Probably the thousands of nurses who have been following this case were encouraged to read the press report of its outcome:

“Texas jury finds nurse not guilty for reporting a physician for unsafe practices.

It took the jury less than an hour on February 11, 2010, to return a not guilty verdict for the nurse, Anne Mitchell, of felony charges of “misuse of official information,” for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care.

Since news of the criminal indictment – and Mitchell’s being fired from her job – first spread through the nursing community, nurses across the country have followed developments. Labeling the criminal indictments “outrageous,” an outpouring of support – and financial contributions to the Texas Nurses Association Legal Defense Fund – has continued.

According to a New York Times article on February 9, the prosecutors claimed that Mitchell intended to damage the physician’s reputation when she reported him to the Texas Medical Board, which licenses and disciplines doctors. Mitchell explained that she felt an obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures – including a failed skin graft that was performed in the emergency room, without surgical privileges.

Conflicts of interest seemed to be part of this case with allegations that this case was, in part, a result of the local sheriff being good friends with, and a former patient of the physician, and bending the rules to protect his reputation.

A number of nurses who had previous worked at the same Winkle County Rural Health Clinic testified in court that they left the clinic because of their concern about the care provided by the same physician that had never been addressed. The case is no less perplexing as to why Mitchell was even indicted – all witnesses (even the state’s) have agreed nurses have a duty to report unsafe care.

The verdict is a resounding win on behalf of patient safety in the U.S., as well as nurses and other healthcare professionals who play a critical, duty-bound role in acting as patient safety watch guards in our nation’s health care system. The greatest concern with this case has been the disbelief that a case such as this was even allowed to reach the trial stage and what a different outcome could have potentially meant for patient safety in this country. Even with an acquittal, the felony charges and trial had a chilling effect on many nurses who may think twice before reporting unsafe practices.

A civil lawsuit has been filed in federal court charging the county, hospital, sheriff, doctor and prosecutor with vindictive prosecution and denial of the nurses’ First Amendment rights. A complete summary of the case is available on the Texas Nurses Association Web site.” (Source: SafetyShare newsletter, Premier, Inc. at http://www.premierinc.com/quality-safety/tools-services/safety/safety-share/02-10-full.jsp#story-01).

Yes, it is encouraging to see that justice was done, and the nurse exonerated. This is only, however, step one. In addition to the doubtful outcome of a civil suit, there is the lurking question of why the situation ever went this far, why this nurse had to go through this experience. Yes, and the other nurses who testified. Why was it acceptable to sustain this problem?

Here are the questions my friend and colleague, Debra Gerardi, RN, JD asked in our email conversation about the case, and I think they are worth pondering.  Why is this viewed “as a win for patient safety and not for what it really is – an example of abuse of power in which the only recourse the person seemed to have was to go to a regulatory body”? As she noted, it is hard to imagine that this is the only or first time that the physician was willing to call his friend the sheriff when he felt threatened and became retaliatory. Even more interesting is the role of the administration of the facility and its governing board. Are they not culpable, and what are the consequences to them of their neglect?

I do not know if the Winkler County Memorial Hospital in Kermit, TX is a client of the Joint Commission, the premier organization that accredits over 17,000 health care agencies, but their leadership standards clearly delineate expectations of hospitals faced with challenges not unlike the one that faced this nurse. In a recent Sentinel Event Alert, focused on Leadership Committed to Safety, they recommend “an organization-wide policy of transparency that sheds light on all adverse events and patient safety issues within the organization, thereby creating an environment where it is safe for everyone to talk about real and potential organizational vulnerabilities and to support each other in an effort to report vulnerabilities and failures without fear of reprisal.” (Source: The Joint Commission, Aug/Sept 2009: www.jointcommission.org/SentinelEvents/). Clearly the leadership in this hospital does not appear to have met this expectation.

This is not the first case of this kind in Texas; I sat through a two-week trial for two whistle blower nurses who also were fired and also won their case. It is reassuring to know that juries get it. I am proud of the support given by the Texas Nurses Association and Ms. Mitchell’s colleagues throughout the country. It is less clear that we have created the practices, policies, and penalties that actually change the underlying culture that creates the challenge faced by Ms. Mitchell.

This entry was posted on Thursday, February 18th, 2010 at 6:39 pm and is filed under Health Professions, Patients, Policy, Politics, Quality. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.