My blogs have moved to www.nursingattorney/b. I have not posted in a while because we were busy setting up the new blog site. I hope that putting the blogs on my website will help readers navigate the blogs and the articles. Let me know what you think.

Nurse of the Year???

This is from David Owens for the Hartford Courant on 8/6/09

" A Norwalk woman once recognized as "nurse of the year" was arrested today after an investigation found she's not really a nurse.

Betty A. Lichtenstein, who is also known as Betty A. Trudel, 56, of Norwalk, was arrested Thursday by inspectors from the Chief's State's Attorney's Medicaid fraud control unit on a single count of illegal use of the title "registered nurse," six counts of second-degree reckless endangerment and one count of criminal impersonation.

According to the warrant for Lichtenstein's arrest, the investigation began after a patient at the Norwalk doctor's office for which Lichtenstein worked complained she had acted unprofessionally.

An investigation then determined that Lichtenstein never had a license, yet had administered injections and given medical advice to the doctor's patients, according to the warrant.

The doctor and his employees' belief that Lichtenstein was a nurse was reinforced when in November 2008 she was honored as "2008 nurse of the year" by the Connecticut Nursing Association.

The investigation determined, however, that the Connecticut Nursing Association does not exist and that Lichtenstein used $2,000 of her own money to stage the dinner, according to the warrant.

"The doctor, his staff and a number of his patients received a letter with the letterhead of the "Connecticut Nursing Association," according to the warrant. "The letter stated there would be a special dinner to honor Betty Lichtenstein [and that she] was to received a $10,000 personal award and an additional $10,000 was to go to the charity of her choice."

On Nov. 30 the award dinner took place at the Norwalk Inn, and the doctor for whom Lichtenstein worked was a guest speaker, according to the warrant. Forty one dinners were served and the inn sent a bill for $3,211.11 to the Connecticut Nursing Association in care of Lichtenstein's employer's office. She then wrote a check for $2,168.02, according to the warrant.

Lichtenstein was arrested by Norwalk police in May in an unrelated charge of trying to illegally obtaining prescription drugs and forgery. According to the warrant, she tried to obtain 96 Oxycodone pills with a forged prescription. She used a prescription slip from her employer. That case is pending in Superior Court in Norwalk.

The illegal use of the title "registered nurse" charge is a felony that is punishable by up to five years in prison.

She was released from custody without having to post bail and is due in court Aug. 26 in Norwalk.

Copyright © 2009, The Hartford Courant"

It is amazing the amount of energy and money spent by this woman to fake being a nurse. Just bizarre.

Pondering

In the 60s, people took acid to make the world weird. Now the world is weird and people take Prozac to make it normal.


Hmm, think about it. Too true. Reuters reports that antidepressant use has doubled in the US.

Pandemic Information

I found a great blog with a lot of information about preparing for a pandemic: Pandemic Information News

On the right hand side is a list of links for preparation and even some of those links have more and more information. I continue to urge health care providers to get prepared now for any emergency or disaster since they are front line responders. We continue to hear about the flu gaining ground and that we are about to enter the prime time for flu, so preparation needs to happen now. Take the time to consider what you would do if a major outbreak occurred and make sure that you have all the items you need now.

Governor fires Nursing Board members

On July 14, 20009, the Los Angeles Times reported that "Gov. Arnold Schwarzenegger replaced most members of the state Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.

He fired three of six sitting board members -- including President Susanne Phillips -- in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.

The shake-up came a day after The Times and the nonprofit news organization ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months to investigate and close complaints against nurses..."


We will have to watch for what the fallout/impact/repercussions will be at other nursing boards. I hope the other states do not overreact to the problems in California because there must be balance for regulation to be effective.

Camp Nurses

Sorry there have not been many postings, but summer is here and my husband (and I of course) volunteers to run the local Cub Scout camp. It takes up quite a bit of time which is why my blogging is scare this time of the year. Every year we are so grateful for all of the volunteers that take time off from work to sweat in over 100 degree weather and spend time with the kids. We are always grateful for the nurses that volunteer their time to staff the first aid office. This year kept them quite busy with several kids having heat exhaustion. It brings peace of mind to have trained and knowledgeable nurses available on site. So, to all of you nurses (and others as well) that take time to volunteer your time for Scouts, rescue groups, community services, etc. THANK YOU!!!

