The Department of Veterans Affairs Office of Inspector General (OIG) recently investigated a VA Western New York Healthcare System for the circumstances that led to a patient’s death. The investigation focused on the alleged mismanagement of a patient’s resuscitation.
The nurses subject to inspection faced accusations of a failure to attempt to resuscitate a patient. The patient died as a result of this alleged failure. The nurses found a patient unresponsive and allegedly failed to act. The nurse stated that they did not want to begin chest compressions and “put the patient’s body through trauma, such as cracked ribs.”
The investigation led to three findings:
- Recognition. The nurses failed to recognize the patient’s cardiac issue at its onset.
- Interpretation. The nurses incorrectly interpreted the issue as “benign.”
- Interference. The nurses silenced alarms monitoring the patient’s cardiac arrest. No alternate action was taken.
Ultimately, the OIG found that the primary nurse failed to call the correct code and other staff failed to advocate for the patient. The lack of teamwork within the medical staff was blamed for jeopardizing the patient’s quality of care. This led the OIG to recommend additional investigations, including a review of the facility’s quality management practices. The OIG also chastised the facility for failing to immediately remove the nurses involved in this situation and conduct a timely review.
An investigation of this nature can destroy a medical professional’s career. As such, any nurse or medical professional that believes they are the subject of an investigation is wise to take prompt and firm action to defend their professional reputation. An attorney can advocate for your interests in these matters.