Monday, July 30, 2012

Amanda Trujillo - Nurse Interupted

I am just now hearing about the case of Arizona Nurse Amanda Trujillo and readers of EverythingHealth may also have missed this conflict between a Hospital, the Arizona Board of Nursing and a nurse advocating for her patient.  Nurses across the Country are blogging about it but I've seen very little from Physicians.  I think it is an important story and here is what happened:

Ms. Trujillo, a registered nurse of six years specializing in cardiology, geriatrics and end of life/palliative care,  was caring for a patient who was being evaluated for a liver transplant in the hospital.   According to Nurse Trujillo, the patient did not understand the complexity of what she would undergo,  nor did she know there were other options.  In the course of her assessment she reviewed the procedure and educated the patient with approved patient education materials.  After a full review of the materials the patient stated, “Had I known everything I would have to go through and the commitment I would have to make, I would not have agreed to the transplant evaluation.”  The patient inquired into whether there was anything else (pt) could do besides enduring more tests, procedures or surgeries.  Ms. Trujillo then explained hospice care services and the differences between symptom relief care and end of life care.  The patient expressed serious concern that (pt) would not be able to commit to an extensive aftercare regimen following the transplant by stating “at this stage in (pts) life (pt) just wanted to be around family.”  The patient requested to visit with a representative from hospice in order to ask some questions and gain additional information that would assist (pt) in making a more informed decision regarding (pts) course of care.   The patient requested a case management consult with hospice to explore palliative care and the Nurse ordered it and documented the conversation in the chart.  She also used the SBAR (Situation, Background, Assessment and Recommendation) format of report required in the Hospital policy when she handed off care of the patient to the day shift nurse.  (this according to State Board Inquiry documentation)

 The next day the physician was unhappy that the planned surgery was in jeopardy and he refused to let the patient visit with hospice.   He accused Ms. Trujillo of acting outside of her scope of practice and the nurse manager became involved as did Hospital administration and Amanda Trujillo was fired for writing an "order" for case management.

This case went through the Arizona State Board of Nursing and her license has been suspended. As a single mother of three, she is unable to find work as a nurse and subsequently she was ordered to undergo psychiatric consultation by the Arizona State Board of Nursing.  She has appealed revocation of her license and it remains "under investigation status".

I am amazed at this case.  That an RN could be fired and have her license suspended for educating a patient and ordering a case management consult is a travesty.  In my hospitals, if there was a difference of opinion, an official ethics consult would be obtained and objective professionals would help resolve any conflict.  We put the "patient first" and that means whatever helps the patient achieve their life goals is what we support.  It isn't about what the doctor wants and it isn't about limiting nurses in educating patients.  Nurses and physicians should support this philosophy and, in the best of worlds, work together to deliver on it.

Amanda Trujillo has been dealt with unfairly.  Plain and simple.  And I wonder what happened to the patient? 

Addendum:  There are many sides to a story and the Trujillo case is complicated if you take into account the other allegations by the Arizona State Board of Nursing (ABON).  Her license was suspended pending investigation of other presumed professional lapses along with this one.  You can read it here.




14 comments:

Craig said...

Unfortunatly your blog posting doesn't necessarily reflect the reality of the Amanda Trujillo case. First, to the best of my knowledge she's single mother of one, not 3.

As more information came out from the investigation by the BON, questions about the accuracy of the origional story, as well as questions about Amanda's history as a nurse were raised. At this point they are still just allegations. Amanda doesn't appear to have had the opportunity to present her side of the case yet and confront the witness against her. It's easy for disenfranchised nurses to grab onto her cause and carry it with a passion that is to be admired in some ways, and feared in others

There is no question that taking over 15 months to resolve this issue is a crime against Amanda. The Doc should never of had the childish temper tantrum.

One of the drawbacks of getting our information from the net and from blog posts, is that the people who take up and carry a cause like Amanda's have passion about the cause, but don't always have an open mind.

OldSquid said...

Bottom line, it is easier to fire a nurse and tarnish her career than to upset a physician that brings money into the hospital.

OldSquid said...

Bottom line, it is easier to fire a nurse and tarnish her career than to upset a physician that brings money into the hospital.

Toni Brayer, MD said...

Craig: Before I wrote on this topic I tried to get all of the information, from both sides, that was available. I agree with you about the internet and errors that get re-stated over and over, which is why I read and report using only the "verified" facts and not just what other nurse bloggers are saying.

This story has a lot of emotionalism throughout that needs to be sifted out. The fact that the ABON (Arizona Board of Nursing)called for a psychiatric eval on her does not change the facts of the event. The fact that she went public may annoy many people, but it doesn't change the circumstances of the event.

I will try to follow this story that has been dragging on for 15 months and give updates as they come in.

Thanks for your comments.

Andrew Lopez said...

Hello Toni,

Thank you for covering Amanda's situation. Amanda & I talk a few times a week.

It was reviewed, fact-checked early on by Patricia Iyer, a Legal Nurse Consultant of over 20 years and the past president of the American Association of Legal Nurse Consultants

It includes a detailed analysis, letter to the Arizona State Board of Nursing on Amanda's behalf.


http://www.avoidmedicalerrors.com/2012/01/amanda-trujillo-nurse-fired-for-being-a-patient-advocate/

Amanda's license is "under investigation," it has not been revoked or suspended.

http://www.azbn.gov/OnlineVerificationDetails.aspx?id=202742&certid=230047

She has had difficulty finding work as a nurse in other hospitals.


