The year was 2013, this writer had been a nurse nearly three years when they encountered a situation in a long term care setting that almost inspired the writer to quit nursing altogether. The situation involved a young Jesuit priest who was actually in the last 14 months of his life unbeknownst to anyone at that time.
Having had early-onset Parkinson’s since 48 years old, the 62 year old Jesuit was losing control of his motor functions which caused him great fear and anxiety. His muscles would freeze when the Sinemet wore off causing his body to collapse where ever despite his frantic efforts to get to safety.
Two weeks before the Jesuit priest came to us, the Unit Manager called a meeting to inform the staff of his coming. She made it clear that he was a “handful” and we had to form a “united front to keep him inline”. We did not know what to think about this crazy patient. She explained that he was “an ungodly, unpriestly priest known for seeking out the weakest link so he can get his way. He is maniacal and manipulative.” We were not to give into his demands according to the unit manager. For this writer, such statements seemed wrong, especially coming from our nurse leader, the Unit Manager.
Two weeks later, the priest arrived without any medications. His belongings had been thrown into his room earlier. He was in a wheelchair seated in the dining room when soon after the meal, his head slumped to the table and he began to call out. This writer did everything to make his admission as safe as possible. It took the writer and a GNA with the Hoyer lift 15 minutes to extricate his rigid body from the wheelchair. The first night was rough but the patient was made as comfortable as possible with great detail to respect and safety by this writer.
Unlike the average patient- the frail 87 year old with dementia, Father's language was intricate, festooned with complicated adjectives and highbrow words that my staff did not understand. He also spoke German, Latin, Italian, Russian, Greek, French and Hebrew…fluently. Father was younger, very alert and had solid muscle. He moved quickly and independently unless the medications wore off, turning him to stone.
Some felt Father was faking when he would abruptly collapse then call out for help. Father was fearful of being paralyzed and lying in cold urine for hours waiting for help. Due to the constant violent tremors he was always ravenous: hence, the bland, meager portions of institutional food could not satisfy the caloric requirements of the disease.
Anyone could see Father appeared very frustrated as he inventoried his losses. Once a brilliant keyboard player, the violent tremors caused by too much medication rendered his hands useless causing him to pound them on the piano until he was able to bang through a bar or two of a complicated piece. He would demand to be taken to the piano at times when his arms and feet could not propel the wheelchair. A few times he had fallen in this writer’s presence but he quickly leapt to his feet and begged it not be recorded as he would be forced to stay in a Geri chair against his will.
Slowly, like the gentle rain before a storm, the unethical treatment began, first small things like throwing away Father’s food in the refrigerator the day after it was ordered. Then, it was kitchen curfew for Father yet any other patient could eat late snacks. Some staff like this writer, continued to help Father get food and made sure he ate it against the Unit manager’s orders. The storm began to rage with peppered arguments over medications.
Unlike other patients, whenever Father asked for a short acting medication the med tech argued with him. One time she screamed at him, calling him names and cussing at him "I'm tired of your shit!" in front of the dining room of other patients. Father had to beg for an immediate release Sinemet to keep him going until the long acting meds kicked in. The med tech was not written up for publically humiliating Father despite this writer’s intervention and report to management.
Other patients were permitted visitors in their rooms, but not Father. The Unit Manager quickly severed ties when she learned that Father had been joining a former priest he knew from Rome. The former priest came to visit his mother for dinner and movies in her room and both had enjoyed Father's company. When the unit manager found out, she forbade them to associate with the Jesuit.
Father was devastated. He wept when he informed this writer. Slowly, Father had been isolated, his food reduced to the meager slop with no additional snacks or whole foods required for the Parkinson’s. Staff was permitted to harass him. The aides who had sided with the unit manager intentionally waited until he was frozen to ask if he wanted a shower, knowing full well he had to decline due to immobility. Cursing at him, calling him a liar, making him wait for help and forcing him to beg for his medications became acceptable behavior for the staff per the Unit manager. We were told to be a united front or else there would be consequences.
Despite the weekly scourging from the unit manager, this writer continued to fight for Father. Father was fed, clean, bathed, shaved, shampooed, medicated and engaged in conversation, humor and prayer. When it became apparent that Father had no rights, this writer contacted Social Work who agreed and tried to do something. Nothing came of that. Being a faith-based facility, it only seemed right to get the in-house Priest involved, so Writer contacted the Priest expressing the abuse in an email confession, yet he did nothing. Father continued to suffer terribly.
