Mom wants nursing overhaul

State board isn’t active enough in deadly cases, Billings woman says
2010-07-13T00:15:00Z 2010-08-12T07:10:21Z Mom wants nursing overhaulDIANE COCHRAN Of The Gazette Staff The Billings Gazette
July 13, 2010 12:15 am  • 

The Montana Board of Nursing does not do enough to protect patients from dangerous nurses, a Billings woman says.

Debra Wilcox has asked Gov. Brian Schweitzer to reform the state nursing board, the entity that issues licenses to Montana’s 14,800 licensed practical nurses and registered nurses.

“I think they’re worthless,” Wilcox said of the board’s members. “They need to have more serious consequences, especially when a death is involved.”

Wilcox’s daughter died after receiving what Wilcox claims was substandard care from a nurse.

Four of the nursing board’s nine seats come open this summer, and Wilcox has asked Schweitzer to fill them with an eye to reform. Nursing board members are volunteers appointed by the governor and confirmed by the state Senate.

Wilcox has also contacted members of the Legislature and plans to testify during a Board of Nursing meeting later this month.

“We need to find a better way for the board to review cases,” she said. “And there should be stiffer penalties for nurses who fail to report incidents, especially those resulting in a death.”

Ashley Wilcox, 18, died in August 2003 after sustaining a head injury during a seizure at a summer camp for disabled children. Ashley contracted encephalitis as a toddler and suffered permanent brain damage that left her with the mental capacity of a much younger child.

On the morning of Aug. 8, 2003, she was knocked unconscious and wet herself after the back of her head hit a concrete floor.

The camp medical provider, licensed practical nurse Paula Ketterling, determined that the girl was fine after checking her vital signs. Ashley lay unconscious on a mattress on the floor for nine hours until her mother arrived for parents’ night.

Debra Wilcox needed help to load her unconscious daughter into a vehicle. She took Ashley to a Billings hospital, where a scan revealed a substantial injury to her brain.

Ashley died four days later without regaining consciousness. An autopsy determined her death was caused by a massive subdural hematoma sustained in a fall.

Wilcox sued Ketterling and the summer camp in District Court. She eventually settled for an undisclosed sum because, she says, a mediator told her that a jury would view her daughter’s death as a blessing because it lifted a burden from her life.

Wilcox said she didn’t know until after the lawsuit ended that she could report Ketterling to the state Board of Nursing. She filed a complaint in March 2008, bringing her daughter’s death to the board’s attention for the first time.

Ketterling had not disclosed the legal action pending against her when she renewed her nursing license in 2006. Ultimately, it was that failure to disclose the lawsuit that got her into trouble.

Nursing board members could not link Ketterling’s action or inaction to Ashley Wilcox’s death, said Kathy Hayden, the board’s president.

“We didn’t have any proof that she was directly responsible for or had contributed to the death of a child,” Hayden said. “Without those facts, there was nothing we could do.”

Board members read depositions taken during the civil suit and a 32-page report compiled by a Board of Nursing investigator. In the end, they agreed with Ketterling’s assertion that she had properly treated Ashley as a post-seizure patient.

Court records show that Ketterling was experienced with seizure patients because her brother suffered from a seizure disorder similar to Ashley’s.

The Board of Nursing placed Ketterling’s license on probation for one year beginning in October 2009 for failing to report the lawsuit against her and for the way she dispensed medication at the camp. She also was required to complete several continuing education courses and may not practice nursing without supervision while she is on probation.

Ketterling admitted to the nursing board that she removed medications from their original bottles and dispensed them from unmarked baggies. Wilcox said she believes her daughter did not receive anti-seizure medication the morning of her fall.

She said she also believes Ketterling should have been disciplined more harshly.

“Everyone is human, and they’re going to make mistakes,” Wilcox said. “But she still does not understand what she did wrong. It’s going to happen again.”

Ketterling declined to comment on the advice of her attorney, Mike Anderson. Anderson said neither he nor his client could talk about Ashley Wilcox’s death because of a confidentially clause in the settlement agreement between Ketterling and Wilcox.

But Anderson said that Ketterling took the Board of Nursing proceedings very seriously, as did the board members who conducted them.

The board was “not in the least” lenient, he said.

“I sure got no impression that anybody was trying to pull any punches,” Anderson said.

The Board of Nursing openly supports rehabilitation for troubled nurses as long as it can be achieved without compromising public safety. Hayden, the board president, acknowledged that stance could seem soft to people outside the profession.

“It’s not that we didn’t sanction this nurse because we did,” Hayden said. “We gave her a lot to do plus she can no longer work in an independent practice setting.”

Nurses take such sanctions seriously because their livelihoods are on the line. Even losing the right to practice independently can limit a nurse’s job options, Hayden said.

“I feel for that mom. It’s really hard,” she said. “But, if the nursing license got pulled from that nurse, does that help that mom?”

Ketterling is not the only Montana nurse to keep her license after a patient death.

In 2007, a registered nurse in Choteau administered the wrong intravenous medication to a patient who went into cardiac arrest and died. The nurse, Susan Nevin, was placed on probation for one year and was required to complete a continuing education course on medication errors.

Records show that the Board of Nursing rarely revokes licenses. From October 2004 to March 2010, 12 Montana nurses lost their licenses.

But nurses who stole narcotics from patients, went to work drunk or high on methamphetamine, were criminally prosecuted for child pornography and stole thousands of dollars from an employer, among other poor conduct, kept their licenses.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.

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