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Thank you for your comment. I did contact my state legislators several months ago, and I appreciate their willingness to review the matter. While legislative offices can often facilitate communication with state agencies, my experience has been that an inquiry does not necessarily result in a correction or resolution. I remain hopeful that the Attorney General's Office will ultimately update the publication to reflect the final legal disposition. One important clarification is that the Attorney General's press release states that I entered a "guilty plea." That description omits a legally significant distinction. The plea was a Newton plea under Washington law, not a traditional guilty plea involving an admission of factual guilt. As recognized by the Washington Supreme Court in State v. Newton, following the U.S. Supreme Court's decision in North Carolina v. Alford, a Newton plea permits a defendant to maintain innocence while the court independently determines that a sufficient factual basis exists to accept the plea. What is also missing from the press release is the final legal disposition: • The conviction was vacated. • The finding of guilt was withdrawn. • The case was dismissed with prejudice by the Pierce County Superior Court. • The National Practitioner Data Bank (NPDB) voided the report, determining that "the original action should never have been taken." These are the final judicial and administrative determinations in the matter. They are not reflected in the publicly indexed press release, leaving readers with only the beginning of the story rather than its final resolution. If this issue resonates with you, I encourage you to read the Attorney General's press release alongside the final legal disposition and consider whether publicly indexed records should be updated to reflect the complete outcome of a case, rather than only its initial stages. https://www.linkedin.com/in/joanne-hardtke-a19392133/

Unfortunately when I looked my name up on my mobile device I can still see this posting at the top of the search. When I look from my PC it is not there. At least there is a little forward movement.

Update: Following my recent outreach to the Washington State Attorney General's Office, I was contacted by a state representative's office, which has indicated a willingness to assist in reviewing this matter. I have also noticed a positive change in search results—when searching my name, the previously referenced press release is no longer appearing. I appreciate the responsiveness and the willingness to look into this issue, and I remain hopeful that a formal and lasting resolution can be reached that accurately reflects the final legal disposition. Thank you to those who offered support and thoughtful input.

Thank you—I appreciate that. In my situation, it's actually just the Washington State Attorney General's press release that hasn't been updated. Other records do reflect the final outcome.

I want to share a real example of an issue that affects more people than most realize: outdated public records that remain online without reflecting final legal outcomes. In my case, a press release published by the Washington State Office of the Attorney General, describing a 2013 matter based on an initial accusation. What is missing is the outcome. That matter was later fully resolved: • The conviction was vacated • The finding of guilt was withdrawn • The case was dismissed with prejudice • The associated National Practitioner Data Bank (NPDB) report was voided, with a determination that the original action should not have been taken In other words, the legal process did not uphold the original allegation. The matter was formally undone and concluded. For additional context: the press release describes a "guilty plea”; however, the resolution involved a Newton plea—which is not an admission of guilt. The medical allegations described were also contested, with subsequent clinical findings not supporting that characterization. Any interim limitations referenced at that time do not reflect my current ability to practice. I submitted a good-faith request asking that the publication be updated to reflect this final outcome—or at minimum include a brief notation for context. Here is the response I received: "It is our policy that changes are only made... where there are factual inaccuracies. The press release does not contain inaccuracies and is a correct statement of what happened at the time. We are not able to accommodate this request.” I clarified that the issue is not historical accuracy—but present-day impact and omission of the final legal disposition. The response: "We fully understand your request and are not able to accommodate it... Your request was reviewed by the appropriate legal authority…” So the position is clear: If something was once true, it can remain published indefinitely—even if the final legal outcome reversed it. That raises a serious question: Is a record truly "accurate" if it omits the outcome that changed everything? When a publication presents an accusation without the resolution that vacated and dismissed it, the result is not neutral—it is misleading by omission. This is not about erasing history. It is about ensuring that publicly indexed information reflects the full and final truth—not just the beginning of a story. Because when the outcome is omitted, the public is left with a version of events that no longer reflects reality—and that has real consequences. This issue extends beyond one case. Many individuals—especially professionals—remain tied to incomplete public narratives that fail to reflect final legal determinations. Public information should inform—not mislead. I remain hopeful that a reasonable solution can still be reached. #PublicRecords #DueProcess #LegalIntegrity #WashingtonState #NPDB #DataAccuracy #ProfessionalReputation