Tylenol and Soma

Just a little info in case you missed it: The FDA is proposing restrictions on acetaminophen (Tylenol) because it is the leading cause of liver failure in the US. Soma has also been made a scheduled medication instead of a dangerous drug.

BON License Applications

As new graduates are completing their applications for licensure, it is time to remind all applicants (and those nurses renewing as well) to be honest with the Board. I have found repeatedly that the Board's reaction is better when the nurse does not try to hide an incident.

Also, be very careful when answering the questions asked. If you are not sure if you should answer yes or no, please take the time to get competent advice. I have seen nurses end up with disciplinary actions because they answered no based on the advice of an instructor, an administrator and an inexperienced attorney. The deception to the Board was unintentional but it is still deception in the eyes of the Board and a disciplinary action is warranted--not how a new nurse wants to start their nursing career.

If your license application is still in the future and you have a criminal conviction (deferred adjudication etc.), it could be helpful to check with a criminal attorney to see if the criminal action could be expunged or sealed. Since the Board does not require a nurse to disclose an expunged or sealed incident, a nurse might be able to avoid a disciplinary action. Worth looking into.

New Continuing Education rules proposed

The Texas BON has proposed new continuing education rules. These rules make some significant changes to continuing education requirements. According to the Board:

"Under the proposed new chapter, a nurse is authorized to demonstrate continuing competency through the achievement, maintenance, or renewal of an approved national nursing certification in the nurse's area of practice, as well as through the completion of continuing education courses. Recognizing this additional method of compliance provides nurses with the option of pursuing and maintaining a certification in a specific area of practice."

"The proposed new chapter also requires a nurse to demonstrate continuing competency in the nurse's specific area of practice. A continuing competency activity should incorporate and relate to the knowledge, skills, or activities performed or required by the nurse in his or her area of practice. In the case of a nurse educator, the Board anticipates that continuing competency activities related to nursing education should meet the requirements of the proposed new chapter." It is not clear how the Board is going to apply this to a nurse who does not have a specific area of practice. The time period to comment on the rules is until June 14th.

HB 3961/SB 1880 and TPAPN

I have been telling all nurses to contact their Legislators to discuss HB 3961/SB 1880. HB 3961 passed the house and should be going before the Senate tomorrow!! You need to contact the members of the Health and Human Services Committee to let them know your concerns or even better come to the Senate Chamber and testify regarding the bills. The main issues that I have identified are:

1. Section 10(b): change the "shall" to "may" to give the Board an opportunity to consider mitigating factors that may not warrant a denial or revocation and make this applicable to current cases.

2. HB 3961 is missing Section 12 of SB 1880 which involves formal charges. If Section 12 from SB1880 is added, then to avoid current problems the following should be added:

Formal charges shall be filed at SOAH. (Sec. 301.458. Initiation of Formal Charges; Discovery)


3. Section 11: Does not allow for the times when the ingestion of a substance in inadvertent nor does it allow for false positives or for unusual situations where it is appropriate that a nurse not continue with TPAPN.

4. Section 8(g)(3): this requires the release of attorney work product and should be deleted.


I also see problems with Section 8, but I am not sure that anything can be done about it because of the push to put more restrictions in place regarding potential substance abuse.

Every Nurse Should Know About IBC

As many of you know, my very close friend Victoria Berry,MSN,RN,CNS,CWCN passed away on April 7, 2009 from IBC/Inflammatory Breast Cancer. When she initially told me her diagnosis, I did not know that there were types of breast cancer nor did I know that this particular type does not show up with a lump. All the steps we have been told to watch for did not apply: self exams, mammograms

This cancer shows up with some, but not all of these symptoms: enlarged breast, redness, hot to the touch, rippled skin, inverted nipple. The symptoms can be so non-specific that it can be misdiagnosed as an infection, bug bite, irritation etc. Victoria had a negative mammogram 5 months prior to her diagnosis. Her IBC showed up looking like mastitis, but she had a very astute physician, Patricia Gunter, MD, who immediately recognized that the symptoms were more than they appeared and it was 2 weeks from the time the symptoms showed up and she was diagnosed with IBC. But, IBC is very aggressive and Victoria lost her battle a little over a year after being diagnosed. Nurses may the first one to see this disease so it is important that nurses know the symptoms in order to urge patients to see a doctor immediately. IBC is not a disease that can wait, it is considered an emergency because it is so aggressive. Also, urge patients to seek specialized care with health care providers that have experience treating IBC.

