No. 60 M.D. Appeal Docket 1984, Appeal from the Order of the Commonwealth Court at No. 106 C.D. 1982, which reversed the Order of the State Board of v. Nurse Examiners, issued December 28, 1981.
Nix, C.j., and Larsen, McDermott, Hutchinson, Zappala and Papadakos, JJ. Flaherty and McDermott, JJ., did not participate in the consideration or decision of this case. Papadakos, J., concurred in the result.
This is an appeal by the Commonwealth of Pennsylvania, State Board of Nurse Examiners (Board) from the Commonwealth Court, 80 Pa. Commw. 603, 471 A.2d 1339, order reversing the Board's order revoking the nursing license of Appellee Ann Marie Rafferty. The Board's action was taken pursuant to Section 14(3) of the Professional Nursing Law, Act of May 22, 1951, P.L. 317, as amended, 63 P.S. § 224(3), which provides that the Board may suspend or revoke any license where the Board shall find that "the licensee has wilfully or repeatedly violated any of the provisions of th[e] act or of the regulations of the Board."
The findings of the Board, which are supported by the record, establish that Appellee was employed by Thomas Jefferson University Hospital as a registered nurse in the Neurosurgical Intensive Care Unit during November, 1978. She was responsible for the care of patient Richard Bartus during the shift from 11 p.m. on November 1, 1978 to 7 a.m. on November 2, 1978. Following surgery, the patient had developed serious complications which left him comatose and in respiratory distress. His pupils were fixed and dilated and he was unresponsive to deep pain stimuli. His respiration was maintained on a Bennett MA-I Respirator, while his blood pressure was maintained by the infusion of dopamine. The patient was presumed to be brain dead, but this status had not been conclusively established at the time of Appellee's shift. The results of two electroencephalograms had not been attached yet to his chart. The patient did not have a "no code" order in his chart. It was the Hospital's policy that in case of respiratory or cardiac failure that all efforts for resuscitation were to be attempted, unless a "no code" order was documented.
The record establishes that the Appellee had reviewed the patient's progress notes covering the previous three or four days prior to undertaking his care. The Appellee was aware of the patient's condition from this review. She was also aware that the patient had "coded" recently and that the cause of the code was that he had suffered primary respiratory failure. The Board further found that at approximately 3:30 a.m., the Appellee remarked to Jeffrey Cameron, another registered nurse, that she was going to bathe the patient and proceeded to his room. Prior to the bath, Appellee checked and recorded the patient's vital signs, disconnected the ventilator from his endotracheal tube, suctioned the secretions which were present, and reconnected the ventilator. During the suctioning procedure, there were no signs that indicated the patient was assisting ventilation.
At approximately 3:45 a.m., the Appellee noted that the patient was experiencing rare premature ventricular contractions (PVCs), which were abnormal for him. She determined they were not life-threatening after viewing the monitor and proceeded with the bath. After bathing the head and neck region, Appellee tested the patient for spontaneous respiration.
Appellee performed the test by adjusting the ventilation so that the patient was given two to three deep breaths of 100 percent oxygen, then removing the ventilator tubing from his endotracheal tube and laying it across his chest, and observing him for any signs of movement. During the test, the patient was off the ventilator for a period in excess of thirty seconds during which time he was deprived of pure oxygen and placed on room air. The Appellee did not touch the patient or administer any type of care during the test. The patient displayed no signs of spontaneous respiration.
The Appellee then reconnected the ventilator tubing, resupplying him with pure oxygen, and continued with the bath. She noticed a significant change in the patient's vital signs as his blood pressure drastically decreased and his PVCs drastically increased. The Appellee failed to incorporate
the cardiac monitor strips documenting the PVCs into the patient's chart.
The Appellee sought out Nurse Cameron to ask his opinion regarding the changes. Noting that the cardiac monitor registered asystole (i.e. lack of heartbeat), Cameron told the Appellee to call the code and began to ventilate the patient. Instead, the Appellee called a third registered nurse, Mary Johnston, who immediately administered CPR. The Appellee was told once again to call the code. She then left the room, called the neurosurgical resident on duty, and then called the code. The code team arrived while Johnston and Cameron were attempting to resuscitate the patient. The code was terminated after the code leader received a call from a physician. The resuscitation attempt was unsuccessful, and the patient was pronounced dead at 4:20 a.m.*fn1
The Appellee was subsequently charged with violations of Board regulations set forth in 49 Pa. Code § 21.11(a)(1) and (4) and 49 Pa. Code § ...