Show her this Copy-Paste Charting in Nursing Documentation: Legal, Ethical, and Patient Safety Implications Under Washington State Standards Accurate medical documentation is a cornerstone of safe patient care, continuity of treatment, and legal accountability. In modern electronic health record (EHR) systems, the ability to copy and paste, copy forward, or use templated language has become common practice. While this functionality can improve efficiency, it also introduces risk when used without careful verification. In Washington State, nursing documentation is governed not only by professional ethics but also by the Washington Administrative Code (WAC), which sets clear expectations for accuracy, accountability, and truthful recordkeeping. In addition, individual healthcare institutions often maintain their own documentation policies that further regulate how and when copy-forward functions may be used. The Role of Documentation in Nursing Practice Nursing documentation serves multiple purposes: it communicates patient status to other providers, supports clinical decision-making, provides legal evidence of care, and contributes to billing and quality review processes. Because of its importance, documentation is considered part of the nursing act itself. What is written in the chart is treated as a factual record of what occurred. Electronic systems allow information to be reused from prior notes. This practice is not inherently prohibited. However, the nurse remains responsible for ensuring that each entry reflects a current, personally verified assessment. Washington State Regulatory Framework Under WAC 246-840, which governs nursing practice in Washington, several provisions are particularly relevant to documentation practices: WAC 246-840-700 (Standards of nursing conduct or practice) requires nurses to maintain accurate, complete, and truthful patient records. The rule identifies unprofessional conduct as including: Falsifying patient records Making inaccurate entries Failing to document care or observations appropriately WAC 246-840-705 emphasizes accountability and professional responsibility in the performance of nursing duties, including documentation that reflects actual care provided and assessments performed. While these regulations do not prohibit copy-paste use directly, they establish that the nurse is accountable for the accuracy and truthfulness of every entry under their name, regardless of how the text was generated. Institutional Policies and Additional Requirements Beyond state regulations, each healthcare organization may establish its own internal policies regarding documentation practices, including the use of copy-forward or templated charting. These institutional rules may dictate when copying is permitted, how entries must be verified, and what level of editing is required before signing a note. Facilities often include expectations such as reviewing all imported text for accuracy, clearly updating patient status, and avoiding reuse of assessment language without direct confirmation. These policies are enforceable at the employment level and may carry disciplinary consequences if not followed, even when no state regulation has been violated. When Copy-Paste Becomes a Risk Copying forward information can be appropriate in limited situations, such as repeating a stable medical history or medication list that has been verified. However, it becomes problematic when: A physical assessment is documented without being performed Language such as "tolerating well,” "ambulating,” or "comfortable" is carried forward without confirming the patient's current status A note implies observations the nurse did not personally witness Outdated information remains in the chart after the patient's condition has changed Under WAC 246-840-700, such entries may be interpreted as inaccurate or misleading documentation, even if the intent was efficiency rather than deception. Patient Safety Implications Inaccurate copy-forward documentation can create a false clinical picture. Providers rely heavily on prior notes when making treatment decisions. If copied statements suggest a patient is stable, mobile, or tolerating procedures when they are not, it can affect: Admission decisions Pain management planning Diagnostic urgency Recognition of deterioration Because of this, documentation errors are not only regulatory concerns but also patient safety concerns. Clinical Case Example: Impact of Inaccurate Copy-Forward Documentation In one recent emergency department encounter at a large college-affiliated hospital in Portland, Oregon, a formal amendment request and Statement of Disagreement were submitted by a parent after documentation was found to conflict with observed events and reported symptoms involving their child. The chart documented that diet was being "advanced" and implied oral intake was being reintroduced. In reality, no food or fluids were offered during the visit, and the patient had already gone approximately 23 hours without oral intake at the time of discharge. This created a misleading impression that nutritional tolerance had been assessed when it had not. Documentation also indicated that pain medication was declined. However, pain medication had been requested during the visit but was not administered. This distinction is clinically significant, as it affects how future providers interpret pain severity, response to treatment, and willingness to accept care. The record further included statements suggesting normal mobility, adequate tolerance of procedures, and absence of dizziness. However, the child had arrived by wheelchair, remained in bed for the duration of the visit, had ongoing dizziness and vision changes that improved only when lying down, and had no oral intake during the stay. During a duplex ultrasound, probe pressure over a tender area caused severe pain. The child cried and stated that it hurt, and then became briefly unresponsive and difficult to arouse before being awakened. This event was significant to the parent observing the encounter and relevant to the child's pain response and procedural tolerance. Additional documentation indicated steady ambulation at discharge. These entries did not reflect the patient's reported condition, which included severe persistent epigastric pain, limited intake due to pain, significant recent weight loss, and functional limitation during the visit. Vital signs obtained while supine appeared normal in the emergency setting; however, subsequent outpatient orthostatic measurements showed marked heart rate elevation when upright. This distinction was clinically relevant to symptom interpretation but was not reflected in the initial documentation context. This example illustrates how templated or copied language—such as "advancing diet,” "tolerating well,” "denies dizziness,” "steady gait,” or "declined pain medication”—can create a clinical narrative that differs from observed functional status when not individually verified and updated. Ethical Responsibilities Nurses are ethically obligated to chart what they personally observe, assess, and perform. Professional standards require: Verification before reusing prior text Updating findings to reflect current conditions Omitting statements that were not observed during the present encounter Even when templates are used, the final note must represent a real-time clinical picture. Legal Considerations Medical records are legal documents. In legal or regulatory review, the chart is assumed to be an accurate account of events. If a copied note includes statements that are later shown to be untrue, it may be interpreted as: Inaccurate documentation Failure to assess Potential falsification if knowingly incorrect Washington's WAC framework places responsibility on the individual nurse to ensure each entry is accurate at the time it is signed, and institutional policy may further define expectations for how documentation must be completed. Best Practice Approach Safe and compliant use of EHR tools generally includes: Using templates only as a starting point Confirming all findings before signing a note Editing copied text to reflect the current encounter Removing statements that were not directly assessed Following both WAC requirements and facility-specific documentation policies These practices align with state requirements for truthful and complete recordkeeping and institutional standards for safe care. Conclusion Copy-paste charting is not illegal in itself. However, under Washington Administrative Code 246-840, nurses are legally and professionally responsible for ensuring that every note accurately reflects the care provided and the patient's condition at that moment in time. Additionally, each healthcare institution may dictate its own rules regarding the acceptable use of copy-forward documentation. When copied documentation creates inaccuracies—such as documenting diet advancement when no intake occurred, stating pain medication was declined when it was requested but not administered, or failing to capture a significant pain response during a procedure—it can cross into unprofessional conduct due to its potential to mislead other providers and compromise patient safety. In the modern clinical environment, efficiency must be balanced with accuracy. The guiding principle under Washington regulations and institutional policy alike is simple: if a nurse signs the note, they are accountable for its truthfulness, regardless of how the words were entered into the record.

