WhiteCoat

Amanda Trujillo

I finally took the time to read some other blogs today. One of the issues that I found disturbing was the case of Amanda Trujillo.

There are a lot of bits and pieces out there about what actually happened in this case. This blog post was reportedly an e-mail from Amanda describing the events. A summary of the post follows.

Amanda was a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care.
In April 2011, she was caring for a dying patient at Banner Del E. Webb Medical Center who had agreed to a major invasive surgery recommended by a staff surgeon.
Amanda used materials from her hospital to educate the patient about the details of the surgery and the aftercare.
The patient became upset, stating that the surgeon never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care).
Amanda also discovered that the patient “had no idea” that surgery could be refused or that the patient could enroll in hospice care. She educated the patient on those options as well.
Afterwards, the patient requested a case management consult to visit with hospice.
Amanda documented her discussions with the patient and informed the nurse at shift change that the surgeon needed to clear up a “gross misunderstanding” the patient had about the surgery.
“The surgeon became enraged, threw a well witnessed tantrum in the nursing station, refused to let the patient visit with hospice, and insisted I be fired and my license taken.”
She was fired and she is not able to find employment due to the actions taken against her license.

As a result of this incident, Amanda’s career has been destroyed. She is a single mom with three nursing degrees and now, unemployed and unemployable, she has no other option than public aid to feed her family.

Back in 1913, Supreme Court Justice Louis Brandeis once wrote:
“Publicity is justly commended as a remedy for social and industrial diseases. Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.”

I’ve tweeted to Amanda to contact me so that I can get more information from her. If the above events can be substantiated, what happened to Amanda was deplorable. And if the events can be substantiated, I’m going to shine some sunlight on the actions of other parties involved.

I’ll request the patient’s permission for release of the patient’s medical records from the hospital. With the patient’s permission, I’ll publish them here, including the surgeon’s notes and Amanda’s notes.

I’ll get the names of the nursing supervisor and everyone involved in Amanda’s firing, including the hospital CEO. We’ll take a look at their careers on this blog.

I’ll get the names of the people from the Arizona State Board of Nursing who reviewed this case and who recommended that Amanda lose her license and undergo psychiatric testing. I’ll publish any correspondence that they sent Amanda. We’ll take a look at just how they arrived at their conclusions.

And I’ll get the name of the surgeon who allegedly does not take the legal doctrine of informed consent too seriously and who allegedly uses temper tantrums as a means to bully people into submission. Maybe we can look into his background a little. If he did have a “tantrum” in a patient care area, has the hospital investigated him for his conduct?

Everything will be published here.

And if ends up that Amanda was wrong for what she did I’ll publish that as well.

That reminds me …

When two nurses complained to the Texas Medical Board that a physician was trying to hock herbal medications to hospital clinic patients, they were fired and prosecuted for criminal acts. The Texas Nurse’s Association became outraged, established a legal defense fund for the nurses, and fought for them. In the end, the doctor was the subject of a complaint by the Texas Medical Board, and the hospital at which the nurses worked was fined for firing the nurses.

Why isn’t the Arizona Nurses Association taking any action on Amanda’s behalf? I might have an idea.
It so happens that the President of the Arizona Nurse’s Association, Teri Wicker, is also the Director of Professional Practice at Banner Del E Webb Medical Center – the same hospital where Amanda Trujillo used to work. Has anyone asked her for comment?

More to come …

UPDATE FEBRUARY 26, 2012
See also this update post on Amanda’s case.
A timeline and several documents have been published at www.medbloggers.org. More documents will be added as they are received.

123 Responses to “Amanda Trujillo”

  1. midwest woman says:

    Just some clarification……her hearing with Arizona BON has ben postponed pending the results of the psych eval. Her license is active but under pending investigation. Which pretty much makes her unhireable.
    Thanks for posting on this. You’re only the third doc to weigh in on this.

    • On the advice of her Attorney, she declined the Psychiatric Evaluation.

