Criminal charges against WI Nurse

U.S.A. Wisconsin

Published

What are your thoughts on the criminal charges brought against the nurse who made a med error at St. Mary's hospital ? I feel this is inappropriate action and sends the wrong message to many nurses. Mistakes happen. I feel very sorry for the family and my prayers go out to the nurse. Here is the article:

Former St. Mary's nurse charged in death of patient

DAVID WAHLBERG and ED TRELEVEN

Contact David Wahlberg at [email protected] or 608-252-6125 and Ed Treleven at [email protected] or 608-252-6134.

Nursing and hospital officials were outraged Thursday after the state filed a felony charge against the nurse whose medication error caused the death of a teenager at St. Mary's Hospital in July.

It's the first time a health- care worker has been criminally charged for an unintentional error in Wisconsin, the officials said. They said the filing could make it more difficult to recruit and retain nurses, already in short supply.

An official with the state Department of Justice, which charged Julie Thao with neglect of a patient causing great bodily harm, defended the move.

"The circumstances of the case go well beyond a simple mistake," said department spokesman Mike Bauer. He said Thao violated several hospital and nursing rules.

Thao, 41, of Belleville, is scheduled to appear Thursday in Dane County Circuit Court. If convicted, she faces a $25,000 fine and up to three years in prison and three years of extended supervision.

Thao, who no longer works at St. Mary's, was caring for 16- year-old Jasmine Gant of Fitchburg on July 5 as Gant was about to deliver a baby.

She mistakenly gave Gant an epidural anesthetic intravenously, a state investigation previously revealed. Gant was supposed to receive penicillin through the IV for a strep infection. An epidural is supposed to be injected near the spine to numb the pelvic area during birth.

Gant died shortly after the error. Her baby boy, delivered by emergency Caesarean section, survived.

According to the criminal complaint, Thao:

Improperly removed the epidural bag from a locked storage system. Gant's physician, Dr. Joseph Fok, never ordered the epidural.

Didn't scan the bar code on the epidural bag, which would have told her it was the wrong drug.

Ignored a bright pink label on the bag that said in bold letters, "FOR EPIDURAL ADMINISTRATION ONLY."

Disregarded hospital and nursing rules in failing to confirm a patient's "five rights" when receiving drugs: right patient, right route, right dose, right time and right medication.

"The actions, omissions and unapproved shortcuts of the defendant constituted a gross breach of medical protocol, resulting in the death" of Gant, wrote Gregory Schuler, an investigator with the justice department's Medicaid Fraud Control Unit.

According to a written statement and an interview with a state investigator, Thao said she got the epidural bag to show Gant what it looked like. She acknowledged she "had no business getting it out" of the storage locker.

Thao said Gant started crying and panicking; others in the room that day disagree. Gant's emotional state caused Thao to "scoop up" the wrong medication bag, she said.

"I allow priority for compassion to override the need for detail," Thao said.

An investigation continues into whether action should be taken against Thao's nursing license, said Steve Gloe, general counsel for the Wisconsin Department of Regulation and Licensing.

Thao and her attorney, Steve Hurley of Madison, couldn't be reached for comment Thursday.

Shortly after Gant's death, regulators threatened to revoke St. Mary's license and Medicare contract. They cited the hospital with three violations of federal regulations and three violations of state regulations.

After the hospital said it was re-educating nurses and updating policies, the regulators cleared the hospital from penalties.

In a prepared statement Thursday, St. Mary's spokeswoman Sarah Carlson said, "We are very saddened by this development and are sorry to see criminal charges filed against the nurse."

Dana Richardson, vice president for quality at the Wisconsin Hospital Association, said in a prepared statement that "it is cruel to allege that this mistake constituted criminal conduct."

The charge "accomplishes nothing other than to compound the anguish of this situation," she said.

In an interview, Richardson said the charge could have a chilling effect, causing people to be less likely to go into nursing or other health-care fields. "This sends the message that you are at risk for criminal charges if you make an unintentional error," she said.

The Wisconsin Medical Society, the state's doctor group, also opposed the charge, saying it could result in decreased access to health care, especially in underserved areas.

Gina Dennik-Champion, executive director of the Wisconsin Nurses Association, said she was "very concerned" about the charge.

Many nurses are already stressed dealing with today's sicker patients, new technology, increased paperwork, staff shortages and requests for overtime, she said.

"This is one more blow," she said. "It certainly isn't going to help morale."

The charge could also cause a setback in the trend within the health-care system toward more transparency about mishaps, Dennik-Champion said.

Rita Vosters, a clinical associate professor of nursing at UW-Madison, said she has talked about the Gant incident in her classes this year.

"Hopefully it will make nurses more careful with medications," she said.

The criminal charge "will be difficult on nurses," Vosters said. "Most nurses do the best job they can . . . But sometimes mistakes happen."

Specializes in Nephrology, Cardiology, ER, ICU.

While I do believe that people are responsible for their actions, I also believe that this nurse (at least from what I have read in the papers), did not do this on purpose. If she goes to jail, what's to stop other prosecutors from filing charges when mistakes are made that harm patients?