Thank you, Davey, I really appreciate your thoughtful response and the time you took to look into both functional pain and MALS. Your point about the risk of accepting prior documentation without reassessing from the ground up really resonated with me — that has been one of the most difficult parts of this experience. We absolutely understand that functional pain is a real and valid diagnosis, and we know many children struggle with it. The Rome IV criteria provide an important framework for identifying functional GI disorders when symptoms are present without an identifiable structural or inflammatory cause. What has been concerning in our situation is the presence of objective changes occurring alongside the symptoms — weight loss, orthostatic tachycardia, syncope during testing, difficulty maintaining hydration, ulcerations seen on capsule endoscopy, and an abnormal finding in the terminal ileum on MRE. These findings were shared with providers, but at times they did not seem to be addressed or incorporated into the ongoing assessment. With findings like these, it has been difficult to feel confident that a purely functional explanation fully accounts for the clinical picture. It has sometimes felt like those objective pieces have been overshadowed by the initial label rather than prompting a fresh look at the evolving presentation. Your examples from your own practice highlight exactly why that "start from zero" mindset is so important, especially in complex cases. That is ultimately what we are hoping to find with a coordinated evaluation — a team willing to reassess everything as it stands now, not just where things started. Thank you again for your encouragement and for recognizing how challenging this process can be for families. I will continue to share updates as we learn more.

