ED Compliance Case Summary

On December 1, 2015, 65 year-old Loretta Macpherson arrived at the emergency room of St. Charles Health System, located in Bend, Oregon. Ms. Macpherson arrived to the emergency room complaining of anxiety. When interviewed about her medication history, Ms. Macpherson was unable to identify the medications which she had been prescribed after her recent hospitalization at St. Charles for brain surgery. After examination, the emergency room physician ordered fosphenytoin, an anti-seizure medication, to be administered via intravenous infusion to Ms. Macpherson. In error she received rocuronium, a paralytic drug, causing her to stop breathing and suffer a cardiopulmonary arrest. Ms. Macpherson suffered irreversible brain damage and was placed

We know that he had sustained an at home fall. We learn that he has a history of pain and a prescription for oxycodone for back pain. We know that his vital signs on admission appear stable; he was not showing any signs of respiratory distress. As we look at the staff that was listed that day we do get the sense the hospital may have been short staffed. Staffing report shows there was one MD, one RN and one LPN managing at least 4 patients including- one patient was a child. Evidence based research has proven that the nurse to patient ratio is directly related to the patient outcomes (Stanton, 2004). It is important that we consider the staffing level that this rural ED as we know short staffing can be blamed for not being able to take the full amount of time needed to do a proper health history. A detailed health history is an imperative part of the care process; it is used by the staff to accurately assess any acute changes that may take place in the patient throughout their stay.

Not only did insufficient staffing contribute to the causes of this particular event, but human error also played a significant role. When Mr. B arrived at the ED, he was hyperventilating. His leg “appeared shortened.” He had edema in his calf, ecchymosis, limited ROM, and he rated his pain at a ten out of ten. Mr. B also had a history of prostate cancer, impaired glucose tolerance, elevated cholesterol and lipids, and chronic pain. He was admitted to the ED with a plan to relocate his hip. Dr. T ordered diazepam 5.0 mg to be administered through IVP and then just five minutes later ordered 2.0 mg hydromorphone to be administered because it appeared that the diazepam was not having the intended sedating effect. Again, just five minutes later, Dr. T was still not satisfied with the level of sedation and instructed the nurse to

It is essential to have knowledge of the previous case which was Rogers v. Okin. Rogers became distressed with the forcible consumption of Haldol, an antipsychotic medication, causing to set herself on fire in order to be transferred to a medical hospital. On April 27, 1975, Rogers, along with six other patients who were also medicated against their will, initiated lawsuit. The lawsuit was filed against officials and staff of the May and Austin Units of the BSH. Plaintiffs were all present or were previous mental patients and were all administered with drugs forcefully. In this case, the Plaintiff prevailed.

When concerning the patient situations there are some important facts that need to be reviewed. The important facts about this case is the patient was a 16 years old guy that got in an automobile accident. The patient stated that he was in a methadone treatment program. A methadone are drugs approved for use in treating opioid dependence patient such as

The claimant was admitted to Tennova Healthcare Lebanon from 5/17/2016 to 6/01/2016. On 5/16/2016, the claimant had some drinks and was not able to drive home. She was in a confused state and apparently her son drove her home. She was last seen about 1 o'clock in the morning and was put to bed. The claimant's mother tried to contact her in the morning, mid morning, and got no response. Her mother went to her house at about 1 in the afternoon and found her in the bathroom laying between the commode and the wall breathing but unconscious. The EMS was summoned and she was brought to the emergency room. She reportedly had taken several tablets of sedatives. In May 2 or 5, the claimant was given Valium 2 mg for some leg discomfort and muscle spasm.

is a nurse practicing in Missouri that has, already, previously been placed on probation for testing positive for heroin. She has recently had a relapse in her recovery and is fighting to get her license back so she can practice nursing. The state board has already given her one chance and she was practicing in Missouri. She has been sober for nearly 3 years and has taken suboxone the entire time of her sobriety to help with withdrawal. E.M. hates that she has a dependency on the suboxone and wanted very badly to wean herself off of it. She spoke with her physician about this matter and her physician strongly suggested that she not be taken completely off her prescription of suboxone. Her physician lowered her dose and she began taking a lower dose. After time passed, E.M. felt like she had things under control and she completely stopped taking her prescription. E.M. went under some stress at her job and ended up leaving the facility she was working at. She knew that one of her old co-workers had access to heroin and after running into him at a local store, she started abusing again. Beginning at the time of her first time being placed on probation E.M. has been required to provide urine samples at randomly selected intervals. During her time of remission, when she was abusing, she failed to call and leave urine samples. At this time, E.M. explained that she was focusing on bettering herself and working on her sobriety. I feel that E.M. was very sincere and was accountable for her actions. She truthfully took responsibility for her wrongful actions. E.M. stated that she now realizes that her heroin addiction is a lifelong addiction that will always be knocking at her door and she cannot stop taking suboxone. The board questioned her and wanted to make sure she did not have plans of going against her physician’s orders again. E.M. was in tears almost the entire time she was explaining her actions to the members of the board and I feel like they were true

