Nurse argued errors could have happened to anybody but treatment didn’t account for patient’s history and region’s suicide problem
The dismissal of a Northwest Territories health care worker for improperly treating a patient who later committed suicide has been upheld by an arbitrator.
Sandra McKiver became a community health nurse in Fort MacPherson, NWT, in August 2000. Fort MacPherson was a fairly remote community in the north of mostly aboriginal people. The health centre where McKiver worked served the town and surrounding smaller communities. McKiver’s responsibilities covered a many medical procedures and evaluations, as there was no permanent doctor in Fort MacPherson – one visited every five weeks and there was an on-call physician in Inuvik, a three-hour drive away in good weather. The community had a high incidence of suicides and alcohol-related illnesses.
McKiver had a record free of discipline and positive performance evaluations until Aug. 27, 2007. On that date, McKiver was the on-call nurse overnight. Around 3:30 a.m., someone called the health centre to report a previous patient who was intoxicated and had taken pills, and was also in possession of a pail of Sudafed. McKiver was aware of other suicide attempts by the individual in question and talked to the patient. The patient denied taking pills and McKiver felt she seemed aware and in control. Later, a police officer took the patient to a cell at the local RCMP detachment.
A little later, the police called McKiver to report that the patient had vomited in her cell. McKiver asked them to bring the patient to the health centre. She observed the patient and took various vital signs. She called poison control about a possible Sudafed overdose and, after a couple of hours of further observation, released the patient back into police custody.
A few hours later, the police brought the patient back to the health centre. She was complaining of stomach pain and had labored breathing. McKiver examined the patient again and determined she was intoxicated. She prescribed pain medication and, after talking to the patient, determined she was stabilizing. The patient said she was feeling better and wanted to go home, so McKiver sent her home with a relative who was instructed to stay with the patient to ensure she stayed hydrated and didn’t consume alcohol or unauthorized pills.
That afternoon, another nurse told McKiver that the patient might be pregnant. McKiver tried to contact the patient and the relative but couldn’t reach either of them. As her shift ended, she told the health centre clerk to continue trying.
Later that night, the police called the health centre with the news that the patient had died. An empty bottle of Tylenol and several empty liquor bottles were found at the patient’s home, as well as a suicide note.
Investigation raised concerns about treatment
The health centre investigated the death and there were several concerns about McKiver’s treatment of the deceased patient. The nurse in charge felt McKiver should have explored the possibility of a drug overdose more quickly and asked poison control about Tylenol as well as Sudafed. She also felt McKiver should have run more tests for an overdose and not discharged her without a follow-up plan. In addition, the patients chart was missing information that should have been written down. After interviewing other nurses and examining the charts, it was determined that McKiver made some bad decisions in treating the patient and didn’t properly document the treatment. McKiver was suspended with pay on Oct. 11, 2007, pending an investigation by outside investigators.
The outside investigators had similar findings, and on Dec. 4, they presented their report. The report stated that McKiver didn’t properly investigate and assess the patient’s drug overdose and later abdominal pain, a lack of assessment of her respiratory issues and other symptoms, and inadequate assessment or follow-up treatment. In addition, she didn’t document or take any information from the initial call regarding the patient, and discharged the patient before consulting with the community suicide team or ensuring many of her symptoms were improving.
On Dec. 10, the health authority sent McKiver a letter indicating it was recommending her dismissal and asking for her response to the recommendation. McKiver replied with a letter explaining that she approached the situation as an alcohol abuse situation and had seen no evidence of Tylenol or other drugs from the patient’s home. She also claimed the patient didn’t seem suicidal and she was gradually sobering up while at the health centre. She blamed the police for not giving her all the information about any drugs and said there was no protocol for contacting the suicide team upon discharge of a patient. McKiver finished by stating she hadn’t done anything wrong and she had fulfilled her duties as a nurse to the best of her abilities. However, McKiver’s arguments didn’t sway anyone’s opinion and she was dismissed on Jan. 4, 2008.
Shortly after McKiver’s dismissal, the nurse in charge filed a complaint with the territorial professional nurses association, which investigated and found McKiver guilty of professional misconduct. McKiver’s licence was suspended and she was required to complete several courses to be reinstated.
The arbitrator found that McKiver “committed serious errors of professional judgment in her treatment” of the patient. The health profession was held to a high standard of conduct and the reasons for McKiver’s dismissal were legitimate, said the arbitrator. Failing to properly chart the treatment and failing to properly assess and follow up the risk of a drug overdose when the patient had a previous suicide attempt and had was suspected of taking Sudafed was serious misconduct.
The arbitrator also noted that it wasn’t a single isolated incident. The patient had been discharged and brought back, and the errors in treatment continued, said the arbitrator. In addition, the professional nurses association’s findings reinforced the seriousness of McKiver’s misconduct.
