Thursday, December 15, 2005

Another Criminal Charge for a Colorado Health Care Provider

As noted in a previous post, manslaughter charges have been brought against a Colorado physician who removed a tracheostomy tube in a patient who subsequently suffered respiratory arrest and anoxic brain injury. While unusual, this incident was soon followed by another manslaughter charge -- this one against a nurse in Colorado:

A former nurse at the Denver veterans hospital is accused of killing an elderly World War II vet in 2003 when she disabled a machine monitoring the oxygen level in his blood. Carol Elkins was treating William Thomas Leslie when she disconnected a pulse oximeter, which resulted in his death, according to a federal indictment unsealed Tuesday.

Federal involuntary manslaughter charges were brought because this incident occurred at a VA facility, where federal authorities have jurisdiction. According to the article, federal authorities will be notifying state regulatory authorities.

Why does removal of this monitoring device matter, and what does it involve? Basically, a pulse oximeter measures how well a patient is receiving oxygen, and how well he is delivering that oxygen to his tissues. In the event of respiratory compromise or cardiovascular failure, the pulse oximeter will alarm to allow potential intervention. If the unit is disconnected, the patient may become hypoxic without anyone knowing. Pulse oximeters are used throughout the hospital in a variety of situations, and the newspaper reports don't specify why this patient needed one. As for its removal, the indictment does not state why the nurse would have disabled the unit; a "mercy killing" is not suspected.
The government contends that Elkins was bothered by noise from the monitor.
Interestingly, this incident was apparently not reported to the state health department, which is required by law. It was also not an issue with this nurse obtaining another job two years ago; a routine pre-employment check turned up nothing of substance:
Elkins was suspended Tuesday from her job in an adult medical unit at the Medical Center of Aurora, where she had worked for about two years, according to spokeswoman Beverly Husted-Petry.....She said there was no report of any alleged incident at the veterans' hospital.
Despite the lack of a report to the state health department, the family was able to press for, and receive, a civil settlement from the Dept. of Veterans Affairs. To make their case, prosecutors will need to have plenty of witnesses who will be able to back up their charge of "wanton and reckless disregard for human life;" or, as in the case of Dr. Hogle in my previous post, this may be a case of an error in judgement that led to a very bad outcome. Or, given the financial settlement from the VA, this could also have resulted from a "system issue," rather than the erroneous, or criminally negligent, actions of a single nurse. And if I was an ICU nurse caring for critically sick patients, I'd worry about the potential for criminal charges in the event of an unexpected death.