby was delivered vaginally at
5:27 p.m. the next afternoon with the um-
bilical cord around her neck. She did not
start breathing on her own for almost seven
minutes and then began having seizures.
A pediatric neuroradiologist, who per-
formed ultrasound scans on the child’s
brain and who would later submit an expert
report for the family in their lawsuit
against the hospital, related the child’s
problems to asphyxia consistent with brad-
ycardic events prior to her delivery.
The Court of Appeals of Texas accept-
ed reports prepared by the family’s experts,
an ob/gyn physician, a labor and delivery
nurse and the pediatric neuroradiologist
which pointed directly at the negligence of
the labor and delivery nurses.
Family’s Medical Expert
When Cytotec has been used for cervi-
cal ripening followed by IV Pitocin for
induction of labor, the labor and delivery
nurses have the responsibility to maintain
readable tracings of the fetal heart tones
and the maternal contraction patterns. The
nurses should not start or continue Pitocin
when there are non-reassuring fetal heart
tracings, when the contractions cannot be
monitored or with uterine hyperstimula-
tion. The physician must be notified of
non-reassuring fetal heart tracings.
Family’s Nursing Expert
When Pitocin is in use the nurse must
see to it that the equipment that monitors
uterine contractions is recording the moth-
er’s contractions, the family’s nursing ex-
Review of the fetal heart monitor trac-
ings showed several lengthy intervals of
non-reassuring heart rates. The records
further revealed that a nurse increased the
Pitocin even with late decelerations with
decreased variability, until it was eventual-
ly decreased and then stopped a few hours
before birth by a different nurse, but then
restarted again until the birth with ominous
tracings showing on the monitor. Abilene
Reg. Med. Ctr. v. Allen, __ S.W. 3d __, 2012
5951982 (Tex. App., November 29, 2012).
The patient’s nursing ex-
pert explained that the Pi-
tocin drip is usually con-
trolled by the labor and de-
It is increased to increase
contractions and decreased
or stopped altogether if the
contractions get too strong,
too long or too close to-
The Pitocin is to be adjust-
ed based on whether the
baby’s fetal heart tracings
are reassuring or non-
reassuring. It is only in-
creased if the tracings are
The nursing expert’s re-
view of the chart revealed
that the tocotransducer
which identifies the begin-
ning and end of each of the
mother’s contractions was
not working for the first
three hours after the mother
was admitted to the labor
and delivery unit.
There were also numerous
intervals evident from the
fetal monitor tracings of
non-reassuring tones that
should have been but were
If the physician had been
notified of the non-
reassuring tones a cesare-
an could have been done
early on to save the child
from brain damage.
COURT OF APPEALS OF TEXAS
November 29, 2012
The Court of Appeals of Mississippi
ruled there was no deviation from the
standard of care by the patient’s labor and
delivery nurses. Norris v. Southwest Miss.
Reg. Med. Ctr., __ So. 3d __, 2012 6118005
(Miss. App., December 11, 2012).
The labor and delivery
nurse’s assessment was
correct that the mother was
not actually in labor.
When the fetal heart tone
was lost a nurse promptly
began trying to reach the
physician while another
nurse kept trying to get a
COURT OF APPEALS OF MISSISSIPPI
December 11, 2012
T he patient was admitted to the hospital through the E.R. for what were at the
time believed to be labor pains.
She was thirty-one years old and thirty
-three weeks pregnant and was considered
high-risk due to obesity, insulin-dependent
diabetes, four previous cesareans and hav-
ing given birth to very large twins.
The labor and delivery nurse immedi-
ately started a fetal heart monitor and a
tocodynamometer and performed a vaginal
exam which showed no dilation of the cer-
vix. The patient’s ob/gyn who had deliv-
ered her other children likewise found no
dilation and gave orders for monitoring her
blood sugars and giving insulin.
Later that morning the patient’s ab-
dominal pain increased and so the nurse
paged her physician. The nurse was get-
ting no heart tones on the monitor so she
asked another nurse to keep checking for a
fetal heartbeat while she kept paging the
physician. A few minutes later the physi-
cian called and said he was on his way.
