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Nurse Practitioner Care

Location:
Illinois, United States
Posted:
February 12, 2018

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JoLynne Anderson AGPCNP-BC

*** *. ******* **.

Indianapolis, IN 46219

317-***-****

Dear Ms. Greene:

I am writing this statement in response to your notification of the consumer complaint, filed by Steven Posar, on August 30, 2016. Although I attempted to discuss my rationale for my treatment plan for the patient’s medical status, it was quite obvious that Steven Posar was not interested in engaging in collaborative type dialogue, involving the situation, on July 19, 2016.

A few days prior to 7/11/2016, I received a call at 5 AM, by Kesa Turpin, RN (a night shift employee at NeuroPsychiatric Hospital of Indianapolis [NPHI]). I was on call, that morning. She informed me that the patient involved had a critical sodium level of 120. Normal sodium range is 135-145. I asked what the patient’s average 12 hour oral fluid intake had been, since her admission. I was informed that her average oral intake was approximately 1200 ml per 24 hrs. Normal first line treatment for low sodium is restriction of oral free water to 1500 ml per 24 hrs. The patient was already restricted by her own self-limiting behavior. I asked what her kidney function was, and I was given her numbers for her blood urea nitrogen (BUN) and creatinine. Although I cannot recall the exact numbers, they were both elevated, showing that the patient was dehydrated, and her kidney function was stressed. I ordered IV fluids that would allow her to be gently rehydrated Normal Saline solution, at 60 ml. per hour. I asked Kesa to please be sure to have the Medicine NP evaluate her, upon their arrival, that morning, for follow up additional orders. It is important to note that this patient was admitted to NPHI almost two weeks prior, and these were her admission labs, that had just been obtained. She had been admitted for confusion and irritability, which is consistent with low sodium symptomology.

On the evening of 7/11/2016, I was in the hospital completing my documentation on my assigned patient s, and I was approached by one of the night shift charge nurses (Rita Nayiga, RN, if memory serves), and informed that the IV had never been initiated. She was going to attempt an IV start, and wanted to clarify the IV solution. It was common practice to approach any NP, who happened to be in-house, for guidance, prior to calling the on-call person. I was informed by the RN that one of the Medicine NPs had changed the fluid to a combination of Dextrose and Normal Saline, and she had concerns that the Dextrose water mixed with the Saline might further dilute the patient, and drive her sodium down, further, placing her at risk for seizures. I wrote the order, changing the IV fluid back to Normal Saline, only. In spite of all of this attention, I was informed, a few days later, that the IV was never established, and the fluid replacement had never been completed. I took the chart to Matt Love, acting CEO, and expressed my concern over her primary diagnosis of confusion, and hyponatremia (low sodium), and absence of any IV replacement therapy for her dehydration. He told me that he would perform the follow-up evaluation, regarding my concerns.

Another situation of concern, that arose on the Friday, prior to my termination on 7/19/2016, was a discussion between myself, and Barbi Washington, LPN-Assistant Director of Nurses. I was writing discharge orders for a patient, and I noted that the patient was receiving Aricept. This was a drug that had been discontinued upon her admission for aggressive behaviors-approximately 10 days prior, and it appeared that she had received it for her entire length of stay. This patient had, also, received another patient’s medication (including a blood pressure medication and an antipsychotic medication), for her initial week long stay. The medications had been written on her Medication Administration Record (MAR), by transcription error. As I was discussing the need for follow-up evaluation of these two medication errors with Barbi, she asked me to hand her the MAR. I handed it to her, and she proceeded to rip it into pieces, in front of me. When I asked her why she would pick that action for medication error resolution, she informed me that this was the manner in which the patient’s week-long medication administration errors had been handled, before this second error. When I pointed out that it was probably a felony offense to destroy hospital records, especially involving medication errors, she informed me that this was how she was instructed to handle this situation. When I asked who instructed her to destroy hospital records, she responded, Dr. Osuntokun (who is the Chief of Staff for NPHI). Dr. Osuntokun happened to walk into the room, at that moment. I asked him if he had instructed Barbi to destroy this patient’s medication error records, and he responded, “I would never tell anyone to destroy hospital records. That is wrong.”

It is my belief that my termination and the subsequent consumer complaint, by Dr. Posar, are retaliation for and a direct result of my repeated efforts in identifying unsafe patient conditions, at NPHI.

I would like to add that I was contacted by Cameron Gilbert, on 7/25/2016. He asked me about the circumstances surrounding my termination, from NPHI. He stressed that Steven Posar was not an owner in the hospital, and sometimes gave the impression that he was part owner. Mr.Gilbert asked me what I believed was my greatest concern, at NPHI. I shared that I felt that the patients were not safe, and that there were too many delays in treatment, along with neglect of the patients. He asked me if I would work as an independent consultant, in order to help identify and correct safety issues. His lawyer mailed me a contract, along with contact by his secretary. I advised Mr. Cameron that I was awaiting contact from the Attorney General’s office, and it would probably be a conflict of interest. Dr. Posar had informed me, upon our last meeting, that he was reporting me to the Indiana Board of Nursing. I reassured him that this would not be a problem, as I would be writing my own report. I did call Mr. Chuck Linquist, the week of my termination, and he advised that I wait to write my report, until I had heard from the AG office.

It is my nursing philosophy to provide the safest care possible, to all whom I am privileged to have contact. I was functioning in my Adult Geriatric Primary Care Nurse Practitioner role, as is my training and scope of practice, with a focus on Behavioral Health. My role at NPHI involved my providing care to all of the patients, when on call, or in the building, acting as the only in-house provider, addressing all medical and behavioral needs. My collaborative physician is required by law to review 25% of my charts. I am not required to check every order, that I write, with another physician.



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