Case #

1. CLINICAL ROUNDS: Criminal case against nurse ends

Wisconsin obstetrics nurse Julie Thao entered into a plea agreement in December that
resulted in the dropping of a felony charge against her. Thao had been charged with criminal
neglect following a medication error.

While caring for a teenage girl in labor, Thao had intended to administer intravenous
(I.V.) penicillin, which had been ordered for a possible strep infection. Instead, she mistakenly
injected an epidural anesthetic into the I.V. line. The patient died. Local prosecutors made the
unusual decision to charge her with one count of neglect of a patient causing great bodily harm, a
class H felony in Wisconsin.

In a courtroom full of nurses who came to offer support, Thao entered a “no contest” plea
to two misdemeanor counts of illegally administering prescription drugs. In exchange, the felony
charge, which could have resulted in jail time, was dropped. During the hearing, Thao tearfully
apologized to the patient's mother for the fatal error.

Taking into account Thao's positive performance evaluations for the past 13 years, the
Wisconsin Department of Regulation and Licensing suspended her license for a relatively short
period, 9 months, retroactive to July 2006 when the error occurred. The state court placed Thao
on probation for 3 years. During that time, she can't work in critical care settings or birthing
units.

One condition of the plea agreement is that Thao may not work more than 12 hours in a
24-hour period or more than 60 hours per week for 2 years. On the day before making the error,
she'd worked two consecutive 8-hour shifts, and her fatigue was considered to be a factor in the
error. Among other conditions of the agreement, Thao must take classes on preventing
medication and health care errors and make three presentations to nurses or nursing students on
the topic.
 2. Nursing home cases are distinct from medical negligence claims, Florida high court rules.

The Florida Supreme Court recently drew a clear distinction between medical care and
nursing home care by ruling that plaintiffs in cases alleging nursing home abuse and neglect can
sue for wrongful death

and negligence without meeting the state's presuit requirements for filing a medical
malpractice claim. (Integrated Health Servs. v. Lang-Redway)

Citing Florida's Nursing Home Residents Bill of Rights statute, the court held that "if a
plaintiff files a lawsuit seeking to enforce only those rights enumerated in the statute governing
the rights of nursing home residents, the plaintiff is not also required to comply with the presuit
conditions for filing a lawsuit involving medical malpractice."

Susan Morrison, a Tampa lawyer who represented plaintiff Pauline Lang-Redway, said
the court correctly distinguished between the two types of claims. "Medical malpractice is
generally an identifiable, single incident," Morrison said. "This is a custodial issue."

She cited findings by the intermediate appeals court, affirmed by the state high court, that
various nursing home staff members, from nurses to aides to dieticians, were responsible for the
neglect at issue in the case.

From October 1997 until his death in April 1998, Lang-Redway's husband, Albert,
resided at two St. Petersburg nursing homes. Lang-Redway sued both homes, alleging that they
had violated the nursing home statute by, among other things, failing to prevent and treat her
husband's pressure sores to prevent him from filling, and to adequately monitor his nutritional
intake. The defendants--a national nursing home chain and a Florida nonprofit facility--
maintained that the conduct on which the plaintiff based her claim constituted medical
negligence. Before they can be held vicariously liable, the defendants argued, the plaintiff must
abide by the state's pursuit conditions for bringing a medical negligence action.

The supreme court disagreed, stating that the nursing home statute provides its own
standard of care specific to such facilities, and therefore "the medical negligence standard of care
and the corresponding presuit requirements ... are inapplicable."
 The court cited the reasoning of the Second District Court of Appeals, which had
affirmed the trial court's decision not to dismiss. Although the plaintiff had fulfilled the presuit
requirements under the nursing home law, the defendants moved to dismiss the complaint on the
ground that she had failed to fulfill the presuit requirements for medical malpractice claims.

The appeals court concluded that because the plaintiff claimed that her husband did not
receive adequate care at the facilities but did not name or identify any physician or other "health
care provider" as a defendant, "this complaint does not seek vicarious liability for the actions of a
health care provider under a medical negligence standard."