The nurse documented all this in the chart.
The physician was there within
minutes and delivered the baby by cesare-
an, but there had been a complete uterine
rupture and separation of the placenta.
Labor & Delivery:
Nurses Ruled Not
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 3
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The law strongly favors alternative
methods of dispute resolution such as arbi-
tration rather than jury trials in civil court
to resolve claims and disputes, but only if
both sides have agreed.
An agreement to arbitrate is basically
a civil contract. For a contract is to be
binding both parties must have the capacity
and the authority to enter into the contract.
The patient did not have the capacity
to enter into a binding contract on his own
behalf because he was quite confused.
The daughter-in-law had no actual
authority to sign a contract as her father-in-
law’s agent. There was nothing to support
the nursing facility’s argument that the
patient somehow communicated to the
facility that he wanted his daughter-in-law
to sign for him or even had the mental ca-
pacity to make such a communication.
A year earlier he had signed a durable
power of attorney naming his son as his
attorney in fact. The son was the spouse of
the daughter-in-law who signed the arbitra-
tion agreement, but that fact was irrelevant.
The nursing facility, the Court said,
made no good faith effort to determine
who was authorized to sign or to request
that that person discuss the arbitration
agreement and make the decision whether
or not to sign.
The patient did sign at least one more
admission contract upon readmission after
a subsequent hospitalization, when he ap-
parently was lucid enough to do so, but the
arbitration agreement was not included.
Koch v. Keystone Pointe Health & Rehab,
2012 WL 6098358 (Ohio App., December 10,
T he patient was transported by ambu-lance from the hospital to a nursing
facility and was met there by his daughter-
The daughter-in-law signed the facili-
ty’s admission contract because the patient
was quite confused at the time and was not
lucid enough to sign any papers.
The daughter-in-law also signed an
arbitration agreement separate from the
admission contract. The arbitration agree-
ment stipulated that all legal claims includ-
ing negligence, malpractice and violation
of the resident’s rights, but not non-
payment of nursing home fees, would not
be decided in a court of law but would be
resolved through binding arbitration.
The patient fell in the nursing home
and then passed away four months later.
After his death his daughter as personal
representative of his probate estate sued
the nursing facility for negligence.
The nursing facility petitioned the
court to dismiss the lawsuit so the case
could be decided by arbitration as stipulat-
ed in the arbitration agreement signed by
the patient’s daughter-in-law.
The Court of Appeals of Ohio ruled
the case did not belong in arbitration but
should stay on the jury trial docket of the
local county court of common pleas.
Nursing Home Admission: Daughter-In-Law Had
No Authority To Sign, Arbitration Agreement Void.
The patient’s daughter-in-
law informed the nursing
facility staff that she did not
have power of attorney to
act on the patient’s behalf,
but the nursing facility dis-
regarded that fact and told
her that it would not admit
the patient if she did not
sign all the forms, including
the arbitration agreement.
Under these circumstanc-
es there is no evidence the
nursing facility acted in
good faith having reason to
believe that the daughter-in-
law had authority to enter
into a legally binding con-
tract on the patient’s behalf.
The nursing facility’s de-
mand that she sign the
forms lest her father-in-law
be denied admission for
necessary rehabilitation did
not create any apparent au-
thority for her to bind the
patient to a contract.
COURT OF APPEALS OF OHIO
December 10, 2012
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 4
Medication Error: Court Upholds
Verdict For Nursing Negligence.
Two physicians testified
that in their opinion, to a
reasonable degree of medi-
cal probability, the nursing
facility erroneously admin-
istered anti-diabetic medi-
cation to the deceased,
which caused a severe drop
in her blood sugar.
Two other physicians, the
nursing facility’s experts,
could only speculate that
malnutrition or a urinary
tract infection could have
caused the problem.
The physicians’ testimony,
taken along with the testi-
mony of two former nursing
home employees as to the
chaotic conditions at the
facility, supports the jury’s
verdict against the facility.