      Can you tell me which other doctors have weighed in? I’d like to list them on our collection of blog articles on Nurseup.com

    • dontwanttobeanurse says:

      reading amanda’s BON order it is so obvious that they were retaliating against her for going public. I have never read such degrading , trash . they must have added to their witch hunt, the ARS list < "hey we can add this one" . just make it fit. SHAME on a BON that acts in this manner. Corupt bunch of evil doers!
      Take away someone career for provding "over 100 pages of information" like the number makes a difference. PSYCH EVAL the investigator for this case. When the BON has nothing else they order psych eval , and then their 'expert'(QUACK) Lett, writes what they tell him too. WHO is the danger to the public? He should have a board complaint on his license!
      those on the BON AZ who voted for this should all be fired and put on their license , 'on probation" . See if anyone else will hire them. A bunch of sicko's thinking that people havent figured out their little scemes. BOYCOTT AZ, And the one that calls herself NOT nurse ratched, is as evil as the BON, nasty person. I would not want for a nurse. The Az ANA is a bunch hypocrites. Who is there for the nurse?

  2. doc99 says:

    Maybe our lurking legal authority Matt can be helpful here. This case seems very disturbing. But more facts are needed before going to war.

    • DensityDuck says:

      Whenever someone brings up a case like this, Matt’s answer is “well we don’t have all the facts so we can’t draw any conclusions”

      That doesn’t stop him invariably siding with the patient in med-mal stories.

      • Matt says:

        I side with the jury, who heard all the evidence. When they say no malpractice, who am I to second guess and when they say malpractice, again who am I to second guess them? I realize that deferring to people who, you know, actually spend days if not weeks hearing the evidence seems crazy when you can read a 500 word article in the newspaper, but I’m just that kind of crazy.

        As to this, it sounds like an employment law matter, and I have little experience there. What’s more, there’s probably some very specific Arizona statutes that are relevant.

        I think what’s important here is that if the surgeon performed wholly unnecessary surgery on this patient, that we be sure that he and his insurer get the maximum liability protection that well compensated insurance lobbyists can get the legislature to provide, regardless of the facts of the case! The people of Arizona are just too damn stupid to judge his actions!

      • WhiteCoat says:

        The jury should decide all matters abou…
        The jury should decide all matters abou…
        The jury should decide all matters abou…

        Hey – someone want to kick the jukebox? The record seems to be skipping again.

        There wasn’t a trial, counselor. The hospital reportedly took action against her and the nursing board reportedly took action against her license without due process.

        What should those “stupid” Arizona people do now?

      • Matt says:

        You missed the post I was replying to evidently. That’s what happens when you don’t gather the facts, man!

        Of course it’s not a trial, never said it was. Read for comprehension.

    • We’ve been following this case for some time, supporting Amanda. What “Facts” would you need?

  3. Lynda M O says:

    I await the rest of this story; I am appalled at what has happened to Amanda and what could happen to the rest of this world’s nurses if doctors are allowed to behave like this again.

  4. Shelby says:

    Kudos for taking the time to fight for this nurse. As a nurse, I’ve found more times than not that patients are not given much information by surgeons on the surgery they are to have. Most patients don’t understand what they are signing when they give consent. I know this because I talk to them about the procedure after they have signed consent. As an ER nurse, most times these surgeries are emergent so the situation is a little different.

    It disturbs me that more nurses aren’t outraged by this. We are taught in school to be patient advocates & teachers. If I can help, you have my email addy.

    • Andrew Lopez says:

      In this case, The Doctor & Banner Health Del E. Webb Medical Center had specific reasons for wanting the transplant evaluation (without offering other options such as comfort care or hospice).

      We firmly believe that she was fired because Banner Health is putting profits before patients, and this was threatened by Amanda’s Patient Advocacy.

      Healthcare for People Not for Profit: Transplants and Amanda Trujillo, Center for Health, Media & Policy, April 4, 2012:”Organ transplantation is a complex and challenging undertaking for both the patient and providers. It can offer the appropriate patient opportunities for greatly improved quality and length of life and it can also offer an opportunity for profiteering and conflicted behaviors. As outlined below, transplantation produces significant revenue dollars, even for a “non-profit” hospital. Estimated U.S. Average 2011 Billed Charges Per Transplant: Heart Only – $997,700 Liver – $577,100 Kidney – $262,900 Nurse Amanda Trujillo identified that a patient she cared for at Banner Del E Webb Medical Center of Arizona lacked full information about what a transplant evaluation and post-transplant self-care entailed. She says she referred the patient for a hospice case management consultation. She was then fired for overstepping her scope of practice. Arizona’s scope of practice for nurses clearly dictates a nurse’s role to promote the client’s best interest.”
      Center for Health, Media & Policy
      Hunter College City University of New York
      425 East 25th Street New York, N.Y. 10010
      email: centerhealthmediapolicy@gmail.com
      http://centerforhealthmediapolicy.com/2012/04/04/healthcare-for-people-not-for-profit-transplants-and-amanda-trujillo/

  5. Leslie says:

    If this is substantiated, the surgeon should lose his license under legal action (civil, I’d presume), she should be reinstated, with back pay

    • JoJo626 says:

      I wouldn’t want to be reinstated at a hospital that had treated me like that. Back pay, of course, would not be turned down.

