Any alumni of Texas Tech University Health Sciences Center out there? That’s my painting on page 28 of their alumni magazine, Pulse. I’m not an alumni, but this image accompanied one of the posts I wrote in support of The Winkler County Whistle Blower Nurses, Vickilyn Galle, and Anne Mitchell, who are, for JParadisiRN.com. The editor contacted me for permission to use the image. I am proud to be connected in a tiny way to these two courageous nurses, who put their careers in jeopardy for the protection of patients.
On Tuesday, February 16, 2010, JParadisi RN’s Blog had the most site hits since its debut in January, 2009. The day is notable, because the blog’s post Whistle Blowers & Patient Advocates: When the Nurse Stands Alone was mentioned by Shawn Kennedy on the AJN blog, Off the Charts. I assumed the two events were connected. Imagine my surprise: they are not. The stats for JParadisi RN’s Blog show that the most popular post on February 16 was an older post: Not a Wonderful Life: No George Bailey for Pharmacist Eric Cropp or His Patient. For the entire week that post and the posts with updates about Eric Cropp were the most viewed on my blog.
Eric Cropp served 6 months of imprisonment for involuntary manslaughter in the death of 2 year-old Emily Jerry. Emily Jerry died when she received a chemotherapy solution containing a lethal dose of sodium chloride mixed by a pharmacy technician at the hospital where Eric was the supervising pharmacist. The Ohio Board of Pharmacy stripped Eric of his license prior to his conviction. Now a convicted felon, he will never practice pharmacy again.
Why the renewed interest in the Eric Cropp case, during the immediate aftermath of the Anne Mitchell trial? Anne Mitchell, RN was publicly supported by the Texas Nurses Association and the American Nurses Association. The TNA donated funds for Mitchell’s legal defense, and the Texas Medical Board acknowledged Mitchell’s duty as a patient safety advocate. Mitchell was found not guilty. There were no fatalities in the Anne Mitchell case. The most obvious difference drawn from a comparison of the two trials is that a child’s death initiated the criminal charges against Eric Cropp. Perhaps this explains why pharmacist professional associations appear silent on the matter. Searching two prominent organizations websites with the keywords “Eric Cropp” I found only one article about the case on one site, and none on the other. Granted, defending a person accountable for the accidental death of a toddler creates an unpopular challenge in public relations.
Physicians are familiar with lawsuits involving the death of patients. It is rare for a doctor to go to prison or be stripped of his or her license in such a case. Eric Cropp was convicted of criminal charges in the absence of public support, except for Michael Cohen of ISMP. Whether this is right or wrong is a matter of opinion.
The pharmacy profession lost an opportunity to speak about patient safety systems, staffing issues, medication compounding practices, pharmacist to technician ratios, and other problems similar to those nurses have brought to public attention for years. In contrast, the TNA, and ANA used Anne Mitchell’s trial to educate the non-medical public about the patient safety advocate role of nurses. It is important to remember that the non-medical public is unfamiliar with common hospital practices. In my opinion, there is an expectation for professional organizations to educate the public on the scope of practice of its members. It is unfortunate that this opportunity was missed during the Eric Cropp trial.
Did a lack of support and public education lead to the setting of a disturbing precedent: the criminalization of medication errors? (Will the Criminalization of Medication Errors Make Patients Safer in Ohio?).
Eric Cropp was released from jail on February 15, 2010, and this explains the increased traffic to JParadisi RN’s Blog on February 16, in the aftermath of the Anne Mitchell case. It was only a coincidence. Whether or not pharmacists compare the two very different outcomes of these trials, I do not know.
I am married to a pharmacist. However, for most of my career, I was a pediatric intensive care nurse dedicated to saving the lives of children like Emily Jerry. I saw firsthand families devastated from losing a child under less unusual circumstances. The opinions expressed in this post do not diminish my sympathy or empathy for the family of Emily Jerry.
A colleague and I discussed the Winkler County Whistle Blowers case and our admiration for Registered Nurses Vicki Galle and Anne Mitchell. They brought the nurse’s role of patient safety advocate into the national spotlight.
My colleague is also a force to reckon with when it comes to patient advocacy. During our conversation she grew quiet and told me once, she had advocated for a patient without the support of her peers or administration.