The nursing facility had
complete control of the anti
-diabetic medication at the
facility that was being taken
by residents who used such
medication, that is, none of
the four residents who ad-
ministered their own medi-
cations were on such medi-
It is not a realistic explana-
tion that anti-diabetic medi-
cation was given to this res-
ident by a third party. Even
if that did happen it would
amount to lax supervision
of the residents’ environ-
ment which itself would be
UNITED STATES COURT OF APPEALS
December 19, 2012
T he eighty year-old nursing home resi-dent suffered from Parkinson’s dis-
ease, dementia and the aftereffects of a
stroke at age seventy-four.
She had no history whatsoever of dia-
betes or hypoglycemia.
She was found unresponsive in her
room in the middle of the morning and was
rushed to the hospital where her blood glu-
cose was discovered to be 12.
The patient was diagnosed with en-
cephalopathy due to hypoglycemia which
the physicians suspected came from oral
ingestion of anti-diabetic medication.
The patient came out of her coma but
never regained her semi-independent func-
tioning and died within fifteen months.
The jury awarded the family $1,250,000 as
punitive damages, $400,000 for her pain
and suffering and $554,000 attorney fees
and costs. The US Court of Appeals for the
Sixth Circuit (Ohio) upheld the verdict.
Disturbing Conditions At The
Two former employees of the nursing
home described disturbing conditions at
the facility, including disorganized medica-
tion carts, pre-pouring of medications and
falsification of medical records.
There were only two LPNs assigned
for the care of eighty residents. The LPNs
were often rushed and as a result of their
haste regularly engaged in the practice of
pre-pouring medications. The medication
cart was “a mess” most of the time. The
wrong pills were in the medication trays.
The nurses would borrow medication from
one resident and give it to another. At the
time of her death more than fifty of this
resident’s pills were found to be missing.
A supervisor altered records to cover
up a medication error. Staff and supervi-
sors routinely filled in “holes” in residents’
medication administration records retroac-
tively at the end of the month.
In the Court’s judgment, the whole
situation went beyond simple negligence
and justified the jury’s decision to award
punitive damages for conscious and mali-
cious disregard of the resident’s well estab-
lished legal right to a safe environment free
from significant medication errors. Freude-
man v. Landing, __ F. 3d __, 2012 WL 6600356
(6th Cir., December 19, 2012).
W hen the inmate was booked into the jail his medical history included the
fact he was being treated by a local spe-
cialist for autoimmune chronic hepatitis,
esophageal varices, anemia, jaundice and
Early in the a.m. the day after being
booked he vomited a large puddle of blood
in his cell. He explained to a jail officer
that he had gastric ulcers for which he took
numerous medications and that he had had
twenty-seven units of blood transfusions
during the previous month.
The officer phoned one of the jail
nurses at home and explained the situation.
She told the officer to give him some liq-
uid antacid. He threw up lots more blood
again. When she was phoned again the
nurse told the officer to give him a Phener-
gan suppository. When they phoned her
again the nurse finally decided to come in
to the jail. She had the inmate moved to
medical solitary and continued the supposi-
tories. The next day the inmate died from
a massive gastrointestinal hemorrhage.
Says Nurse Was
The nurse violated the in-
mate’s Constitutional rights
through deliberate indiffer-
ence to his serious medical
UNITED STATES COURT OF APPEALS
December 12, 2012
The US Court of Appeals for the Fifth
Circuit (Texas) placed blame on the nurse
for failing at least to alert the physician and
for not sending the inmate to the hospital
due to the seriousness of his condition.
Deputies working for the county sher-
iff who was responsible for the jail did all
they were expected to do and the jail phy-
sician was never informed by the nurse
what was actually going on with this in-
mate. Bolin v. Wichita County, 2012 WL
6194359 (5th Cir., December 12, 2012).
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 5
Age Bias: Court
Sees Grounds For
A n Hispanic CNA in her mid-fifties had consistently positive performance
reviews and was rewarded with pay raises
for more than sixteen years and was recog-
nized for her service by being selected for
the Resident Care Specialist Leadership
Council at the nursing home.
Then a new director of nursing took
over. A few months later the CNA was
suspended and then fired over an incident
involving alleged substandard care of a
The CNA sued for race and age dis-
The US District Court for the District
of Colorado found evidence to support the
allegations of age discrimination.
