When Nurses Kill

Hello health care system.  This is weird, to put it mildly.

As far as anyone seems to be able to figure out what happened, this 38 year old nurse killed five dialysis patients and “assaulted” five others by putting sodium hypochlorite – bleach — in their dialysis tubing.

She had some problems with domestic violence and public intoxication and such.  But according to the relevant statements, that was all resolved before she did this.

Jurors have convicted her of capital murder, but she is not going to get the death penalty.  Mostly, this is because she is deemed to be of no further danger if she’s kept out of health care.  Her daughter seems to be taking it hard.  This is an indication for counseling, but not a change in Mommy’s sentence.

Mommy was working as a licensed vocational nurse (LVN).  Okay.  To get this credential in Texas it costs two hundred bucks.  Plus, you have to get some kind of a grade on some kind of a licensure test.  Or, if you’ve done this kind of work in the past four years, you can be “grandfathered” in (to use the legal but politically-incorrect sexist term).  You’re also fingerprinted by a live scan system.

This always makes me smile, as certain employers have required fingerprints from moi.  Presumably to make sure I have not committed a crime since my last employment.

At any rate, this woman apparently had not been a felon before this.  I suppose the fingerprints were proof.  I guess this is why they go to all this trouble.

Okay, so she had it out with her husband and started injecting bleach into people’s tubing. But she is no danger to the general public so she gets life without parole?  God Bless Texas.

As far as I’m concerned, the hero of the story is the fire department official who noticed that there were an abnormal number of paramedical team calls to this facility.  If he had been anything other than anonymous he would receive a fan letter from me.

I remember a four-foot-nine Vietnamese doctor who was a supervising colleague in obstetrics gynecology.  She was a brilliant woman who reconciled Oriental philosophy with Western medicine about twenty times daily with little more than an eye-blink.  “Routine obstetric checkups are the dullest job on the globe,” she told me when I was a highly impressionable medical student.  “If anything is even a little bit abnormal, you have got to see it.  You have got to maintain constant and perfect vigilance or else a woman, perhaps too young when thrust into the responsibility of pregnancy, and a voiceless human unborn, could both suffer. ”

“Never lose your vigilance!  That is what it means to be a competent doctor, or even a great doctor.”

Now — thirty years later — I remember her words and think they should be used to anoint an unknown Texas fireman.

It says in the first of the articles cited above that the court had subpoenaed records from the clinic — a national chain known to be slipshod in its record keeping.

A licensed vocational nurse is not terribly high in the hierarchy.  The ones I have worked with have needed lots of direction.  Oftentimes, they also had either physical or psychiatric diagnoses or just plain limited amounts of experience or problem solving abilities.  They have not been bad or horrible folks.

I do not think any of them would have logged in how much bleach they injected into the dialysis tubing.  Then again, I’ve never personally known one I think would have done that.

I have reviewed the cases — in print only — of some of the female serial killers.  There are fewer females than males in the homicide field, which may be one reason we are called “The gentle sex.”

They are often health care personnel who see themselves as doing something “sacred” or morally justified.  I have not got a whiff of any such motivation from what little public press I’ve read on this case.

I do not know how to explain why a victim of domestic violence — who may have had some substance problems — would go this route. I hope that even though she will be in the Texas prison system, there will be some kind of a way for her to get some kind of treatment.  Or maybe even some comfort.

The Lone Star State has had justice – a “scapegoat” who may not actually have to die.  But is she really the only one at fault?

My husband and I drive the major thoroughfares of this great nation.  We have driven past many dialysis facilities, including some owned by this company.  They are quiet and usually have a parking lot full of cars.  I have had a few dialysis patients share with me how much they love life.  At least enough to cling tenaciously through their three times weekly visit to these centers — visits that take them from family and all that is familiar.

A crime that could kill people like this is especially heinous.

A licensed vocational nurse is generally not well-enough trained to turn loose without supervision.  One at this level of education should be closely monitored and supervised.

However, this is what cutting costs on health care brings us – and there are more brilliant ideas for further cost reductions in the works.

I am grateful beyond words to the fireman who raised questions about the facility.  After all, the patients in a facility such as this usually are stable and emergency calls should be few.

Nobody was supervising this woman adequately.  The RN, the doctor above her, the director of the individual facility, and even the chain of clinics have some level of responsibility for these inappropriate actions.

Yes, the doctor is responsible in this manner even if she or he had no idea what was happening.  Although God in his heaven knows at least that I try, I have had many a nightmare about my own supervisory responsibilities.  It is now a horrible daily reality of being a doctor.

Perhaps her supervising RN or her own Vocational Board of Registration should have known she was stressed.  It is very hard to keep marital discord with substance problems from affecting work.  Somehow, the initial reporting process has to be nurturing and no-fault.  I know this is tough.

I have worked with impaired doctors, impaired nurses, even impaired medical students.  It is not easy.  I have advised others who have asked me what it is like.  If you cannot say, “There but for the grace of God go I,” you probably should not do it.

The more layers of minimally supervised or unsupervised “doctor extenders” that are in place, the more dangerous health care becomes.  Not just in Texas, but everywhere.