      • amanda trujillo says:

        …Im never returning to the bedside. Seeking to start my own nurse advocate business, a future in teaching, and and also working as a heart failure NP. Im also writing a book about this experience for nurses to learn from: “The evolution of the corporate nurse…” There is no way I will ever voluntarily enter another hospital again, knowing what I know now about the expectations of our profession within those walls.

  6. jillian says:

    I am totally outraged at this — not on behalf of the nurse, exactly, since I’m not one, but on behalf of the patient. S/he was coerced into consenting to a surgery with lifelong effects, up to and including a miserable death in the ICU instead of a hospice death at home. This travesty, even if reversed, will certainly have a chilling effect on what nurses choose to tell patients. To the surgeons, it’s just another chance to do a cool surgery, but to the patients and their families, it’s a huge, life-altering decision, and a surgeon’s EGO should not be a consideration. Disgusting.

    • Jillian,

      This is exactly what scares me in this case.
      As Amanda has previous stated, this hospital is cultivating a culture of fear among nurses. It limits a nurses autonomy and ability to feel like he/she can advocate for their patients without fear of retaliation. It also reinforces an archaic medical model where physicians are supreme and nurses are merely existent to do their bidding.

      • Palliative Care Doc says:

        Hospitals are continually limiting nurses autonomy. They are implementing rules which require specific doses instead of ranges, the inability to do anything with a patient without a physician’s order, and they are saddling you with more paperwork so that you spend about 25% of your time with the actual patient. As limited as the nursing role is becoming, it’s a wonder they make you get degrees anymore. If anything, they should be expanding your roles as part of the health care team, as you guys spend significantly more time with the patient than most physicians.

    • Andrew Lopez says:

      Hello Jillian, the patient consented to a “Liver Transplant Evaluation” not a surgical procedure. The patient was to be transferred that day to another facility for the evaluation.

      I agree it sends a chilling message to patient advocates.

  7. Thank you for posting this story…it is a case with important implications for not only nurses, but patients and physicians as we work within the same healthcare system!

  8. DefendUSA says:

    My two? I love exposing fraud people for who they are…you need help WC, I will be happy to do what I can…

  9. Emily says:

    Good for you. Shine the light on these types of cases and situations.

  10. anon says:

    I’m pretty sure that medicine is a team sport; in that light, Amanda Trujillo doesn’t seem to like work with the rest of the surgical team to present a cohesive set of options to the patient. Seems like splitting no way you slice it. I wouldn’t want her as my nurse.

    • WhiteCoat says:

      So I’m just curious.
      If the facts are as alleged, does this mean that you agree she should have been fired and had action taken against her nursing license for not having been a “team” player?

    • jillian says:

      You wouldn’t want her as your nurse?? So…. then… you would rather have been coerced into having the surgery. You would rather that a surgeon decide whether or not you can MEET with the hospice people. You would rather the surgeon decide what information you’re allowed to have, and just let him decide what’s best for you, so you don’t have to worry your little head about it?? I agree that this team is dysfunctional, but the NURSE is not the problem here.

    • Apatient says:

      In other words Amanda is not a team player for greedy surgeons. Pass this in to your greedy colleagues : first do no harm! Second: remember patients come first and you should not use your education to take advantage. The patients have a human right to change their mind at anytime even if that patient signed the consent! That’s why in the end many people will end up going to Nurse practitioners vs Md’s.

    • DefendUSA says:

      I was once accused of not being a team player in a medical practice, simply because I knew what was required to do my job and did not need direction. Neither did Ms. Trujillo. She knew the protocol and followed it in the care of her patient, then pissed off the arrogant physician in charge because of it.

      I would take her as my nurse any day of the week.

    • Amanda was playing her role in the team.

    • WarmSocks says:

      I would love to have a nurse take the time to give me all the information I need, one who explained everything instead of just handing me papers to be signed. If the facts are as presented here, I’d be happy to have Amanda as my nurse.