As soon as she came on board as inter-
im DON the person who would eventually
become the new permanent DON started
making remarks to the CNA pointing out
that she was the oldest CNA in the facility
and was “as old as the woodworks,” asking
her when she was going to retire, telling
her that she was too old for her job and
telling her that she was “like an old penny
that keeps coming back.”
As interim DON she also reportedly
threatened the CNA that she was going to
be watching her closely and would fire her
as soon as she became permanent DON.
The CNA was told this well before the
occurrence of the patient-care incident that
was used ostensibly to justify her firing.
Alfonso v. SCC Pueblo, 2012 WL 6568468 (D.
Colo., December 17, 2012).
A discriminatory motive
can be seen in the DON’s
derogatory remarks about
the CNA’s age.
These remarks raise seri-
ous questions whether the
patient-care incident was
merely a pretext to move
the CNA out because of her
UNITED STATES DISTRICT COURT
December 17, 2012
Race Discrimination: Nurses Did
Not Prove Their Case.
A fter complaining about various as-pects of their working conditions over
a span of several years, two minority nurs-
es sued their employer for race discrimina-
The lawsuit alleged they were victims
of discrimination as well as victims of re-
taliation for their complaints about what
they considered to be discrimination.
The US Court of Appeals for the Sev-
enth Circuit (Illinois) dismissed their case.
More Favorable Treatment Alleged
For Non-Minority Nurses
The two African-American nurses,
before filing their lawsuit, had delivered a
written petition to human resources at the
hospital complaining that Filipino nurses
were being given easier assignments, more
training and more leadership opportunities.
These allegations were apparently
investigated by human resources and dis-
missed as unfounded.
The Court said that these allegations,
if they could be proven, would certainly be
adequate grounds for a civil rights lawsuit.
However, a lawsuit cannot be based simply
on vague assertions and innuendo.
For a successful discrimination lawsuit
the alleged victim must identify a specific
person or persons who were treated more
favorably, specify the manner in which
they were treated more favorably and show
that they were similar to the victim in all
relevant respects except for not being a
racial minority. There was no specific
person or persons identified for purposes
of comparison in the nurses’ lawsuit.
Was Not Racially Motivated
The two nurses were criticized and
given negative performance evaluations for
lack of teamwork. One of them was called
a “trouble maker,” a “cry baby” and a
“spoiled child” in one particular meeting
with a supervisor and had to leave the
meeting in tears.
Even if all this was true, the Court was
not able to find any discriminatory racial
motivation behind the nurses’ supervisors’
actions, which is a necessary element for
them to be able to go forward with a civil
rights lawsuit against their employer.
Brown v. Advocate, __ F. 3d __, 2012 WL
5870725 (7th Cir., November 21, 2012).
The alleged victims con-
tend that the Court can infer
racial bias from the fact that
their employer did not re-
spond to their complaints
as they would have liked.
The fact that someone dis-
agrees with you or declines
to take your advice, without
anything more, does not
suggest that they are dis-
criminating against you.
All of the supervisors’ crit-
icisms used non-racial lan-
guage and there was noth-
ing in the context to sug-
gest the criticisms were ra-
Perhaps their supervisors’
criticisms were unfair, but
there is no evidence that
the criticisms were motivat-
ed by race.
The civil rights laws pro-
tect against discrimination,
not personal animosity or
Over a two-year period the
alleged victims made nu-
merous complaints to man-
agement, some involving
racial issues and others in-
volving general workplace
The complaints were in-
vestigated. Action was tak-
en on some of them and de-
clined as to others. The al-
leged “harassment” was
only negative feedback
about lack of teamwork.
UNITED STATES COURT OF APPEALS
November 21, 2012
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 6
Cannot Be Sued.
I n 2009 in response to an outbreak of H1N1 influenza the US Secretary of
Health and Human Services made a formal
declaration that a public health emergency
existed and recommended administration
of a specific antiviral vaccination.
The Secretary’s authority came from
the US Public Readiness and Emergency
Preparedness (PREP) Act of 2005.
The Governor of New York then is-
sued an executive order authorizing state
and local authorities to take steps to dis-
tribute and administer the vaccine.
