For the 17th consecutive year, the Nursing profession has been voted the most ethical and moral profession. As a nurse of 29 years, I am quite proud of that accomplishment. You see, we earned that achievement by being patients advocates. Nurses are the largest healthcare force comprising over 3 million.
Therefore, when the reports came out that a disabled lady had given birth in a nursing home. I was horrified. I had so many questions on many different levels. You see, as nurses, we failed this patient. This was a breakdown on many different levels.
Background of the Nursing Facility
This facility is Arizona’s leading provider of specialized health care services for medically fragile and chronically ill infants, children, teens, and young adults as well as those with intellectual and developmental disabilities according to its website.
Hacienda Healthcare has a children’s hospital, a skilled nursing facility, and an autism training vocational center. They provide long-term, short-term, respite, and palliative care. These are services that are very much needed.
Background of the Patient Giving Birth in a Nursing Home
This patient was admitted to this facility when she was 3 years ago. She is now 29 and has been in a vegetative state for about 10 years. The patient was involved in a near drowning accident. According to reports, the staff noticed the patient was “moaning”. The staff was unaware the patient was pregnant.
The patient then delivered a baby boy. By that time the staff was calling 911. The baby boy had some problems breathing and according to the nurses, “the baby was turning blue”.
The nurses went on to resuscitate the baby, and the mother and child were brought to the hospital.
Patient Gives Birth in a Nursing Home
Did the nursing staff let this patient down? These are vulnerable people and the nursing staff is supposed to “protect” them. Don’t misunderstand me, I think all employees of Hacienda Health should be charged with making sure the patients are safe. However, the doctors and the nurses are the ones that are doing direct care. Nurses are with the patients 24 hours a day.
I know long-term care is a bit different, but the doctors should be doing at least a monthly exam. I would assume the nurses should be doing at least a head to toe assessment each month.
Since I have never worked in long-term care, I went about asking other nurses who work long term care what is the protocol. I got so many different answers. Some of the protocols listed were as follow:
- The physician does a once a month assessment or PRN
- A complete set of vital signs are done monthly
- medication reviews are done monthly
- Some nurses stated they do nurse assessments monthly, and some nurses stated they did not do any routine assessments.
Clearly, the ball was dropped. This facility has fired two physicians and the CEO has resigned.
Nurses Are Advocates
Nurses are patient advocates. This is why nurses have for the 17th year in a row, been voted the most ethical and moral profession. Therefore, in a facility that has nurses and nursing aides as the majority of the staff, how could this happen?
In my opinion, the nursing staff failed this patient on many levels. How can a vegetative patient be pregnant for nine months and no one knows about it? For example, let’s start with the nursing assistants.
Someone, most likely a nursing assistant is charged with giving the patient a bath daily. Are these nursing assistants sufficiently trained to report “abnormalities” in patients?
Did the nursing assistants not see her ever-growing abdomen? Did the nursing assistants not report that she has not had her menses? Were the nursing assistants turning her as scheduled? Did they notice that she was gaining weight and her clothes no longer fit?
The Nurses. Let just say the facility policy is to do a nursing exam monthly. When the nurses examined her abdomen and listened to her bowel sounds, they did not notice anything different?
Not one nurse noticed her growing abdomen? The patient probably had a feeding tube because she was in a vegetative state. The nurses had to give her medication through a feeding tube? There was no notice of the patient being pregnant? One of the nurses’ roles is to supervise nursing assistants.
The nursing assistants should have some kind of logs to document when the women residents have their menses.
The doctors. I have not let the doctors off the hook. The doctor is billing the insurance companies for the care of these patients. The doctors have the overall responsibility for the care of these patients.
The doctors are the healthcare professionals who order labs, order tests and do the monthly physical exams on the patient.
Clearly, this was a sexual assault case and the facility and the perpetrator must be held accountable. The Arizona Department of Economic Security has launched a review of all of the patients at the Hacienda Healthcare Facility. Arizona State Department of Health Services has all started an investigation.
According to the Department of Economic Security, this facility was charged with fraud by the state for overcharging. I am sure the facility will be paid a visit by The Joint Commission and The Centers for Medicare and Medicaid.
Since the patient was nonverbal, the staff had to go by other signs and symptoms of abuse. For example, staff who insist on caring for the same patients every day. Since nursing assistants are the ones to give direct care, they should be educated about reporting any type of bruising. Has the patient suddenly become depressed, fearful, or agitated. Staff should be on the lookout for bruises on the thighs or genitals.
The police served a warrant to the Hacienda Healthcare Facility to have all of the males employed at the facility DNA tested. It was determined that an LPN employed at the facility was the father of the child. He has since been charged with sexual assault and was arrested. However, he has not been convicted.
I must admit this was a heartbreaking story. This story hit the nursing community at its core. However, I am sure there are nurses and nursing assistants at the Hacienda Healthcare Facility that are passionate and care about their patents.
Let this be a reminder to always be an advocate for your patient.
Phyllis Robinson MSN, RN is a Registered Nurse of 27 years. Phyllis is passionate about the prevention and healing of heart disease using traditional and alternative methods. She has experience in emergency room, telemetry, infusion, and critical care. Phyllis currently practices in an intensive care unit.