A harsh work environment was created by the unit manager in an effort to purge this writer from employment. Yet, this writer held firmly to her beliefs and high moral standards. She broke the united front rules by continuing to advocate for Father, feed Father, bathe, visit, respect, honor and medicate Father. The unit manager threatened other staff into submission. Most had feared for their jobs and did as she ordered. Not this writer who just could not go along with the abuse, despite the threats.
Together the unit manager with her minions concocted a plan to have the writer fired. After three harsh months of harassment the group effort worked and this writer was expelled. Father was devastated. Despite the false charges, the writer's nursing license had no blemishes because they had done nothing wrong. It was not against the nursing laws to feed a hungry patient or to treat them with dignity and respect.
Father had no voice because his family was across the country and the Jesuits were very busy caring for their other infirm priests. Even the Ombudsman was told that the writer was a threat to his life and was forbidden to see him. Yes, the writer’s reputation was trashed to the point that the Ombudsman, the Jesuits and the family actually believed the unit manager at one point. Truth will always surface.
Eventually Father was bed ridden with a peg tube for nutrition . Before being expelled, this writer had gone over the on call’s head to get a life-saving IV fluid bolus after the staff had injected Father with Haldol sending him into Neuroleptic malignant Syndrome- confirmed by his doctor who then rushed him to the hospital during rounds the next day. The day nurse had cussed out the writer, saying they should have let him die despite his Catholic beliefs and verbalized and written wishes to live. That nurse also hissed that she was not going to give him the necessary water flushes which later dehydrated him.
Father had lost 60 pounds in five months and their excuse was “patient was refusing the food”. Father was kept over-sedated and suffered from forced dehydration as staff refused to give him flushes- all supported by the unit manager. After being expelled, this writer continued to fight for Father by contacting the Board of Nursing, The DHMH, EEOC and an attorney. Father died nine months later asking to see his nurse. He was dehydrated and kept over-sedated until he gave up.
This story is based on an actual events that went unpunished. Senior Citizens are at great risk of Elder Abuse despite the governing policies written to protect them.
OUTCOME
The EEOC reported that the facility and the unit manager were guilty of abuse, neglect, harm, false imprisonment, chemical restraints and possibly manslaughter but because of their documentation, the patient was made to look like he was refusing and resisting care, treatment, food and medications. Nobody sued for the near death Neuroleptic Malignant Syndrome, nor did anyone fuss over the fact that the priest had no rights. The facility had known just how far to stretch the truth over the broken laws in order to get away with it.
The DHMH did investigate the facility for a month and found the patient was chemically restrained, forced dehydration and starved. The facility did receive a few tags and the staff responsible for this atrocity had a few demotions but nothing more. The unit manager’s husband was a state politician.
The unit manager and her united front ganged up on the patient and the person who had tried to advocate for him. That person was naive to how it all works but knew it was not right. New nurses are often afraid of their superiors and are not quick to go over their heads. In this case, it was too late but the State did investigate.
VIOLATIONS IN THIS CASE
1. Rights-based ethics that stresses the individual’s rights (Fremgen, 2016). Not practiced by the staff. Pt had no rights to choose treatment, food or Medications.
2. Duty-based ethics- “our actions should be universal which means that everyone would act the same way with the same set of circumstances” (Fremgen, p,11, 2016).
3. Justice based ethics: “the veil of ignorance” to prevent the decision makers from being biased (Fremgen, 2016).
4. Virtue-based ethics- the unit manager singled out the priest and dehumanized him which is against the laws of man and God. She did not practice virtue-based ethics. There were facts and evidence, witnesses and statements that could have put her in jail had this gone to court.
CONCLUSION: Lessons Learned
A unit manager is accountable for how the staff treats patients and he/she is not above the law. The proper chain of command does not always work; in that case contacting DHMH or MBON or another governing body for suspected abuse, neglect and violation of patient rights must be done. There are no laws against great, compassionate care. Persons who have mental issues that affect their ability to make sound, ethical decisions should not be permitted to manage staff, especially in patient care facilities.
References:
Fremgen, B., (2016). Medical law and ethics, 5th edition. Pearson. Boston, MA