The event occurred early in her nursing career, before she gained the skill and knowledge, which now empower her ability to act confidently as an advocate. In the end, she followed orders, even though they conflicted with her ethics. Decades later, she still regrets her choice.
I listened to her story, and tried to imagine her as a young nurse, uncertain and faced with a situation nursing school had not prepared her for. I imagined her alone and isolated, the only one in a nursing unit who felt, or more likely, spoke out loud the feeling that what was happening might not be best for the patient.
The Winkler County Whistle Blower case demonstrates that this kind of moral isolation still happens to nurses. However, it also demonstrates that nurses have developed resources for themselves and learned how to access them. These days, many hospitals have ethics committees and safety committees for reporting unsafe systems and behavior. Many hospitals have policies protecting nurses who refuse to administer treatments that conflict with their moral beliefs. Winkler County Memorial hospital fired Anne Mitchell and Vicki Galle when they used the hospital’s safety chain of command to protect patients, but the hospital and the doctor bringing charges against them found out this kind of punitive behavior is no longer tolerated by the court system or a majority of health care professionals. The Texas Nurses Association and the American Nurses Association said, “We are watching,” as did the Texas Medical Board. I’ve heard the conversations of doctors who ask why Dr. Arafile’s colleagues didn’t report his behavior. Why was the responsibility left to nurses? If any of these resources were available for my nurse colleague when she faced her dilemma decades ago, I would be surprised.
My heart breaks for that young nurse, facing an ethical dilemma alone and unsupported, with nowhere to turn. I told my colleague I hope she has forgiven that young, inexperienced, and frightened version of herself, with her older, more experienced self’s compassion. I suggested that what she learned from that episode long ago has forged her into the warrior nurse advocate she is today, benefiting hundreds of patients during her long career as their advocate.
Congratulations to Anne Mitchell, RN and her lawyer John H. Cook IV on winning an acquittal for Anne, charged with misuse of patient information when she reported a doctor for medical misconduct. Mitchell faced charges of using the patient information with intent of harming the career of the doctor. If convicted, Mitchell could have faced imprisonment of up to 10 years, and a fine as large as $10,000. The jury ruled unanimously in Mitchell’s favor, on the first ballot. The Texas Nurses Association, and the American Nurses Association have supported Ms. Mitchell’s innocence.
Next, Mitchell and her lawyer are prosecuting Winkler County Memorial Hospital, which fired her and Vicki Galle, and Doctor Arafiles in federal court for violation of Mitchell’s First Amendment Rights.
You go, Anne and Vicki! Thanks for standing at the plate and taking a hit for the team. Your courage as patient advocates is inspiring.
An opinion on the Anne Mitchell case is posted by David Gorski on Science Based Medicine. Anne Mitchell, RN stands trial for reporting a doctor for behavior that she asserts is medically inappropriate. She was fired from her job at a Winkler County, Texas hospital for filing the anonymous report. If convicted, Mitchell faces up to 10 years of prison, and a felony record. The Trial has begun.
Related posts on this blog:
No one is free when others are repressed.
attributed to Mahatma Gandhi
For a couple of years, I worked in Quality Improvement (QI) for a nursing department. My job was to review error and near miss error reports, tease out the cause(s) and develop strategies preventing error recurrence. I learned a lot of things that helped make patients safer in a hospital. I loved that job.
So, I am concerned about a situation I became aware of last week in a post by Shawn Kennedy, MA, RN, AJN interim editor in chief, on the American Journal of Nursing’s blog Off the Chart. In the last paragraph of her post, she discusses the case of two Registered Nurses in Texas, who are facing prosecution as whistle blowers for reporting a physician of behavior they assert is unsafe for patients. Vicki Galle was in charge of the Hospital’s Quality Improvement and Anne Mitchell was the hospital’s Compliance Officer. For readers not involved in health care, this means it was their jobs to investigate hospital safety issues and report noncompliance ( people who aren’t following the rules). Both nurses were terminated from their jobs in June, 2009. Although Texas is a state with laws protecting whistle blowers, the laws do not prevent the physician they reported from filing a harassment suit against the pair. Sounds like another “damned if we do, damned if we don’t” scenario that health care providers can
inadvertently find themselves party to. Please read more about this complex case on the Texas Nurses Association website. There is also link to click which allows you to contribute to the legal defense fund of these two nurses, should you wish.