Target Practice

So, a patient was admitted to an Aurora, CO hospital owned by HCA – America.  Depending on what news source you read, he was a 94 or 97 year old gentleman and had the following diagnoses:

• Pneumonitis due to inhalation of food and vomit
• Encounter for palliative care,
• Pressure ulcer of left hip, stage 3 pressure ulcer of right hip, severe, open, yellow and sloughing skin,
• Stage 3 sepsis, unspecified organism 
• metabolic encephalopathy
• Acute respiratory failure unsp w/ hypoxia or hypercapnia,
• Severe Sepsis with septic shock,
• Acute infarction of large intestine, extent unspecified acidosis,
• Acute kidney failure, unspecified,
• vascular disorder of intestine, unspecified
• non-PRS chronic ulcer of right heel and midfoot,
• UNSP severe hyperkalemia
• Hypokalemia
• Alcohol abuse, uncomplicated
• chronic obstructive pulmonary disease
• unspecified fecal impaction
• other specified disease of intestine
• Bradycardia, unspecified
• Age-related physical disability,
• contusion of other part of head, initial encounter 
• exposure to other specified factors initial encounter,
• fall from bed, initial encounter, 
• History of TIA and cereb infrc w/o resid deficits

All of these diagnoses are listed in the complaint filed by DonQuenick Joppy in a lawsuit against the hospital. Given this patient’s age, would this list of diagnoses paint an optimistic picture for you?  If your answer is yes, you likely missed the severe sepsis, pneumonitis, septic shock, and respiratory failure plus a few others.

The physician, along with the family, determined the kindest way to treat this patient was palliative care. Another nurse caring for the patient related these orders to Ms. Joppy.  The respiratory therapist was busy so after turning off the ventilator, Ms. Joppy removed the breathing tube. (An alternate version in another story says Ms. Joppy discontinued the respirator and removed the breathing tube.)  These are not difficult tasks.  

The coroner ruled the death as natural and when asked about the care the patient received, the family said, “Oh, I see, the lady was black, she was very, very helpful, and none of the other nurses, and I’m battling cancer okay. I was getting weak, I told them I needed something to eat to please bring me something, and she brought me a sandwich and coffee, I think it was, and it helped me. The main person I was talking with was this one lady and she was black, very nice. The other ladies were coming in on his vitals and that’s basically it, I can recall.”

The official hospital story is that the patient was transferred from the ER and due to the admission process, Ms. Joppy stayed past her shift.  This was against hospital policy and her supervisors terminated her.  Frankly, it would be irresponsible to leave until report is given and the patient is ready to hand off to an incoming nurse.  There was also an issue that she terminated life support before an order was actually written in the chart which was proven to be false.

But that’s not where the story ends according to the court documents.  Prior to this incident, Ms. Joppy complained to her immediate supervisors who acknowledged a problem with certain charge nurses but these were never addressed.    She then complained to the VP of Human Resources and getting no response, Ms. Joppy put in for a transfer but it was denied because she was on a PIP, unbeknownst to her.  On another occasion, she was denied advanced cardiac training because it required much deeper critical thinking and organizational skills than she had.  (But it was okay to give her three critically ill patients with no help.)  She was observed to keep a neat and clean work area and was jokingly asked by a charge nurse if she wanted to clean his house and cut the dog’s toenails.  This was not a person who joked around with Joppy. Joppy interpreted it as a reference to all the maids and housekeepers of her race.  I think I might have taken it that way, too.  

I hate the word ‘microaggression’.  It sounds like it’s just a small little thing, like a micro-gram vs a milligram but clearly Ms. Joppy had to live with these microaggressions and they were not little things.  She worked in a racially hostile environment and complained through the proper channels with no results.

When a patient complained that Joppy stole her credit card and bought a stethoscope, Joppy was asked to stay out of the break room and then thanked for ‘not making a fuss’.  No investigation took place. Patients have a right to have their property respected.  She should have been fired if she stole the credit card or absolved of guilt if the complaint was unfounded but since no investigation occurred, the hospital punished her in a way that did not protect other patients but humiliated her.

Countering this isolated patient complaint were many accolades and awards in addition to high praise from patients and family members.

According to the claim document, after the patient from the ER died, the hospital then referred the case to the Attorney General’s Office who proceeded to file charges of manslaughter against her.  An email from the hospital stated it was required that the death of the patient be reported to the  Colorado Department of Public Health and Environment and that the Attorney General’s Office decided on its own to investigate the death.  I’m having trouble imagining an employee of the AG’s office sifting through all the required reports of all the hospitals in Colorado and independently deciding to charge a nurse with manslaughter given the overall condition of the patient.  Perhaps recreational marijuana played a part in the decision.  I hear it is very prevalent in Colorado.

After almost a year, and ‘in the interest of justice’, the charges were dropped.  Imagine – being under investigation for manslaughter for almost a year for caring for a terminally ill patient.  I don’t understand how these things work but apparently, the charges were not spelled out for the public record.  There is no way of knowing exactly what or if the AG was thinking when the charges were filed.

So, now she is unemployed.  Apparently being accused of manslaughter is a deal breaker for most employers.  Her living situation is unstable because she cannot pay rent or a house note.  It kind of makes me wonder if the goal was better patient care or the ruination of a career.  I hope the hospital pays her well.  Back pay and reinstatement of her job just doesn’t seem enough.    

Regardless, having reviewed Ms. Vaught’s ordeal and Ms. Joppy’s demise, it appears as though it is open season for nurses.  In my life, I never thought we would be targets of this magnitude. But here we are.