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In the realm of healthcare, the responsibility of healthcare providers, especially nurse practitioners, to conduct thorough assessments and prescribe medications with utmost caution is crucial for patient safety. When faced with allegations of inadequate assessment and inappropriate prescription practices, seeking the guidance of a nurse attorney becomes crucial for a nurse practitioner. Beyond legal representation, a nurse attorney can effectively communicate with licensing boards, navigate the complexities of investigations, and work towards a resolution that safeguards the practitioner’s professional reputation while prioritizing patient safety.

At the time of the initial incident, RN was employed as a Family Nurse Practitioner at a hospital in San Angelo, Texas, and had been in that position for four (4) years and eleven (11) months.

On or about November 14, 2020, while employed as a Family Nurse Practitioner at a hospital in San Angelo, Texas, RN failed to adequately assess the elderly patient and intervene when she presented to the clinic with a headache and mouth bleeding. Additionally, RN inappropriately ordered a Ketorolac 60mg injection for the patient, though she was on aspirin and Plavix, both blood thinning medications. Ketorolac is contraindicated in patients at a high risk of bleeding and requires caution and reduced dosages for elderly patients. Additionally, RN failed to completely and accurately document in the patient’s medical record, including assessment of the patient’s report of mouth bleeding, and the rationale for prescribing Ketorolac to the patient. Subsequently, the patient went home and approximately seven (7) hours later was found unresponsive. She was then transferred to the emergency department where she was diagnosed with abnormal blood clotting lab values, cardiac arrest secondary to hemorrhagic shock, gastrointestinal bleeding, hypotension, and shock, and was pronounced deceased. RN’s conduct resulted in an incomplete medical record and was likely to injure the patient from adverse effects of combined medications with blood thinning effects, such as increased bleeding.

Without consulting with a nurse attorney, RN responded and stated that he heard the patient tell the receptionist at the clinic that her tongue was bleeding, and he escorted the patient back to the exam room. RN states that he assessed the patient’s mouth and there was no blood during his exam. RN states that she reported a headache that had lasted on and off for three days. RN states that he appropriately ordered a Ketorolac injection to treat the patient’s stated symptoms of a headache. RN states that he used caution due to the patient’s age, the Plavix she was taking, and the blood thinning properties of aspirin, and the dose of Ketorolac he ordered was a standard amount for someone within a standard international normalized range (INR). RN states that it is highly unlikely that his administration of Ketorolac would have caused the lab values at the patient’s subsequent hospital visit to be so abnormal. RN states that the nurse gave the injection, and the patient was observed in the clinic for fifteen minutes before she was allowed to leave. RN adds that this was a routine visit with no indication of a more serious condition being present.

The above action constitutes grounds for disciplinary action in accordance with Section 301.452(b)(10)&(13) Texas Occupations Code, and is a violation of 22 TEX ADMIN. CODE §217.11(1)(A),(1)(B),(1)(D)&(1)(M) and 22 TEX. ADMIN. CODE §217.12 (1)(A),(1)(B)&(4).

However, without seeking advice from an experienced nurse attorney and without enough evidence to prove he’s not guilty, the RN lost the case. This is the reason why the Texas Board of Nursing placed his RN license under disciplinary action.

If you ever undergo cases such as this, it’s best to seek the assistance of a good nurse attorney as it could make the case better in your favor. Be sure to find a nurse attorney who is experienced and knowledgeable in several nurse cases to ensure the best assistance possible. Texas Nurse Attorney Yong J. An is willing to assist every nurse in need of immediate help for nurse licensing cases. He is an experienced nurse attorney for various licensing cases for the past 17 years and represented over 500 nurses before the Texas BON. To contact him, please dial (832) 428-5679 for a confidential consultation or for more inquiries.