A local county health department held
a vaccination clinic in a local school where
a nurse gave a kindergartener the flu vac-
cine without either parent’s consent.
The child’s mother sued the county
health department for negligence and civil
battery. The New York Supreme Court,
Appellate Division, dismissed the case.
Continued on page 7.
The US Public Readiness
and Emergency Prepared-
ness Act protects licensed
health professionals who
are authorized to administer
or dispense countermeas-
ures in response to a public
health or bioterrorism emer-
The Act does not detract
from a licensed healthcare
professional’s legal immun-
ity when a countermeasure
is administered without
As a Federal law the Act
takes precedence over any
state statute or rule of the
common law that goes con-
NEW YORK SUPREME COURT
November 21, 2012
Skilled Nursing: Court Finds
Upholds Civil Monetary Penalty.
A fter the death of a seventy-eight year-old patient who had been on Couma-
din for a blood clot in her leg, survey in-
spectors decided that the facility’s proce-
dures for laboratory work were out of com-
pliance with Federal standards.
A civil monetary penalty was levied of
$3050 per day for more than half a year,
the period of time during which the facili-
ty’s procedures were deemed out of com-
pliance, more than $587,000, which was
upheld by the US Court of Appeals for the
Fourth Circuit (North Carolina).
Resident’s Death Sparks Investigation
A nurse saw and charted swelling in
the patient’s lower leg and reported it to
the patient’s physician. He ordered a Dop-
pler test which found a blood clot. The
physician ordered 10 mg of Coumadin plus
Lovenox daily and daily PT/INR tests.
The care plan was “badly mishandled”
according to the Court and the PT/INR
testing did not begin for over a month.
The first result showed a critically high
After the same result two days later
the physician scaled back the Coumadin to
6 mg. The order for a follow up PT/INR
was not properly transcribed and the PT/
INR was delayed two more days until an-
other nurse caught the mistake.
The blood sample was sent back by
the lab as too small to test so a nurse tried
to draw another the next day. The patient
refused the blood draw, which was her
right, but any such refusal has to be report-
ed promptly to the physician, which was
The nurse did see and charted unusual
bruising around the breast and shoulder,
possible signs of a Coumadin overdose, but
that also was not reported to the physician
as it should have been.
Finally a sample was drawn which
showed a critically high Coumadin level
and the patient was sent to the hospital.
The hospital administered one dose of Vit-
amin K, but the family then decided to
decline further treatment and the patient
passed away the next day. Universal
Healthcare v. Sebelius, 2012 WL 6217619 (4th
Cir., December 14, 2012).
A skilled nursing facility is
required by Federal regula-
tions to ensure that each
resident’s drug regimen is
free from drugs given in ex-
cessive doses, for exces-
sive duration or without ad-
equate monitoring in the
presence of adverse conse-
quences which indicate the
dose should be reduced or
A skilled nursing facility
must have a system in
place to ensure that labs
are drawn when ordered,
drawn correctly, processed
correctly and the results re-
ported to the patients’ phy-
Residents on anticoagu-
lant therapy require not on-
ly lab tests but also proto-
cols for monitoring and ob-
servation by direct caregiv-
Special instructions for
Coumadin should be placed
in care plans that any sub-
tle signs of injury should be
At this facility there was a
systematic failure to antici-
pate and plan for the risk of
bleeding, to monitor for ad-
verse reactions and to in-
struct rank-and-file staff on
touching and handling resi-
dents on Coumadin.
UNITED STATES COURT OF APPEALS
December 14, 2012
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 7
Nursing Assessment: Damages
Awarded For Negligence.
There was no error by the
judge who assigned fault
100% to the night nurse and
held the agency that sup-
plied her to the hospital
100% liable for the $1.4 mil-
The day nurse, the hospi-
tal and the treating physi-
cian were properly dis-
missed from the lawsuit.
There was no evidence the
day nurse breached the
standard of care in her
nursing assessments or her
nursing care of the patient.
There was nothing wrong
with the treating physi-
cian’s initial diagnosis and
plan of care for the patient.
