A registered nurse who worked at a skilled nursing and rehabilitation facility was charged in criminal court for amputating a 62-year-old man’s foot without consent.
Mary K. Brown, RN pled not guilty to charges including mayhem, physical abuse of an elderly person, and intentionally abusing the patient, causing great bodily harm. The patient’s foot was frostbitten, and Nurse Brown allegedly decided to take it upon herself to amputate it without a physician order or the patient’s permission. Around a week later, the patient was dead.
There’s a lot to unpack in this story.
Nursing care is guided by physician orders
Texas Board of Nursing Rule 217.11 imposes standards on all nurses to institute appropriate nursing interventions that might be required to stabilize the patient’s condition and/or prevent complications. With that said, it exceeds the scope of practice for nurses to perform a procedure or administer medications without an order.
Registered nurses and licensed vocational nurses are licensed and trained to make and report on clinical observations. For nurses to implement most treatments, they must first have an order from a physician, physician assistant, or nurse practitioner.
Nurse Brown allegedly performed the amputation without an order, which led to her criminal prosecution. Such conduct would also violate nursing board rules and the standard of care.
Procedures require informed consent
Before a non-emergency surgical procedure or treatment can go forward, a patient must give informed consent. Under Texas law, this is a non-delegable duty of the treating physician.
Informed consent is a two-way conversation between the patient and his or her physician. At a minimum, it needs to detail the risks and benefits of the proposed procedure or treatment, any alternatives, and doing nothing. A patient can only give informed consent when armed with this information.
It goes without saying that if there’s not an order for a procedure and no physician involvement, there’s also no informed consent. Under the alleged facts of Nurse Brown’s care of this patient, this would be a second violation of the standard of care.
Nursing home care
Texas nursing homes are generally understaffed. While criminal cases are rare, the sad truth is that the general level of care provided to many nursing home patients is pretty poor. I believe the reason that Texas consistently ranks at the bottom of nursing home quality surveys is the economics of tort reform laws that were enacted back in 2003.
It’s easy to explain.
If a retired nursing home patient dies because of poor nursing care, then the medical malpractice claim is limited to $250,000, plus funeral expenses. Do you think that the corporations who run Texas nursing homes factor that limited liability into the business model? Do you think that leads to poor staffing levels, training, and supervision? I think so!
If you’ve been seriously injured because of poor nursing care at a skilled nursing facility or rehabilitation center, contact a top-rated, experienced Texas medical malpractice attorney for a free strategy session about your potential case.
