Holland & Hart Healthcare Law Blog

THE GREAT NURSE ANESTHETIST “OPT OUT” DEBATE

 

 

Under Medicare rules Certified Registered Nurse Anesthetists (“CRNAs”) must be supervised by a physician, typically an anesthesiologists or perhaps by a surgeon in rural areas where anesthesiologists are not available.  Medicare has a state “opt out” provision which permits CRNAs to practice without supervision of a physician.  To date, 15 states have chosen to opt out and others like Colorado are considering doing the same.  Anesthesiologists are compensated for supervising CRNAs and can supervise up to 3 at a time because they are not required to be in the same room.

METHADONE CAN BE A “REASONABLE ACCOMMODATION” FOR ADDICTED NURSE UNDER THE AMERICANS WITH DISABILITY ACT

    A federal district court in the middle district of Pennsylvania denied a motion to dismiss and ADA claim by an opiate dependent nurse who was clean but participating in a methadone program to avoid relapse.   The Methadone program required frequent opioid testing to insure compliance with the program.  The Pennsylvania Board of Nursing had a secret policy prohibiting the licensing of any nurse on Methadone. 

“VULGAR” MYSPACE BLOGING NURSING STUDENT ORDERED REINSTATED BY FEDERAL COURT.

Nina Yoder was a nursing student at the University of Louisville on an obstetrics rotation. In February 2, 2009, she posted a blog article on her MySpace page entitled “How I witnessed the Miracle of Life.”  The article, despite its uplifting title was largely snarkey, even vulgar as described by the defendants and even the judge in Nina Yoder v. University of Louisville, et al., Case No.3:09-CV-205-S (W.D. KY at Louisville),issued on August 3, 2009. The University dismissed Ms. Yoder for violating the School of Nursing Honor Pledge in a Memorandum Opinion  granting summary judgment reinstating Ms. Yoder. The blog article described a difficult birth in the context of the frustrations and emotional reaction of a tired and conflicted nursing student using graphic and unattractive descriptions of the participants and family awaiting the arrival of “the Creep.”

VIGILANTE NURSE SUIT NEEDLES STIMULUS ACT WITH CONTRIVED HEALTH CARE REFORM VENOM

Something about the State of New Hampshire sometimes attracts odd adherents to the “Live Free or Die” philosophy of which the state is proud.  In the recently filed case of Beatrice M. Heghmann v. Kathleen Sebelius, Secretary of Health and Human Services, Nancy-Ann Deparle, Director, White House Office of Health Reform, and Charlene Frizzera, Administrator, Centers for Medicare and Medicaid Services, 09 CV 5880, filed by Ms. Heghmann’s husband Robert Heghmann in the U.S. District Court for the Southern District of New York,  the Heghmann’s inartfully cobble together a number of perceived grievances emanating from the American Recovery and Reinvestment Act of 2009, colloquially known as the Stimulus Act or ARRA depriving Ms. Heghmann and “all others similarly situated” from constitutional protections of privacy and from medical privacy and security protections under the Health Insurance Portability and Security Act of 1996 (“HIPAA”). This complaint seems more designed to attract attention and notoriety to the Heghmanns than any serious challenge to the implementation of the provisions of ARRA.

TEXAS “WHISTLE BLOWER” NURSE INDICTMENTS RAISE EYE BROWS.

 Things happen differently in West Texas where it can rain red mud. In Winkler County Memorial Hospital in Kermit, Texas two nurses who consider themselves as “patient advocates” have been indicted by Winker County Attorney, Mike Fostell for violation of Texas Penal Code 39.06, the misuse of official information, a third degree felony with the possible sentence of ten years.  Their crime?  They filed an anonymous complaint to the Texas State Board of Medicine concerning Dr. Rolando Arafiles, in which they assert that Dr. Arafiles improperly encouraged patients to purchase herbal remedies from him and wanted to use hospital supplies for a procedure in the home of a patient.  The nurses provided medical file numbers of six patients to the board.  The action of the nurses was in direct violation of a hospital board requirement that all physician complaints be filed with the hospital first before being reported to a state agency.

 

NEGLIGENT DISCHARGE?

The  Indiana Court of Appeals, in McSwane v. Bloomington Hospital and Healthcare System, Ind. App. ct.,No 53A04-075-cv-243 (March 12, 2008) reversed a summary judgment granted in favor of Bloomington Hospital in a claim, that the hospital negligently discharged Malia Vandenneede into the custody of her estranged husband, Monty Vandeneede, following her treatment for apparent martial abuse. The hospital treated Mrs. Vandeneede for laceration puncture wounds and arm and wrist pain
which Mrs. Vandneede herself related to falling off of a horse onto a pile of debris. The plaintiff in the case, Mrs. Ava McSwane, was Mrs. Vandeneede's mother,who advise a hospital nurse that Mr. Vandeneede had beaten his wife with a fireplace poker.

NURSING LOYALTY TO HOSPITAL/DOCTOR OR TO PATIENT?

One of the major stressors in the practice of nursing is the presence of nurses at the fault lines between hospitals, physicians and patients and a sometimes confusing array of demands on a nurses primary loyalty, where the interests of a hospital and/or a physician conflict with that of a patient.  The practice of nursing is now a heavily regulated profession governed by individual state nursing codes and overseen by State nursing boards who have the power to issue or withdraw licenses to practice nursing.  Included in most state nursing statutes and regulations are general obligations to patients and their families to provide care, counseling and teaching to assist the patient in acquiring and maintaining good health or in dealing with poor health.

Unauthorized Disclosure of Patient Information To Non-Treating Doctor Supports Discipline Against Nurse

Britton Cherish Walters, a nurse at Columbia/St.David's Healthcare System in Austin, Texas took matters into her own hands and consulted with a non-treating physician when she became concerned that a patient in the hospital was suffering a stroke. She did so after the treating physician did not come into the hospital to evaluate the patient, but did give instructions for futher tests and observation. The patient had in fact suffered a stoke.