The patient was already
irreversibly paralyzed by
the time the hospital’s resi-
dent was alerted to the pa-
tient’s condition by the
night charge nurse. The
medical review panel criti-
cized him for delay in ob-
taining the diagnostic
scans, but even if the scans
were done and the neuro-
surgeon came in and oper-
ated earlier the outcome
would not have changed.
When the treating physi-
cian was finally contacted
during the night by the resi-
dent at the hospital, there
was likewise nothing he
could have done at that
point that would have
changed the outcome.
COURT OF APPEAL OF LOUISIANA
December 5, 2012
Continued from page 6.
Countermeasures in a Declared
Public Health Emergency
The PREP Act states that a covered
person shall be immune from suit and lia-
bility under Federal and state law with
respect to all claims for loss caused by,
arising out of, relating to or resulting from
the administration of a covered counter-
measure to an individual.
The definition of a covered person
includes licensed health professionals or
other individuals who are licensed by the
state in which the countermeasure was
prescribed and authorized to administer
and dispense such countermeasures.
The only exception to the broad sweep
of immunity granted to covered persons
with respect to administration of counter-
measures is for death or serious injury
caused by willful misconduct.
Congress also enacted the Counter-
measures Injury Compensation Program
creating an administrative agency to handle
claims for certain injuries stemming from
countermeasures taken in response to the
declaration of a public-health emergency,
which was intended to be the exclusive
legal remedy for persons with such claims.
Lack of Consent Does Not Create
Basis for Legal Action
The Court was not persuaded that an
exception should be read into the PREP
Act, as argued by the mother in her law-
suit, for situations involving a duly de-
clared public health emergency where a
countermeasure is administered without
informed consent. A healthcare provider
could be held liable if an immunization
was given without consent under normal,
The Act itself and supporting Federal
regulations and an Executive Order from
the President make no mention of any in-
tent by Federal lawmakers for the courts to
read in such an exception. Parker v. St.
Lawrence County Public Health Department,
__ N.Y.S.2d __, 2012 WL 5869773 (N.Y. App.,
November 21, 2012).
T he patient was an insulin-dependent diabetic with a history of drug abuse.
During the night he was admitted to
the hospital suffering from abdominal pain,
back pain and vomiting which had caused
The diagnosis was diabetic ketoacido-
sis which his physician intended to treat by
gradually restoring hydration and correct-
ing his blood sugars through careful insulin
At 9:00 a.m. the physician determined
that his condition was improving and or-
dered his IV hydration, antibiotics and
blood sugar testing continued.
The day nurse performed two head-to-
toe assessments of the patient. She charted
that the abdomen was soft, that there were
active bowel sounds and that the patient
was voiding yellow urine. He had equal
range of motion in his upper and lower
extremities, equal and strong extremity
strength and a steady gait.
Night Nurse’s Assessments
Significant Findings Not Reported
At 7:00 p.m. the night nurse who was
an agency nurse took over the patient’s
care. Right away the patient’s wife in-
formed the nurse that his legs were numb
and that one leg had flopped out of the bed.
The nurse told the wife this was caused by
his fever. The nurse did not report this to
the charge nurse or to a physician.
At 8:15 p.m. the night nurse did her
first head-to-toe assessment. She charted
that the abdomen was firm and strength
was weak in all the extremities. There was
no charting as to weakness being equal or
unequal and her note for sensation was
“unable to assess.” There was no report to
the charge nurse or to a physician.
At 3:40 a.m. the patient told the nurse
he could not move his legs at all. He had
not voided since 1:30 p.m. the previous
afternoon, so the nurse inserted a Foley
and obtained a large amount of dark urine.
Finally the nurse notified the charge
nurse who called in a resident. By this
time the patient was irreversibly paraplegic
from an epidural abscess in the thoracic
spine which could not be corrected surgi-
cally. The Court of Appeal of Louisiana
approved a $1.4 million judgment. John-
son v. Ray, __ So. 3d __, 2012 WL 6055584
(La. App., December 5, 2012).
Cannot Be Sued.
Threat Of Violence: Nurse’s Termination Upheld,
Allegations Of Sexual Harassment Dismissed.