Below is a video from Komo News 4 in Washington. They have done multiple stories about IBC. They include a report about a 16 year old that died from IBC!

Nursing Jurisprudence Educational Seminar

I am speaking at a seminar, "Avoiding Litigation", on April 4, 2009 at the Thompson Conference Center, Austin Texas. The one day event is sponsored by the Texas Nurses Association District 5 and is incredibly CHEAP to attend ($15 for TNA members and $30 for non-members)!!!!

Time is Almost UP!!!

Have you contacted your Texas State Senator and Representative to encourage them to support HB 998? This bill helps nurses when they have an issue before the Texas Board of Nursing by making the administrative process much more fair. So please take the time to call/fax/write/email your Legislator and urge him/her to support HB 998.

Prevention of Medical Errors

On last Thursday's ER, Dr.Carter was about to receive a kidney transplant and the whole surgery suite was rush-rush. Dr. Benton stopped the surgical team in order to go over a safe surgery checklist. He was berated by the surgeon for slowing things down and was told that it was not needed. Dr. Benton insisted and during the checklist, it was brought out that a fluid was missing. The surgeon said that they would not need the fluid, but nursing said that they would get it anyway. As the surgery progressed, there was a complication and the fluid was necessary to preserve the kidney and thus, make the surgery a success. Dr. Benton drove home the point that safety checklists are there for a reason and the reasons are good and valid.

I immediately thought of the five rights of medication administration. Too frequently, nurses bypass this crucial checks and balance safety checklist and the result is a medication error. Thank goodness, most of the time the error has no long term effect on the patient, but occasionally the result is death or serious harm. Nurses care for their patients and to cause harm is horrible and not something any nurse wants to go through.

So, even if it seems like a waste of time, you must take the time to do the safety checklists. Bypassing even one step could result in something tragic that you will have to live with for the rest of your life.

TPAPN - When Not to Go

I have written many times on all of my blogs regarding the Texas Peer Assistance Program for Nurses. However, I have been receiving questions from nurses regarding whether they should go to TPAPN because they have been accused of diverting medication or because they have had a positive drug screen or because they are a recovering addict. Each case is different and there is no set answer, so a nurse should contact an attorney with experience before the Board and find out what option is the best for their situation. But, please do not agree to TPAPN if you do not have chemical dependency problems or if you are not an addict. And, do not agree to TPAPN if you do not understand what you will be required to do and not do while in TPAPN.

Do not believe a blanket statement such as "If you do not enter TPAPN, the Board will take away your license." Do not enter TPAPN just to avoid the Board - once again, TPAPN is for nurses with addiction issues or substance abuse/dependency problems and for nurses that are new to recovery or that have relapsed. TPAPN is not for nurses with a past history of addiction, but that have years of recovery.

In summary, do your research, understand your options and then take action, but make sure it is action based on knowledge, not fear.

HB 998 Needs All Nurses to Support It

Go to Texas Jurisprudence and read about HB 998 filed by Fred Brown. It is a helpful bill and it needs to pass. Please take the time to contact your Legislators.

Nurses win in whistleblower suit

Thanks to Ohio nurse attorney LaTonia Denise Wright for posting info about this news article, "Two RNs will be awarded 4.9 million dollars [out of a 24.7 million dollar settlement] in a whistleblower lawsuit" It is nice to see nurses receive justice.

Medical Hints

Okay, maybe you already know about this, but since I just found it and thought it was cool, here goes: Medical Mnemonics is a website that gives you those helpful hints to remember medical tasks. Go have a look, very cool.

Malpractice Insurance - Get It NOW!!

I know I have commented on this so many times, but there are still too many nurses still not get insurance on their careers. Please take the time to protect your livelihood. It is not that expensive and the benefits FAR outweigh the few problems.
Remember that the main reason to get malpractice insurance is to provide legal representation and expense reimbursement in case a complaint is filed with the Board of Nursing (it is appears much more likely that a nurse will be reported than ever before).