For more than a month, our family had been living inside a steady progression of symptoms that were changing our child's daily life. What began as abdominal pain at the end of December gradually intensified into severe post-prandial pain, poor oral intake, rapid weight loss, dizziness, and persistent visual disturbances. As a parent, I watched my 12-year-old begin to fear food because eating consistently made the pain worse. As a nurse practitioner, I tried to interpret what I was seeing clinically while also managing the reality that this was happening to my child. By early February, his condition had not improved. He was experiencing severe abdominal pain daily, worsened by eating and movement. He had ongoing dizziness and described visual changes, including tunnel vision, that had first appeared days earlier and had not resolved. His oral intake had steadily declined because eating triggered pain. Over the course of approximately one month, he lost 10 pounds. His energy level dropped, and weakness became more noticeable. At home, we began noticing a concerning heart rate pattern. At rest, his heart rate would sit around 90 beats per minute. When he stood up, it would rise dramatically — into the 150s. These episodes were accompanied by dizziness and a sense that he might pass out. On February 4, we brought him to the OHSU emergency department because the symptoms were not getting better and his ability to eat and drink was worsening. That morning, he had not had anything to eat or drink. He reported dizziness, epigastric pain, and persistent visual changes that had been present since late January. He appeared pale, tired, and uncomfortable. During the visit, he remained in bed and did not ambulate around the department. Movement was slow and guarded because position changes increased his pain. He continued to report dizziness and difficulty focusing visually. These concerns were shared as part of the history. We expressed concern about the significant increase in heart rate when standing and asked if orthostatic vital signs could be checked. The response given was that his resting vital signs were normal. Standing vitals were not obtained. At one point during the visit, a bedside Doppler/duplex ultrasound of the mesenteric vessels was performed. Pressure applied to his abdomen caused a visible increase in pain, and he verbalized that the area being pressed was where it hurt most. During the study, he became increasingly uncomfortable and at one point lost responsiveness and passed out while the probe was pressing over the painful area. For a brief period, he was unresponsive. As a parent, this was alarming, particularly given the ongoing dizziness, weight loss, and difficulty maintaining intake leading up to the visit. Afterward, he appeared weak, quiet, and more withdrawn, and his pain was worse. Throughout the day, his symptoms did not meaningfully improve. He remained in significant abdominal pain. He continued to feel dizzy. His visual symptoms persisted. His intake had been poor leading up to the visit and remained a concern. In reviewing the documentation afterward, several charted statements did not reflect what occurred during the visit. Notes indicated that he denied needing medication for discomfort, that his diet was being advanced, and that he was moving comfortably or changing positions quickly. From the parent's perspective, these statements did not match what was happening clinically. He continued to have severe pain throughout the visit. He did not appear comfortable, and his movements were slow and guarded. There was no meaningful oral intake, and advancing diet was not something that occurred in practice. He had not eaten or drunk that morning and continued to struggle with intake due to pain. One moment that stood out was a conversation about expectations. During the visit, nursing staff explained that admission is not provided for severe pain and is not provided for inability to eat or drink. Hearing that shaped how we understood the plan of care and the likely outcome of the visit. It reframed the situation from one where we were hoping for stabilization and evaluation to one where we began preparing to leave despite ongoing symptoms. As the visit continued, he stayed mostly still in bed, conserving energy. He did not walk through the department. When it was time to leave, he stood slowly and walked out carefully. He reported dizziness as he left. There was no sense of resolution — only that we were returning home with the same symptoms that had brought us in: severe pain, weight loss, persistent dizziness, visual changes, and an ongoing inability to maintain normal intake. From a clinician's perspective, it is easy to focus on resting vital signs, imaging, and brief observations. From a parent's perspective, the experience is shaped by watching your child lose weight rapidly, struggle to eat, become dizzy when standing, and briefly lose responsiveness during an exam meant to help find answers. This experience reinforced for me how important it is to capture the full clinical picture — not just isolated observations, but patterns: rapid weight loss, prolonged intake intolerance, orthostatic symptoms, neurologic complaints, functional decline, and symptom escalation with examination. In pediatrics, families are often the ones tracking the trajectory. What happens across days and weeks can be just as important as what happens during a single visit. For nurses, the story behind the chart matters. A child quietly lying in bed may not be comfortable — they may be conserving energy. A child who moves slowly may not be steady — they may be pushing through dizziness and pain. A normal resting heart rate does not always reflect what happens when that child stands. Small details, carefully documented, can change how the next team understands the child in front of them. Sometimes the most important part of care is recognizing the pattern that is unfolding, even when the answers are not yet clear.

As a parent of a 12-year-old child with severe, ongoing abdominal pain and related symptoms, I want to share how difficult it can be to navigate the medical system when an early ER diagnosis becomes the narrative that follows a child everywhere.Despite significant clinical concerns — including rapid weight loss, documented tachycardia on standing, fainting from pain during testing, inability to maintain hydration, and prior studies suggesting possible vascular stenosis and small-bowel ulcerations — our child was labeled with "functional pain" during an emergency visit. From that point forward, it became nearly impossible to move past that label.We have submitted multiple amendment requests to correct or clarify the chart across several major institutions in Washington and Oregon. Even when additional findings and specialist notes were available, they were often placed in addenda or media sections that providers did not appear to review. As a result, new providers frequently relied on the original ER documentation rather than reassessing the current clinical picture.In several instances, when our child presented trembling in severe pain, dizzy, unable to eat or drink, and clearly declining, the response remained focused on outpatient follow-up rather than immediate support. Requests for pain control and hydration were declined. We were repeatedly told this was "functional,” despite objective changes in health status.Multiple hospitals have been involved in his care, including Seattle Children's, Mary Bridge, and Oregon Health & Science University. Each system has pieces of his medical story, yet the early label has made it difficult to be heard. We have reached a point where we are traveling out of state to Stanford to pursue coordinated evaluation with GI, vascular, and surgical teams due to strong suspicion for Median Arcuate Ligament Syndrome (MALS), a condition that is known to be challenging to diagnose.This experience has shown us how powerful and lasting a single ER diagnosis can be, and how hard it can be for families to correct the record once that narrative is established. When documentation does not fully reflect the clinical picture, it can affect access to care, provider perception, and ultimately patient outcomes.We are sharing our experience in the hope that greater awareness can help improve how complex pediatric cases are documented, reviewed, and reassessed over time.