The Supreme Court noted that nursing homes employ a variety of workers and that the
failures the plaintiff alleged "may have been caused by the nursing staff, by the nursing home in
not having adequate staff, by the negligence of aides or other workers, or by a combination of the
above." The ruling is important for cases involving claims that accrued before May 15, 2001,
when the Florida legislature enacted dramatic reforms aimed at improving the quality of care at
nursing homes, but that also afforded them greater protection from patient lawsuits. "This
[decision] is pretty far-reaching," said Morrison. "There are potentially hundreds, if not
thousands, of cases where the cause of action accrued" before the reform law took effect.

Decision of the court

1. CLINICAL ROUNDS: Criminal case against nurse ends.

a. Taking into account Thao's positive performance evaluations for the past 13
years, the Wisconsin Department of Regulation and Licensing suspended her
license for a relatively short period, 9 months, retroactive to July 2006 when the
 error occurred. The state court placed Thao on probation for 3 years. During that
time, she can't work in critical care settings or birthing units.
b. One condition of the plea agreement is that Thao may not work more than 12
hours in a 24-hour period or more than 60 hours per week for 2 years. On the day
before making the error, she'd worked two consecutive 8-hour shifts, and her
fatigue was considered to be a factor in the error. Among other conditions of the
agreement, Thao must take classes on preventing medication and health care
errors and make three presentations to nurses or nursing students on the topic.

2. Nursing home cases are distinct from medical negligence claims, Florida high court rules.

a. The Supreme Court noted that nursing homes employ a variety of workers and
that the failures the plaintiff alleged "may have been caused by the nursing staff,
by the nursing home in not having adequate staff, by the negligence of aides or
other workers, or by a combination of the above." The ruling is important for
cases involving claims that accrued before May 15, 2001, when the Florida
legislature enacted dramatic reforms aimed at improving the quality of care at
nursing homes, but that also afforded them greater protection from patient
lawsuits. "This [decision] is pretty far-reaching," said Morrison. "There are
potentially hundreds, if not thousands, of cases where the cause of action accrued"
before the reform law took effect.

Highlighted point of R.A. 9173 or Philippine Nursing Act of 2002

1. CLINICAL ROUNDS: Criminal case against nurse ends.

• the Wisconsin Department of Regulation and Licensing suspended her license for a
relatively short period, 9 months, retroactive to July 2006 when the error occurred. The
state court placed Thao on probation for 3 years. During that time, she can't work in
critical care settings or birthing units.
 • R.A. 9173 Section 23. Revocation and suspension of Certificate of
Registration/Professional License and Cancellation of Special/Temporary Permit. - The
Board shall have the power to revoke or suspend the certificate of
registration/professional license or cancel the special/temporary permit of a nurse upon
any of the following grounds:

(a) For any of the causes mentioned in the preceding section;

(b) For unprofessional and unethical conduct;

(c) For gross incompetence or serious ignorance;

(d) For malpractice or negligence in the practice of nursing;

(e) For the use of fraud, deceit, or false statements in obtaining a certificate of
registration/professional license or a temporary/special permit;

(f) For violation of this Act, the rules and regulations, Code of Ethics for nurses and
technical standards for nursing practice, policies of the Board and the Commission, or the
conditions and limitations for the issuance of the temporarily/special permit; or

(g) For practicing his/her profession during his/her suspension from such practice;

Provided, however, That the suspension of the certificate of registration/professional license

shall be for a period not to exceed four (4) years.

1. Nursing home cases are distinct from medical negligence claims, Florida high court rules.

• Negligence without meeting the state's pursuit requirements for filing a medical
malpractice claim.
• She cited findings by the intermediate appeals court, affirmed by the state high court, that
various nursing home staff members, from nurses to aides to dieticians, were responsible
for the neglect at issue in the case.
• The appeals court concluded that because the plaintiff claimed that her husband did not
receive adequate care at the facilities but did not name or identify any physician or other
"health care provider" as a defendant, "this complaint does not seek vicarious liability for
the actions of a health care provider under a medical negligence standard."
 Law’s related to the safe practice of nursing

1. Clear Air Act

2. Waste management law
3. Family code
4. Local government code
5. Dangerous drug act.
6. Generic drug act.
7. Health insurance and Phil. Health
8. Breast feeding
9. Tabacco act.
10. RA on mercury prohibition
11. Milk code