Aaron, you have demonstrated knowledge of Department policies and procedures and pose questions when concerns arise. You have demonstrated an understanding and practice of HIPAA laws as is evident in your ability to remain confidential with all investigations despite ongoing inquiries from those that are not authorized including Reporters and various family members. Aaron, you have demonstrated knowledge of the Department’s goals and also Division programs as evidenced by your investigative plans including requests for HCBS, assistance with Medicaid applications and reinvestigations, and care plan or provider changes. Many of these cases required follow up after case closure which you completed thoroughly. Throughout your hotline investigations,

Your affiant conducted the drug evaluation with McManus at the Shenandoah Police Department. The findings were that McManus was under the influence of a drug. I requested McManus to submit to a chemical test of blood, at the Pottsville South hospital, to which he agreed on. McManus' blood was drawn at 1743 hours and his right arm was wiped clean with iodine prior to venipuncture. The blood was sent to Nation Medical Service Labs in Willow Grove, Pa for blood analysis. NMS Labs indicated positive findings of Morphine - Free 95

It is essential to have knowledge of the previous case which was Rogers v. Okin, 738 F.2d 1. Rogers became distressed with the forced consumption of Haldol, an antipsychotic medication, causing to set herself on fire in order to be transferred to a medical hospital. On April 27, 1975, Rogers, along with six other patients who were also medicated against their will, initiated lawsuit. The lawsuit was filed against officials and staff of the May and Austin Units of the BSH. Plaintiffs were all present or were previous mental patients and were all administered with drugs forcefully. In this case, the Plaintiff prevailed.

Ms. Webster is a 28 year old female who presented to the ED via LEO under IVC by her mother for suicidal ideation and alcohol dependence. Ms. Webster denies allegations to nursing staff. Per documentation she appears intoxicated. Per documentation Ms. Webster states, "Going through withdrawals". Before assessment this clinician spoke with nursing staff about Ms. Webster, they reports she has been asking for Ativan since she has been placed in her room. They reports she informed them that she had not consumed any alcohol today. At the time of the assessment Ms. Webster is found sitting upright in her room. Ms. Webster reports she had a plan to hang herself. She states, " you know I have to say that to get into detox." Ms. Webster reports alcohol abuse as primary stressor contributing to her distress. She denies depressive symptoms. Ms. Webster states,

REPORTER: The reporter/ Social Services Director (Vernestine) called with concerns for the victim, Tanya. Tanya has had an aneurism, and she has paralysis. The reporter said the victim’s cognition is off, and she cannot perform her daily ADL’s, but she can talk. The reporter said Tanya has two small children, but her mother (Phyllis) may be keeping the children. The alleged perpetrator is Bryan Blakemore (Husband). On Yesterday (03/29/2016), the victim was discharged AMA (on medical advice). The reporter said when the victim is discharged AMA, they are not given any medications. The victim left with out any medications, but Bryan was given a list of all the victim’s medication. Bryan said he was going to see a doctor in Jackson, MS to have

Ms. Maness is a 45 year old female who presented to the ED with an alleged overdose on 3 pills of Keppra and 3 pills of Librium in a attempt to harm self. Ms. Maness denies suicidal ideations, homicidal ideations, and symptoms of psychosis. Ms. Maness reports a history of Alcohol abuse and recently was 3 days sober, however last night relapsed after conflict with hr boyfriend. Ms. Maness does not appears to be responding to any internal stimuli.

Patient didn't call or show up for his scheduled individual counseling session today at 7 am; however, he received his dose of methadone at the Clinic around 9 :30 am. This writer called pt.’s phone number on file to reschedule a mandatory individual session. Counselor will be flag pt. in the system to see counselor before dosing tomorrow, 12/15/16 to discuss his recovery progress, what the program expects of him at this stage and how to get the most of out

It is often wrongly asserted the primary abusers of the ED are uninsured individuals. The ED in the United State is not being flooded by poor, uninsured individuals seeking medical care. Instead, the NEHI (2010) found that the uninsured populace accounts for only a small percentage of the population using the ED inappropriately. Research from the NEHI (2010) states that ED misuse can be contributed to all populations regardless of insurance status, age, demographics, and race (p. 3). The following graphics by the NEHI (2010) offer evidence that the ED use is universal in the State of Massachusetts in 2005; similar studies were found in several other states.