This month we look at the case of a nurse practitioner (NP) who spent years trying to get the courts to overturn a Board of Nursing decision placing her on 3 years of probation based on a finding of gross negligence.

Ms B, aged 56, was an NP with close to 30 years of healthcare experience in a variety of settings.  For the past 2 years she had been working for a medical group, under the supervision of her collaborating physician, Dr G. The medical group provided care for residents in assisted living facilities. The work provided a great deal of flexibility, which Ms B enjoyed. She worked from a home office and provided care onsite at the facilities as needed.

One of her patients, Mr H, was an 82-year-old man living in a facility for patients with dementia. Ms B had been working with this facility since she started with the medical group, and she and the staff at the facility primarily communicated via fax, which Ms B had in her home office.

At 6 PM on March 23rd, the facility sent a fax to Ms B stating that Mr. H appeared to be in distress and asking whether a urinalysis was needed. Ms B was at dinner with friends and did not see the fax until the following morning.

On March 24th, Ms B responded to the fax with a phone call and spoke to the wellness nurse, who reported that Mr H’s vital signs were stable, he was walking around, and he did not have abdominal distension. Ms B filled out a lab request for a urinalysis and faxed it to the facility.

At 2 PM that same day, the wellness nurse faxed Ms B reporting that Mr H had experienced 2 episodes of “chocolate-colored” diarrhea and that the urine sample had been obtained and sent to the lab. Ms B did not respond. At 4:30 PM, Ms B received a second fax from the facility, this one marked “URGENT.” The fax stated that in the last 2 hours Mr H had urinated on the carpet while screaming in pain. According to the faxed message, “He is VERY uncomfortable and when urinating, screams loudly. Please advise as soon as possible.”

Four hours later, at 8:30 PM, Ms B arrived at the facility and examined the patient. After the exam, she called a pharmacy that was able to deliver antibiotics so that the patient could be started on them as soon as possible. The patient began taking the antibiotics at 3 AM on March 25th.

Later that same morning, at 10 AM, Ms B received another fax from the facility, reporting that Mr H had lost his balance and fallen on the floor. The faxed message read that he was sweating, had no balance, and had been placed on 1-on-1 care. Ms B faxed a reply, instructing that the patient’s condition should continue to be monitored. She also prescribed a narcotic pain reliever for the patient.

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Two days later, on March 27th, Ms B received a call from the wellness nurse advising her that Mr H had vomited a “chocolate-like” substance after lunch. The nurse advised that he had ingested chocolate pudding with his medications that afternoon. Ms B replied that the medications might be causing an upset stomach and she advised that the patient be given Gatorade and acidophilus. That evening the patient fell again.

The next morning, Mr H was vomiting blood. Paramedics were called, and he was transported to the hospital where he was diagnosed as suffering from acute renal failure and septic shock. He died in the hospital the following day.