    • Palliative Care Doc says:

      It’s unfortunate that two issues were probably at work here:

      1. The surgeon would miss out on collecting from that surgery, and

      2. The patient changed his mind based on information obtained from a nurse.

      I work with many physicians who will throw a fit if a patient changes their mind regarding aggressive treatment based on what my Palliative Care NP’s present to them. However, if I present the information to the patient, they aren’t quite so vocal about it. It’s sad, but true.

      • NewNurse says:

        While I thank you for standing up for the nursing staff you work with to other physicians, few physicians have the balls to do so and even fewer have the inclination, but I do have a small nearly infinitesimal issue with your post that may seem conspiracy theory/nitpicky.

        “…based on what MY Palliative care NP’s present…” (Emphasis added is mine)

        I know it is likely a completely subconscious word choice created by spending such a significant amount of time around other physicians and Med School Docs who use the same language, but it is very indicative of the very problem that currently exists in the medical system in the US.

        Physicians do not, ever, view a nurse as a colleague. Even a DNP educated NP is viewed as being “lower” than the physician. Not only is that cultural, but it is a legal distinction made by putting these false hierarchies into the Nurse Practice Act. Physicians view nurses as working for them, even hospitalists or other physicians who are employed by the Hospital exactly the same as the nurse think of the nurse as being someone there to serve them, someone who in many ways is treated as belonging to the doc and who must do whatever the doc needs at the drop of a hat. What’s worse is that many nurses who have been in the field for 15-20-30+ years actually behave like this, dropping everything the second a doc asks them to do something even if it neglects a patient in need to do a trivial task with that doc’s patient. Even more egregious is that I have seen nurses just out of nursing school who also treat physicians with a combination of reverence and fear as though they are speaking to one of the Greek gods, or at least Demi-gods.

        Nurses do not belong to the doctor, rarely do nurses even work for the doctor. Nurses duty, first and foremost is with the patient, their employer is at most a distant second. I will never follow a physician order which I believe is harmful to the patient (provided I have an evidence based cause for my concern)and have very little reverence for physicians (though I certainly have respect for many of them). I believe that physicians and nurses are absolute equals in serving the patient, both filling extremely vital, complicated, and difficult roles which requires significant education and critical thinking. Physicians do a hell of a job, it is extremely nerve racking to prescribe medications which if wrong may end a persons life or cause relationship and life shattering addiction or side effects. However, it is just as difficult to be facing a ward with 14 acute patients who all need hourly assessments of one type or another, plus needing to pass meds accurately (because god forbid you make a mistake and get terminated instantly, if not sent in front of the BON), deal with family members bitching about the physicians who don’t listen to them or provide enough information or take enough time to know what is going on, and through it all having to do the most important part of the job which is educating the patient and attempting to ensure they have full knowledge about their condition and treatment options while also attempting to keep their spirit up as it helps healing. Also, both the nurse and physicians roles are indispensable in the healing process, neither being able to function fully without the other.

        So, that very long winded post being aimed at saying that you should be mindful of your word choice when referring to your colleagues who are nurses, especially nurses who are at the pinnacle of their profession as are NP’s. While it is a tiny thing, and based on your statements a thing which you certainly don’t mean to convey, but believe me anytime you say “my nurse” within earshot of the nurse working with you, they hear it and it is disheartening and hurtful. It is that ubiquitous constantly present reminder that our profession, while equally vital to patient outcomes, is not respected within society or even within the ranks of our colleagues.

        Just something to think about.

      • Beenthere! says:

        Then throw in the fact that the facility has a history of turning on anyone that is a true patient advocate. Even physicians! You speak up for the patient……….you are soon history. They have been known to make physician’s life hell on the way out the door. Oh yeah, seen that too. Beenthere!

  11. David Wander says:

    Awesome. So glad you’re getting to the bottom of this disturbing case. The conflict of interest between Banner and the Nurses Association is disturbing, as is the censorship practiced by Banner on comments at their website, as is the (bogus?) psych eval, as is the attack on Trujillo by the physician blogger who was primed to jump to an “Angel of Death” conclusion, as is the general paternalistic attitude evinced in that post blog.

    We can’t just take Trujillo’s allegations at face value or accept her lawyer’s account as necessarily reflective of all the facts in the case, but there are a lot of red flags here suggesting the nurse is being scapegoated.