If you run stop lights, its no accident and of course you are liable. However his nurse did not INTENTIONALLY cause harm to the patient.

This is what I view as the difference in the two situations.

We had a very experienced RN in our NICU about five years ago, somehow gave tube feeding via an IV and the child died. It was horrible, she lost her job, her license was in jeopardy and she felt just awful. I do not know the particulars except that she was not criminally prosecuted. She no longer practices nursing.

Specializes in Utilization Management.
If you run a bunch of traffic lights and kill somebody in a car accident ... you're still guilty of negligent homicide, even if you didn't maliciously mean to kill anybody.

That's what the negligent homicide statute is for. At some point, people have to be responsible for their actions.

:typing

If I ran a bunch of traffic lights and killed someone, I'd expect to be treated as a criminal. That's no accident.

However, what if a truck pushes my car through all those stoplights and then disappears? Was the accident entirely caused from my negligence alone?

This is the only way I can demonstrate that the problem here is, IMO, one of scapegoating the nurse rather than questioning the system that caused the accident.

We always shake our heads when we see dangerous patient loads, exhausted staff trying to make do, and management always comes out clean as a whistle.

We always ask ourselves, "What will it take for management to wake up and change things?"

Well, here we are. This is the day we dreaded for ourselves and for our fellow nurses--a patient has died.

Are we asking how we could've prevented this? Is Admin?

No.

Another nurse is gonna hang and we're all just going to go to work and hope that the next time it isn't us.

We always shake our heads when we see dangerous patient loads, exhausted staff trying to make do, and management always comes out clean as a whistle.

We always ask ourselves, "What will it take for management to wake up and change things?"

I'm not going to argue with you on this one. Generally, understaffing and exhaustion is not a legal defense, although it probably should be.

However, this is why I will NEVER work anywhere but California. Not just because of the ratio law but, we can legally give employers four hours notice that we are unsafe if, for example, a nurse doesn't show up for a shift and they want us to work overtime.

We have to stay for four more hours to give them a chance to find a replacement. But, as long we as give notice that after four hours we're exhausted and unsafe ... we've legally covered and cannot be charged with patient abandonment, even if they don't find a replacement.

We can also legally protest unsafe patient assignments by filing incident reports. Let's say they give you too many high acuity patients or they violate the ratio law. You still have to accept the assignment but, if you protest it and declare it unsafe with risk management, you're totally covered with the board and lawsuits. They can't fire you for protesting the unsafe assignment either.

:typing

While I do believe that people are responsible for their actions, I also believe that this nurse (at least from what I have read in the papers), did not do this on purpose. If she goes to jail, what's to stop other prosecutors from filing charges when mistakes are made that harm patients?

If you run stop lights, its no accident and of course you are liable. However his nurse did not INTENTIONALLY cause harm to the patient.

This is what I view as the difference in the two situations.

We had a very experienced RN in our NICU about five years ago, somehow gave tube feeding via an IV and the child died. It was horrible, she lost her job, her license was in jeopardy and she felt just awful. I do not know the particulars except that she was not criminally prosecuted. She no longer practices nursing.

There could be differences in the case you've mentioned also. I don't think the board or prosecutors expect nurses to be perfect. And the law, at least in my state, requires prosecutors to prove several elements in the case, not just one.

For example, prosecutors have to prove that the deadly consequences were foreseeable by the nurse. If the consequences aren't foreseeable then, they don't have a case. Presumably the bright pink warning label is a foreseeable consequence in this case but, maybe there wasn't foreseeable consequences in the NICU case.

I don't think prosecutors will have carte blanche with prosecuting nurses because of this case. Looks to me like the nurse had several opportunities to avoid the error but didn't.

:typing

This just makes me sick. I am just upset. I feel that she had no intent on killing this girl. I admit this is the most neglegant thing ever. Did not do the rights of drug administration. I feel that she definentaly deserves to lose her license. Criminal charges are way too much. I feel that drunk drivers who are caught should have criminal charges and be in jail. I feel that every drunk driver should have criminal charges they are a lot more unsafe then Thao would ever be.

If she was found guilty it would definitely make me think twice about continuing nursing in my busy ICU. I've never made a mistake that hurt a patient but sometimes I think "There but the grace of God go I..." when I hear something like this. I admit that from the description it sounds like a particularly negligent mistake, but we don't know all the details or what was going through her mind -- I'm sure she did not want to hurt this girl at all. Very sad story. :(

Things have really changed at the hospital as I work there. She was a very experienced RN and very caring. However, mistakes were made.

I feel horrible for both Julie and the Grant family.

Question: if it was a member of your family who died because of this, would you still think the RN should only lose their license and not be prosecuted?

I realize we don't have all of the details here. But I'm still trying to figure out why she would go into a locked cabinet to get the epidural bag. The article says she wanted to show it to the patient.

Seems weird ... like how would showing a patient the bag make any difference, even if the patient was upset?

:typing

Specializes in Utilization Management.
Question: if it was a member of your family who died because of this, would you still think the RN should only lose their license and not be prosecuted?

