Legal Question

[HSMom2RB]

My 92 yo Grandmother was recently admitted for a total hip. She was moved to a swing bed where her Daughter-in-law told the nursing staff she was taking Ambien 10mg po QHS. The problem is my Grandmother has never had an RX for the Ambien. My aunt (who is NOT licensed and has NO medical training) and/or her daughter having been giving her Ambien at home. My Mom has medical power of attorney, and is in charge of all her medication. My Grandmother has been receiving Ambien, and no one knew...including her MD. My Grandmother lives alone, and was taking Lortab TID for pain control for hip. It's obvious what my aunt did is wrong, if not illegal. Evidently everyone is satisfied with the fact that my Grandmother will not receive any more Ambien:banghead:. My question is, as a nurse, do I have an obligation to report this? If so, who do I report to? I don't have any proof this was being done, it would come down to my word against my aunt's. My Mom found a zip lock bag with ambien pills, but she threw it away. This is not the first time my aunt has done this sort of thing, and I am pretty sure she will do it again. I feel like she should be stopped from practicing medicine without a license before she kills someone. Any suggestions?

[Jolie, BSN]

I suspect that you will be hard pressed to get law enforcement interested in this case. It is probably more of a family isue than a legal one.

You might want to contact Adult Protective Services in your area and ask for their input.

[HonestRN]

:yeahthat:

[RN1989]

Someone was prescribing the sleeper. Just because one doctor didn't know about it doesn't mean that your grandmother did not see another doc to get the rx. And a doc obviously would have had to order it while she was in that swing bed.

I don't see where anything illegal occurred. Unless your relative is forcing your grandmother's mouth open and shoving the pills down her. That might constitute battery.

If the RX isn't in your grandmother's name but she willingly takes meds given to her - there isn't anything you can do about it. I'm sure you have shared tylenol, etc with people who complained of a HA before. No, sharing RX drugs isn't a good idea but again...if your grandmother was a willing participant...

If your grandmother is confused and taking meds because she doesn't know any better - then why are you and your mother allowing her to live alone if she is not competent to make decisions about the meds she takes? That could be construed as being as bad as your relative giving your grandmother meds that aren't RX'd for her.

There are obviously some family issues that need to be worked out. There isn't anything that APS or the police, etc. will do about this situation. If you don't like what is going on, then your family needs to have a sit down and work things out.

[HSMom2RB]

"Someone was prescribing the sleeper. Just because one doctor didn't know about it doesn't mean that your grandmother did not see another doc to get the rx. And a doc obviously would have had to order it while she was in that swing bed."

The order was to resume home meds, and my aunt lied and told the nursing staff she had an RX for it. She has never had an RX for it. Thus the pills were put in a zip lock bag. My Mom is the only one who takes her to the MD. My Grandmother could not take herself. My Mom is very careful to have all her medicine in prepared medication boxes for my Grandmother. My Grandmother is alert and oriented (well, that is until someone overdoses her on Ambien), and chose to take the medication my aunt gave her. None of her MD's knew she was taking this medicine. The legality of it comes into the hospital when my aunt lies and tells the hospital she has an RX when she doesn't. My Mom lives 3 blocks from my Grandmother and checks on her constantly, plus she has a med alert button she wears around her neck. So, it is a very responsible situation. The problems come when the lying gets in the way. My question was simply my responsibilty as a nurse. I did contact APS, and they said it is considered abuse to administer medication for which there is no RX. Also, I think there is a big difference between giving someone Tylenol for a HA, and medicating a 92 yo woman, who weighs 94 lbs, Ambien 10 mg. The geriatric dose is 5 mg. Combined with Lortab, it becomes a dangerous situation.

[Jolie, BSN]

Who put the Ambien in a plastic bag? If your aunt convinced the nursing staff that Ambien was one of Grandma's regular meds, why was a prescription not written or called in for home use? I can't imagine the nursing staff handing over a plastic bag of Ambien to take home. Are you certain that this medication came from the facility and not your Aunt's own supply?

[Candy,MSN,RN]

Did your aunt lie with intentions of an adverse outcome. Did your aunt lie at all? Sounds like there are family issues if you are concerned about your aunt lying in a situation like this. What does your aunt have to gain in the event of her mother-in-laws death?

Home medication lists are "erected" in many fashions. Some people bring their pill bottles. Some people have their records from pharmacies. Some people simply state they take a certain medication. Healthcare professionals transfer the information in which they are given. This results in a home medication list. It is up the the medical practitioner, with prescriptive rights, whether to resume the medication or not. You note that your aunt is no medical practitioner, therefore, how would your aunt know ambien 10 mg is not an appropriate geriatric dose and could thereby be harmful? If no malice was intended or no malice can be proven, nothing will come of your accusations.

In regards to your question, are you bound to report, you should report any suspected abuse of neglect or anyone nursing license or not.

