Updated: Published
RN amputates foot .... me thinks necrotic foot possibly fell off or cut during dressing change.
ABC News
11/10/2022
Charges: Wisconsin nurse amputated man's foot without orders
QuoteA nurse in Wisconsin has been charged with elder abuse, accused of amputating a hospice patient’s frostbitten foot without his consent and without doctor’s orders.
After she cut off the man’s right foot last Spring, Mary K. Brown, 38, of Durand, told her colleagues that she wanted to display it at her family’s taxidermy shop with a sign that said: “Wear your boots kids," according to charges filed last week in Pierce County.
The amputation happened May 27, and within about a week the 62-year-old man was dead....
...According to the complaint, the man was admitted to Spring Valley Health and Rehab Center after he fell at his home in March. The heat in his home was not turned on, and he suffered frostbite to both feet, leaving the tissue necrotic. His right foot remained attached to his leg by a tendon and roughly 2 inches (5 centimeters) of skin.
One nurse who had changed the man's bandages on the morning of May 27 said he could wiggle his toes, the complaint said. Brown told two other nurses at shift change that she was “going to cut off the victim’s foot for comfort,” but they told her not to. Brown and two certified nursing assistants went into the man's room to change his bandages, but Brown cut his foot off instead, one of the nursing assistants told an investigator. ...
...Brown told an investigator that the man did not ask her to remove his foot, which she described as “mummy feet,” but that there was no life in the foot and she did it to make his quality of life better, the complaint said. She acknowledged that it was outside her scope of practice and that she did not have authorization. ..
Oy ve......reported to BON.
I would've called the doctor and told him the necrotic foot was hanging on by one tendon, and let the doctor decide what should be done. If he said, "Just sever the tendon" I would ask if I could write that as an order that he would sign.
Just asking: would the necrosis continue on up the tendon into the leg if it was just left alone? I would still dump the decision in the physicians lap.
I've had a patient's necrotic toe fall off during a dressing change. Just called to inform the doc and reapplied the dsg as we had been doing.
Never personally encountered a situation like this, but here is just one of those things that make me say "huh?". From the article:
"His right foot remained attached to his leg by a tendon and roughly 2 inches (5 centimeters) of skin."
and
"One nurse who had changed the man's bandages on the morning of May 27 said he could wiggle his toes, the complaint said."
An old nurse can always learn something new, but though those two things sound kind of improbable in the same foot at that time.
Puh-Leeze! The man’s foot was hanging on by ONE tendon and TWO INCHES OF SKIN!
The doctor should have taken it off himself. No I don’t think a nurse should be in a great amount of trouble for amputating this.
(I have had people’s toes fall off just because I changed their dressing…..and that WASEN’T the goal.) I find it irritating as well when other nurses tell me to be “super careful and gentle” when changing such dressings. I will be careful with painful dressing changes and elderly people with paper thin skin, I will be normal with people who can’t feel their feet and there is no way we are restoring circulation or saving the limb per the doctor’s notes and test results. Because it is useless to post pone the inevitable just so it doesn’t have to “happen on my shift”.
She should have advocated for the doctor to do the right thing and remove it. She shouldn’t have been crass after she cut it off. She should have waited until it fell off on it’s own, I guess, but the smell must have been awful….
I don’t know. This would be the kind of thing I’d lose my license for too. Do you know how many times I wrote for a laxitive because it had been DAYS since I FIRST asked and the patient is like on day 14 of no poop? And then have the doctor refuse to sign the order because he didn’t like what I ordered. But when I asked if he would write it he would say sure…I waited. Then during follow up he would say “Didn’t I tell you that you could give that??” So then I write it and then he won’t sign it. 14 days without a BM and 4 of them me asking for an order.
Newer nurses think this story is a ‘duh! I would NEVER do that’ kind of story….I would have 3-4 years in. Now I’m like well maybe I would do something like that. I mean my God how distressing would it have been for the patient to see his foot like that every time they changed the bandage?!?!?! The man was already on hospice for goodness sake, don’t make him suffer more. And if he wants to be buried with it, put it in a box and send it to the funeral home refrigerator until the rest of him is ready to join.
On 11/17/2022 at 12:13 AM, KalipsoRed21 said:Puh-Leeze! The man’s foot was hanging on by ONE tendon and TWO INCHES OF SKIN!
The doctor should have taken it off himself. No I don’t think a nurse should be in a great amount of trouble for amputating this.
(I have had people’s toes fall off just because I changed their dressing…..and that WASEN’T the goal.) I find it irritating as well when other nurses tell me to be “super careful and gentle” when changing such dressings. I will be careful with painful dressing changes and elderly people with paper thin skin, I will be normal with people who can’t feel their feet and there is no way we are restoring circulation or saving the limb per the doctor’s notes and test results. Because it is useless to post pone the inevitable just so it doesn’t have to “happen on my shift”.
She should have advocated for the doctor to do the right thing and remove it. She shouldn’t have been crass after she cut it off. She should have waited until it fell off on it’s own, I guess, but the smell must have been awful….
I don’t know. This would be the kind of thing I’d lose my license for too. Do you know how many times I wrote for a laxitive because it had been DAYS since I FIRST asked and the patient is like on day 14 of no poop? And then have the doctor refuse to sign the order because he didn’t like what I ordered. But when I asked if he would write it he would say sure…I waited. Then during follow up he would say “Didn’t I tell you that you could give that??” So then I write it and then he won’t sign it. 14 days without a BM and 4 of them me asking for an order.
Newer nurses think this story is a ‘duh! I would NEVER do that’ kind of story….I would have 3-4 years in. Now I’m like well maybe I would do something like that. I mean my God how distressing would it have been for the patient to see his foot like that every time they changed the bandage?!?!?! The man was already on hospice for goodness sake, don’t make him suffer more. And if he wants to be buried with it, put it in a box and send it to the funeral home refrigerator until the rest of him is ready to join.
Nah. Can’t relate. These are not our decisions to make.
Well dear, right back at ya. “It isn’t our decision.” Is the mantra for those who don’t want any responsibility for the suffering they are ignoring.
Was this an appropriate decision? No.
If the title of the article was “Nurse debrided necrotic skin flap on patient in hospice without an order.” would y’all be all up in arms about that?!
Based on what I read, and there is always that caveat, what the nurse did was no worse than that. Does she deserve some sort of minor punishment for not asking first and writing an order? Sure. Does she need some sort of decorum education? Okay, I’ll by that.
Should this be license revoking? Nope. This did not lead to an unexpected outcome to the patient. It didn’t expedite any poor outcomes. It is only shocking enough to make the news because they can describe it as an amputation.
Lynker, ASN, RN
318 Posts
How do you even manage to do that?!