I've been following her case and others like it since January. We've compiled most of the blog articles, documents here.

http://www.nurseup.com/trujillo/

We'll add a link to your post to our list.

Andrew Lopez, RN

Anonymous said...

The facts are the patient wasn't scheduled for a liver transplant, the patient was in hosp for an unrelated problem, the patient was given large amounts of information during the wee hours of the
morning, after she had been medicated with narcotic for pain.

No one is arguing that taking over 15 months for the BON to take
action is a travesty, but what started this was a nurse who possibly made a bad decision (which we all,have at one time or another). We also don't know the facts about Amanda's work history. What should have been a local, human resource issue became a "national" movement.

It appears that most people are bored with it, and have moved on.

When you read the actual charges against Amanda, it paints a picture,
completely different than what she is claiming. Even though there are
parts of the claim that are laughable. The whole issue of the (s) in her signature block.

My perspective on this whole issue is unique, I've been a CNO, and now
work with a couple of attorneys who defend nurses in cases of malpractice and license issues. I do agree that Banner health
turning this into the Board of Nursing was probably unwarranted. This wasn't a scope of practice issue. It appears, and this is only
speculation on my part based on 35 years of experience, was a poor
nursing choice, and a nurse who refuses to admit that she did anything
wrong.

Despite popular opinion from the nurse side of the house, nurses can
be as stubborn and ego driven as MDs are made,out to be

The Nerdy Nurse said...

Additional information has been revealed.
http://thenerdynurse.com/2012/07/cry-havoc-a-fair-and-balanced-account-of-the-amanda-trujillo-saga.html

Andrew Lopez said...

Hello Toni,

If you're going to link to the Arizona State Board of Nursing charges against Amanda (Which I also do on Nurseup.com), kindly also link to a rebuttal of how these charges are formulated, publicly released and distributed BEFORE they've been contested or cross-examined.

RN Guardian’s Position Statement on Registered Nurse #AmandaTrujillo’s Accusation from the Board of Registered Nursing #nurseup:"While outrageous and seemingly unjust, Amanda’s situation is not unique. I have stacks and stacks of files in my office with Accusations from the California BRN which include horribly damning language against the nurse, much of which, according to the nurse, is stretched, fabricated, embellished or just downright wrong. These accusations are not sent to me by the client. They don’t have to be subpoenaed. They aren’t sent to our lawyers because we are the named counsel of record, no. They are public record easily accessible on the BRN’s website for everyone including my grandma and 11 year old son to read."
http://nurseup.com/wordpress/2012/04/rn-guardians-position-statement-on-registered-nurse-amandatrujillos-accusation-from-the-board-of-registered-nursing-nurseup/

It appears State Boards of Nursing in Arizona, California and other states have tossed the legal right of "Innocent Until Proven Guilty" out the window when it comes to licensed nurses.

Andrew Lopez said...

Anonymous:

What are you basing you statement that the patient was under the influence of "narcotics" based on please? Kindly present your source of that information.

I'd like to fact-check it please. I strongly doubt Amanda would have initiated that conversation knowing the patient was unable to coherently have it.

nursesfyi said...

Whats the latest on Amanda's case?

nursesfyi said...

Whats the latest on Amanda's case?

Anonymous said...

UPDATE AT

http://www.azbn.gov/OnlineVerificationDetails.aspx?id=202742&certid=230047

SEE LINK AT BOTTOM OF PAGE

Anonymous said...

Thank you for the latest link that gives the BON of Arizona's account of the charges and details of Amanda's probation. I am still unsure of how I feel about this whole situation. Obviously the nurse had many jobs, and made some poor decisions such as bringing family members on a home health visit that was unprofessional and in bad judgement. She also was ordered by the board to undergo mental health therapy so I can surmise that must have been in her history somewhere. I am unsure what the patient DF really was in the hospital for, and if the pt did have end stage liver disease, surely hospice consulting should have not been an issue. We as nurses usually order consults while they are inpatients with a verbal order....which of curse protects us if we actually speak to the said MD...of course. I pray this nurse gets the help she needs, and overcomes all of this. I hope she can use all of the education and skills she has earned to once again help people. We as nurses do age, we do as humans suffer from illnesses as well. We become so focused on helping others that we forget to take care of ourselves. We are in a high stress job enviroment, and administration and BON's regardless of the state do not always protect us the nurse.

Peary Brown said...

This is a post by an experienced nurse. I know this case in most of the details and have communicated and read many documents coming from the Board as well as from Amanda herself. First off the Board is overwhelmed with the managerial and political side of state licensing of more than 75,000 nurses. A daunting task and their ability to get accurate information brought forward in a timely fashion is basically an impossible task with the staff they have. The Board has been audited and been found to be delinquent in their ability to do timely investigations, and the Board found a solution in issuing letters of concerns in cases that clearly warranted closer monitoring. You could actually flush an IV with bleach and get a letter of concern. The political side of Amandas' case is like many other cases that could be summed up in one sentence. If a doctor complains then it must be right. If there is anything further from the truth
I don't know what that is. The case against Amanda Trujillo is a sham from start to finish. It could have been resolved in a 5 min hallway consult and forgotten about. She is the nursing statute of injustice and will not shut up or let the lawmakers forget they've got corruption in the health care systems. Injustice never shuts up, and neither will Amanda.