[HSMom2RB]

"Who put the Ambien in a plastic bag? If your aunt convinced the nursing staff that Ambien was one of Grandma's regular meds, why was a prescription not written or called in for home use? I can't imagine the nursing staff handing over a plastic bag of Ambien to take home. Are you certain that this medication came from the facility and not your Aunt's own supply?"

The ziplock bag of medicine was found at home in my Grandmother's purse. Currently my Grandmother is still in the hospital, and she received a dose of ambien per my aunt stating it was part of her home medications (the MD ordered to resume home medication). The plastic bag of medicine was found by my Mom before my Grandmother was hospitalized. My aunt and her daughter have rx's for ambien, and gave my Grandmother the medicine, in the ziplock bag-my Grandmother admitted that information. I don't believe malice was the intent, but rather control...or lack there of on my aunt's part. My aunt is notorius for medicating people with whatever works. She thinks if something works for one person, it will work for someone else. No, she has no medical training (she is a hairdresser), and has no idea the dose is different for her than it is for my Grandmother. She told the hospital my Grandmother was taking ambien at home, because she thinks she knows how to medicate someone. Prime example of a little (and I mean little) knowledge is a dangerous thing. She is constantly doing stupid things, like putting a phonebook under a stool that wan't tall enough for my Grandmother to use. Suprise, suprise my Grandmother fell. No injury resulted, this time, but this is a constant battle with my aunt. She wants to be seen as the "hero" who helped my suffering Grandmother, because in her mind no one else is helping. I live 500 hundred miles away, so I am not in a position to monitor the situation more closely. It absolutely is a family problem that has been going on for years. Talking until we are blue in the face obviously has not helped. So far my aunt has not killed anyone with her hair-brained ideas, but I would rather it not reach that point. I honestly don't know if there is anything I can do, but the reason I posted was to brain storm with other nurses. I had not thought of contacting APS, so that information was helpful to me. What she did was illegal, but proving it is another story, although proving there was no original rx for the ambien will not be difficult to prove.

"You note that your aunt is no medical practitioner, therefore, how would your aunt know ambien 10 mg is not an appropriate geriatric dose and could thereby be harmful?"

She didn't know this was an inappropriate dose. She didn't know it is contraindicated with narcotics. She doesn't know about medicine, and that is the point. She is not malicious in her acts, but that doesn't make her any less dangerous. There have been many times my Mom would find my Grandmother acting "drunk", and she didn't know why. She had been working with MD to try different meds so she wouldn't be so "drunk", and yet still control the pain she was having in her leg (she had bone deteriorization (Sp?) in her left hip). Neither my Mom or the MD knew she was taking Ambien. The only one being irresposible in this situation is my aunt.

[jeepgirl, LPN, NP]

so this is a geriatric patient who's daughter has the right to make medical decisions, right?

i would think i would report it - even if nothing comes from it. she could have been hurt. she could have fell and broke that hip or gotten into some sort of household accident that may have killed her on the ambien.... especially when mixed with the lortab.

i know i am a peds person, but the people who say "well this is a family issue"... well...

what would you say if it was a peds patient? i'm just saying - if the lady is to the point where she can't really care for herself and others have to make her decisions and care for her...

you know?

its just food for thought.

[Vito Andolini]

This is a tough situation. You are assuming your aunt is not malicious and I hope she's not. She is dangerous, though, intentionally or not, as you yourself say. I guess this does constitute abuse and you are required to report it, being a nurse.

Should family report family? Tough call, I know, but if you have knowledge of this problem and don't report, I think you put your own license in jeopardy, if it ever is learned that you knew and did not report. Not sure, really. You need to learn what the law requires in your state. I know it's hard to report family or friends but you have to protect yourself and your Grandma and if talking to your aunt is meaningless and not helpful, what choice do you really have? Can you talk to your cousins?

I think I'd mostly be concerned about Gram's safety. IT sounds like she can't really live alone any more, especially in view of this hip fracture and the meds making her dopey. Very dangerous. Is there a social worker who can be helping you with placing your Gram in either your Mom's home, your home, getting helpers to come in so Gram can stay in her own place, or getting her into a facility where she will at least get her meals, her bath, her meds, and be attended better?

Very hard thing. sorry you have to go through this. But there are agencies and people who can help. Best wishes.

[HSMom2RB]

Thanks for all the responses. I have contacted the BON, and I am waiting for a reponse. I agree, it is not safe for my Grandmother to live alone anymore. I approached my Mom about this months ago. Currently they are building on to their house so perhaps my Grandmother can move in with them. One day at a time. I don't believe my aunt is malicious...she just is not very bright:smackingf. I think it is a blessing she has not killed anyone yet, but I do want to stop her from medicating anyone else like she does, and not have such a good outcome. Thanks for everyone's help and brain storming .