I realize we don't have all of the details here. But I'm still trying to figure out why she would go into a locked cabinet to get the epidural bag. The article says she wanted to show it to the patient.

Seems weird ... like how would showing a patient the bag make any difference, even if the patient was upset?

:typing

I'm not sure how to answer your first question, Lizz, because although I realize that you're asking a hypothetical question, a member of my family actually DID die from a med error. So I can speak from experience.

It never occurred to our family to pursue criminal charges. It was not what we considered a criminal act.

It was an accident.

Just like this death.

Having lost a young family member to a med error, I can imagine the grief, pain, and anger of the family of the patient. Being a nurse who has made med errors myself, I can also imagine the grief, pain, and anguish of the professionals involved.

Either way, there are no winners.

We might want to bear in mind that all our Monday-morning quarterbacking is based on articles written by reporters who most likely have no medical background and have no clue as to what nurses do or how hospitals work.

IMO, there is nothing to be gained from throwing this nurse--or any nurse--in jail and ruining her career--for life--for a mistake unless it can be proven that the nurse was somehow impaired or had previously proven herself to practice in a substandard manner.

I see that your feelings are different and I respect that, but nothing you say is going to make me change my position on this issue.

We are people. We are human. We make mistakes. We became nurses despite the fact that we were terrified of hurting anyone, and crossed our fingers and prayed and did everything we could possibly do to prevent that inevitable mistake.

But it happened anyway.

This is the danger in prosecuting nurses. It will happen again, to another nurse, another patient. Mistakes are inevitable.

Perhaps now you can answer a couple of questions for me:

Do our prisons have enough room for all the nurses who will accidentally harm a patient?

How does society gain by prosecuting nurses who err?

How does the profession survive if all nurses make mistakes, and nurses who err are prosecuted?

Perhaps now you can answer a couple of questions for me:

Do our prisons have enough room for all the nurses who will accidentally harm a patient?

How does society gain by prosecuting nurses who err?

How does the profession survive if all nurses make mistakes, and nurses who err are prosecuted?

As far as prison space, the answer in California, at least would be no ... there's not enough space. But, the state is also under federal court order to build more prisons so, that may be a moot point eventually.

Does society gain? Depends on the case. In this case I'd probably feel better about not prosecuting this particular nurse if I knew why she got the epidural bag out of the cabinet in the first place. I dunno but, when I'm really busy the last thing I do is go into locked areas and grab meds I don't need. The explanation of wanting to show the patient the bag just seems really weird to me but, still, we don't know the answer to that question.

Not too long ago, two nurses were prosecuted for negligent homicide in a case where an elderly man was in a great deal of pain, and they didn't feel they could wake up the doctor. So they gave him the pain meds without an order, and it killed him.

In that case, it probably does some good because they were praciticing medicine without a license. And I hate to say it, but I do see that a lot on the floor. If we never prosecute nurses for things like that then, it could cause a lot of problems.

We also had a local Angel of Death case where the RN claimed K IV push was a med error, and/or he didn't know that K IV push could kill people. In that case the standards of practice was the key thing that got him convicted. Regardless of whether or not he knew, as an RN he should have known. So, in that case, it probably did society some good. Afterall, look at how long it took for them to catch Charles Cullen.

As far as mistakes are concerned, I don't think nurses will be prosecuted for all mistakes. As I previously mentioned, many elements have to be proven for prosecution ... not just one. There are many safeguards and defenses available to RN's.

It's a fine line but the key question here is .... if nurses are never prosecuted for gross negligence that results in a death, is losing their license enough of deterrent to prevent those deaths? Again, it obviously depends on the case but, I'm not sure that it is. In some cases, maybe the consequences should match the crime, so the speak, if you're responsible for that death.

While the profession may not survive if too many nurses are prosecuted for error (which hasn't been the case ... prosecutions are actually rare). The profession may not also survive if too many med errors are killing people and nurses lose credibility and trust.

:typing

Specializes in Utilization Management.
In that case, it probably does some good because they were praciticing medicine without a license. And I hate to say it, but I do see that a lot on the floor.

"Lots"?

I don't quite understand how the WI case is an error and that you're OK with a criminal prosecution, but you witnessed deliberate, illegal acts "a lot."

When you say "a lot," it implies that you were aware, but did not report. That's complicity, and it puts your license at risk too.

And if the trend is to prosecute rather than discipline, or--Heaven forbid! do a root cause analysis of the entire system involved in a med error--then you've just proven my point.

We're all, being human, at the mercy of a very capricious justice system.

"Lots"?

I don't quite understand how the WI case is an error and that you're OK with a criminal prosecution, but you witnessed deliberate, illegal acts "a lot."

When you say "a lot," it implies that you were aware, but did not report. That's complicity, and it puts your license at risk too.

I did report it but, unfortunately nothing came of it. I guess that's why I'm not too worried about prosecutors going after nurses like you guys are because, it doesn't happen very often ... even when it should. There wasn't any patient death or harm, however, so that's why nothing came of it. Prosecutors are really only interested in extreme cases.

:typing

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