A nurse was fired after she made a remark to one coworker that was
interpreted as a threat to shoot another
coworker over a remark he made to her
about her husband leaving her.
After being fired she sued the hos-
pital for sexual harassment and for re-
taliation for reporting sexual harass-
ment. The sexual harassment, she said,
involved the coworker whom she later
threatened being a little too friendly,
smiling and staring at her too much and
making one vulgar sexually-oriented
remark to her.
The US Court of Appeals for the
Tenth Circuit (Oklahoma) dismissed the
A lawsuit for a sexually hostile
work environment can only be based on
conduct that permeates the workplace
with intimidation, ridicule and insult.
Garden-variety boorish, immature,
juvenile and annoying behavior is not
uncommon in the American workplace
and does not give grounds for a lawsuit
for sexual harassment, the Court said.
Another important factor was that
the nurse was the perpetrator’s supervi-
sor, not the other way around.
The most important factor in the
Court’s mind was that the hospital had
legitimate, non-discriminatory and non-
retaliatory grounds to terminate the
nurse, her threat of violence against a
She reportedly told a coworker she
owned a .357 magnum handgun and
knew how to use it and stated that the
kind of remark another coworker
voiced to her about her marriage was
the kind of thing that gets people shot.
Gaff v. St. Mary’s Reg. Med. Ctr., 2012 WL
6604579 (10th Cir., December 19, 2012).
The reason given by the
hospital for the nurse’s ter-
mination, that she made a
threat of violence against a
fellow employee, was not a
pretext to cover up a plot to
fire her for her complaint
about sexual harassment.
The nurse told a coworker
that she owned a gun and
knew how to use it and said
that what her coworker said
to her was the kind of thing
that gets people shot.
UNITED STATES COURT OF APPEALS
December 19, 2012
Stolen Prescription Form: Nurse Practitioner
Implicated In Narcotic-Overdose Death.
A physician and a nurse practitioner em-ployed in a Federally-funded community
health clinic were originally named as defend-
ants in a wrongful-death lawsuit arising out of
the death of the nurse practitioner’s daughter’s
friend from acute fentanyl poisoning.
The deceased was found dead with a partial-
ly dissolved 1600 mcg Actiq lozenge in her
mouth. Post-mortem toxicology also found
Xanax in her system.
The Actiq lozenge was apparently the last of
six obtained by the deceased from a community
pharmacy using a prescription form signed in
blank by the physician and given to the nurse
practitioner and then stolen by the deceased or
given to the deceased by the nurse practitioner’s
The daughter was charged with criminal
offenses in connection with the death but died
herself before her case went to court.
The investigation revealed that the deceased
had previously come into possession of three
other blank prescription forms from the same
clinic signed by the same doctor and had used
them to get drugs before she met her end.
The US District Court for the Middle Dis-
trict of Georgia ruled the physician and the nurse
practitioner were negligent because their conduct
in signing and handling blank prescription forms
violated the clear letter of state law.
Civil liability was appropriate because it is
foreseeable that illegally pre-signed prescription
forms can be stolen, passed on, forged and used
to obtain controlled substances to be used in an
illicit manner which can cause a person’s death.
However, the physician and nurse practi-
tioner were employees of a Federally funded
community health clinic. Under Federal law the
US Government has had to step in as the defend-
ant and try to defend their actions as they cannot
be sued individually even if they were negligent
and their negligence caused harm, a legal techni-
cality not available to caregivers in the private
sector or in many state-run healthcare settings.
The Government’s argument will be that the
nurse practitioner’s daughter’s criminal act sup-
plying the form to her friend was an intervening
cause that relieves the Government from liabil-
ity, but the Court has not yet ruled on that issue.
Eaton v. US, 2012 WL 6203002 (M.D. Ga., December
Legal Eagle Eye Newsletter for the Nursing Profession January 2013 Page 8
Read the two case summaries provided
. The case summaries are on page 2. Once you read the two case summaries, follow the instructions below.
Compare the appropriate nursing interventions by the nurse completed in Mississippi to the inappropriate nursing interventions by the nurse in the Texas case. Provide rationale supporting your comparison citing at least two scholarly sources.
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