Sunrise nurses under scrutiny

Two Sunrise Hospital nurses involved in incidents of "disrupted catheters" that have left at least one newborn in critical condition and forced another into an unplanned operation have had their nursing licenses suspended, the executive director of the Nevada State Nursing Board said Monday.

At this point, said the board's Debra Scott, it is unknown whether the disruptions -- which medical authorities say can mean disconnections that won't set off the usual electronic alarms -- were deliberate.

"We do know it was misconduct," Scott said.

In a telephone interview from Chicago where she is attending a conference, Scott said the nursing board suspended the nurses' licenses based on an investigation by Las Vegas police. She said the nurses no longer can practice.

Sunrise Hospital officials revealed Friday that they had asked police to investigate 14 incidents of disrupted catheters in its Neonatal Intensive Care Unit going back to February.

Police Capt. Patrick Neville refused to comment on the investigation Monday through the department's public information department.

Scott declined to comment on whether the nurses were acting together or whether they meant harm to the children when catheter tubing often used to draw blood, deliver medication or nutrition to newborns was "disrupted."

"The investigation is ongoing," she said.

Scott refused to release the names of the nurses or say whether they have been the subject of past disciplinary action.

Sunrise authorities refused Monday to answer more than 30 questions from the Review-Journal, including whether any of their health care personnel had been disciplined because of the incidents.

"We don't want to jeopardize the integrity of this investigation," Sunrise spokeswoman Ashlee Seymour wrote in an e-mail.

On Friday, Seymour wrote that after finding problems -- which hospital officials first thought were technical failures -- officials "increased security, installed cameras, removed staff in the vicinity from the schedule and conducted ongoing review of clinical technique."

Seymour also wrote that police were called in to investigate after an umbilical catheter, which seldom fail, was "disrupted." The other 13 cases involved peripherally inserted central catheters, PICC lines.

Luana Ritch, interim chief of the state's bureau of health care quality and compliance, said Monday that state investigators were pleased that the hospital removed staff "that were working" in the neo-natal unit.

She said the state's investigation is ongoing and said she couldn't comment as to whether criminal behavior was involved.

Ritch said she doesn't think any other children are in danger now.

Clark County Medical Society President Dr. Mitchell Forman said Monday that he wished hospitals would be more transparent when such events happen.

"It's perfectly natural for people to have questions that need answering," he said. "People want to feel safe. We ask electricians questions, why not hospitals?"

Katherine Ramsland, a criminologist at DeSales University in Pennsylvania who has written on health care professionals who run afoul of the law, said Sunrise will have to study incidents and deaths in the neo-natal unit "over many months and perhaps years."

"These are very difficult cases to investigate," she said. "You have many medications and technologies involved, where human error can be involved and there is no criminal intent. And then you sometimes have to deal with people who are very good at covering up what they do. Often they're not caught for years."

Ramsland said it is not unusual for hospitals to limit the flow of information on incidents.

"They're trying to protect their reputations," she said.

Ramsland, who wrote the best-selling book "Inside the Minds of Health Care Serial Killers," noted that nurses who have killed or attempted to do so are often referred to as "Angels of Death."

Frequently, Ramsland said, nurses will say they are mercy killers, helping children die, for instance, who are very ill. Or they use it to exert power. Or they deliberately hurt someone to save a patient and "be the hero."

Dr. David Gremse, professor and chair of pediatrics of the University of Nevada School of Medicine, said that nurses who work in a neo-natal unit are specially trained, often the best of the best.

Stressing that he had no knowledge of what happened at Sunrise and that he is not commenting directly on events that happened there, Gremse said it is important for the public to realize that "it is highly unusual for an infant to tear out a catheter."

Catheters, he said, can be placed in different parts of the body, including arms and the head. Sunrise officials refused to say where the catheters were connected.

He also said that a "disrupted catheter" is not a medical term but one that could mean many things, including a disconnection.

Generally, he said, alarms would go off on most catheters if a problem such as clogging occurs, but if one was disconnected, it wouldn't.

"An alarm wouldn't go off if the line or catheter was disconnected and still pumping fluids onto the bed or floor or somewhere else," he said. "It would still think it was pumping correctly."

Normally, Gremse said, neonatal units take care of premature babies, who frequently have lung, heart and infection difficulties.

He said the units are highly secure and take a badge or code for someone to enter. Working in the units, he said, are doctors, respiratory therapists, nurses, dieticians and social workers for family support.

Gremse said that in some cases a "disruption" could throw a baby quickly into shock and that the effects of a "disruption" might not be known for years when brain damage or other internal damage could be found.

Sunrise personnel refused to say how long the catheters were out of the babies or whether any tests have been done to see whether the babies might have suffered long-term damage. They also refused to say when the "disruptions" occurred or why the hospital decided to release information on the incidents Friday.

While authorities said they spoke to the families of the two infants who had "unexpected outcomes," they did not reveal whether they told the other families that their children experienced catheter "disruptions" or when an outcome is "unexpected."

Hospital authorities also would not say what kind of injuries the baby suffered that is now in critical condition nor would they say what kind of procedure the infant needed to overcome the disruption of a catheter. Information was not provided as to age or sex.

Seymour refused to ask any of the 14 families affected by the catheter "disruptions" whether they would talk to the Review-Journal about their experience, replying: "We are respecting the request for privacy of the family of the patient who had an unexpected outcome but is now doing well."

Though Sunrise officials continually refuse to answer even the most basic questions about when, where, why and how the catheter "disruptions" occurred, Seymour wrote:

"We believe our Neonatal Intensive Care Unit at Sunrise Children's Hospital remains safe and is one of the most state-of-the-art facilities in Southern Nevada."

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

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Comments

Note: Comments made by reporters and editors of the Las Vegas Review-Journal are presented with a yellow background.

1. inforlif Jul. 13, 2010 | 11:05 a.m. Report Abuse

   @RWM it is not only at Sunrise does the billing department do that, I was in the Cardiac ICU at Summerline and the same thing happened to me, I was there for 3 days and never saw a Dr but I did see the billing department. At least are valley health care has their priorities straight.

2. KeithM Jul. 13, 2010 | 8:27 a.m. Report Abuse

   Kudos to Sunrise Hospital for self reporting this incident and involving the police. It was a risk to their reputation, but one that needed to be taken. I've had enough of companies trying to cover things up. Admit what happened and take steps to prevent it happening again.

3. RWM Jul. 13, 2010 | 7:04 a.m. Report Abuse

   When I was hospitalized there....a nurse gave me IV meds with some other patients name on the bag. She said it was the same stuff....I doubt the strength was the same etc etc. Wonder I didn't die. Then billing can in the ICU and wondered how I was going to pay my dedectible. No class at all. I was suffering and had no reason to write a check or pay anything at that time. That is what insurance and billing is for.

4. Greg Jul. 13, 2010 | 3:38 a.m. Report Abuse

   Well that's great news, the ONLY hospital in Southern Nevada providing a children's hospital, and something like this comes out.
   
   Again, Southern Nevada needs a branded, high quality hospital and clinic provider. The standards and expectations need to go up, the attorney row revenues need to go down from the resulting increase in reliable care.