  12. landlockedtxn says:

    Get ‘em, good!!!

  13. Anonymous says:

    I’ll wait to get more facts before giving a full opinion. But really to me this sounds like something that’s being spin to make her look like the victim.

  14. ER Jedi says:

    I think anon has a somewhat valid point. If a member of the healthcare team thought I did something wrong as a doctor, I’d want them to bring it to my attention first, and give ME the chance to correct it first. I also fully understand the difficulty of a nurse doing this to a CT surgeon and fully appreciate he may have thrown the exact same tantrum. And I also don’t fault her at all for doing what she did, and clearly the response to her actions is completely inappropriate. But I also endorse the sentiment that if I do something wrong, I want a crack to make it right before someone else does it for me, and I might be a little ticked if a member of my team didn’t bring it to me first and went right to the patient with it. But then, that person would also know beforehand that I’d be glad for them coming to me first and not bite their head off for doing so, which I doubt was the case in this situation.

    • NewNurse says:

      Well, I agree that intra-team communication is essential but sometimes things cannot wait until the next time the person in error is there to fix it personally. In this case, as I understand the stories I have read (and details are very scattered and few to begin with) the patient was awaiting a Liver transplant which could be performed at any time. So there was some urgency to providing proper patient education. In addition as a nurse it is vital to address questions, that are within your scope, in the moment rather than to place them on hold for later. Had Nurse Trujillo answered the patients questions regarding the surgery by saying “I am not sure about that I will have to speak with the surgeon and have him speak to you” she would instantly lose all credibility with the patient, even worse if she had then spoke to the surgeon who refused to speak with the patient so she now looks like a liar. And still more, this was not only a gross oversight, but from reading other posts made by Nurse Trujillo (and others working at that hospital willing to speak) the physician in question was a well known tyrant and also notorious for not respecting informed consent.

      If I am on a team, and am faced with a patient telling me of an error that a co-worker made, and that I have the ability to correct immediately, I am most likely going to correct the error right then, and speak with my colleague as soon as possible about the patient report. Now, had the physician been in the hospital at the time this came up, I would agree that she should have paged him and asked him to come answer some patient questions, but also made sure she was in the room to ensure accurate information was being given. But in this case he was no in the hospital. Also, if in a situation where I am on a non-functioning team, and I know that pointing out an error is going to end with 1) me getting verbally assaulted, and likely having my job threatened and 2) the outcome being that the patient is still not given the correct information, as was the case in Nurse Trujillo’s situation, you can bet your ass I am going to treat the patient first and worry about bruised egos and politeness after that.

  15. KimNP says:

    I’m still trying to find out why someone with her credentials was working as an RN and not as an advanced practice nurse? Maybe she was waiting to take boards, just seems a little odd to me. Either way, as a nurse, I have been asked by patients multiple times in my career to explain what the doctor failed to explain in “real terms.” Often, after asking the surgeon to re-explain, the patients have been even more confused than before.I think I’ll do a blog post about it. Everyone else is.

    • Stephanie says:

      I too wondered why someone with her credentials was working as a staff nurse. That’s also a lot of initials, MSN DNSc, for a 6yr career. Not saying it’s not possible but highly improbable. Even more improbable to consider oneself a specialist in cardiology, geriatrics and palliative/end of life care in that span of time. Can you say illusions of grandeur = psych eval? There are several issues here, but I think we should press pause until we hear more from BOTH sides. Has anyone heard from the patient; surely they would speak up to come to the aid of the nurse who sacrificed her career on their behalf.

      • amanda trujillo says:

        …i dont have my doctorate yet–that is a misconception, im in school for it….and I meant that my area of nursing specialty…not that i am a master of anything or a specialist. if that was misconstrued i apologize. the patient would be happy to come to my defense, this i know for sure, but for ethical reasons–im obviously not allowed to go search for them….they did corroborate the details when interviewed at the hospital…..i assure you i have no delusions of grandeur…quite the opposite actually….and at the “next” legal phase the records and the patient will be summoned but im not there yet–I have to get through the board stuff first…..the unit i used to work on was very high acuity, and the population was mostly geriatric, all cardiac and cardiac surgery, and end of life heart failure….hope that explains…

      • Beenthere! says:

        Stephanie, you are questioning why she was working as a staff nurse with her credentials? Highly improbable? No, look around. I personally know of many with much more wider years experience and Masters prepared nurses that are still working the bedside. For Amanda’s personal reasons, we don’t know. Perhaps for the income and hours with some tuition reimbursement while working on her doctorate? I also work with many Master’s prepared nurses unable to even obtain an interview for a higher level position in this Valley of the Sun. Are you from the Phoenix area?
        As far as your “psych” assessment and tossing out terms such as illusions of grandeur, let me enlighten you. Banner Del Webb Medical Center has called for these requests for ANY PROFESSIONAL they choose to throw under the bus. Oh yes, (note my name) Why? So, they can then make the insinuation to the VARIOUS Boards (again read please) when reporting against said professional. You see, it will make it appear (appearances can be deceiving) that the accused, without merit looks a bit off. You want to hear more from BOTH sides you say? LOL, good luck with that one. Their administrators are too busy at this time trying to figure which other professionals might speak the truth! You want to read their Mission Statement? They are lovely words. Words that have no intention of becoming action words on part of the management and administration team of BDWMC.

  16. Pattie, RN says:

    This MAY be a huge miscarriage of justice, with a nurse’s life on the line for doing her job.

    But…there is SOMETHING not quite right with the whole story. Can’t put my finger on it, but my Spidy-Sence is picking up some static that says there is a HUGE chunk of information that hasn’t come to light yet.

    Either she is being railroaded or there is missing piece…

    • Craig, RN says:

      I agree that something is missing here.

      What, we don’t know. I’d like Amanda to publish a scanned copy of the letter of termination. You always get something in writing.

      The meltdown by the doc was apparently public, and that shouldn’t be tolerated no matter what really happened.

      • amanda trujillo says:

        I requested the copy as shown to me by my former attorney–which was one sentence I am not allowed to quote but it is any derivative of “nurse went out of scope.” I got a letter yesterday that asked me to sign an agreement stating i would not share the initial complaint from banner to the board or I would be disciplined. So, Im gagged there now too.

      • Matt says:

        Crazy that a malpractice trial is in the public domain but these state sanctioned/created boards (i assume theyre state entities) are allowed to keep complaints and findings secret. Particularly of one of the parties wants to publish. That sounds fishy to me.

      • amanda trujillo says:

        yes–its a state agency. I was ready to get the copy, scan and send it out to the team of nurses who have organized across the country to help me–but then I got that release statement that pretty much shot that out of the sky.

      • Matt says:

        Your supporters should FOI them and see what happens. I’ve not read Arizona’s FOI act, but if it has any teeth at all surely this is public record.

      • Aaron says:

        That’s kind of interesting, because I would actually look into the scope of practice involved in the case. I would expect some sort of level of patient education to be in the scope of a professional nurse.

        Doctors aren’t the only people who put their license on the line when they clock in. I have a feeling that a case could be made that not educating a patient in a situation like this could be neglecting a duty within a professional’s scope of practice. A venturous person may not even pursue this as a defense, but as an affirmation of their profession’s role in healthcare.

    • Beenthere! says:

      Pattie RN, you picked up on something for sure! The nurse is being railroaded. First off, let’s look at the facility that did the dirty deed to Amanda. I say, let’s expose them for what they are. There will be those that will come forward and tell THEIR true story at Banner Del Webb. It will not be pretty. What is the missing piece you ask? I will tell you, Banner Del Webb comes across a nurse they cannot stifle. One that stands behind the nursing ethics and stands for her patient. One nurse that has a voice and is not afraid to use it. I am not saying going off half-cocked either. I am stating using it with descriptive examples of glaring improper actions (or inactions) done in their facility. BDWMC will immediately pull out no stops to end that nurse’s career, no matter how long or how reputable said nurse has been practicing. THEY DO NOT CARE. They seek to end your articulation of the very vulnerable population we choose to protect. Why? Because it will hurt their top management/administrators in the pockets. How do I know? BEEN THERE, WITNESSED IT.

  17. What can I say but thank you.

  18. To respond to Anon, Amanda’s story is all too common. I’ve seen her story play out more than once, and I’ve had my own issues with doctors and hospital administrators in the past. Amanda’s story sound more than plausible, and I look forward to hearing all the facts.

  19. Glad to see another doc weigh in on this, and we appreciate your support.

    The Brandeis quotation is quite relevant. And for those that stand back and say “we don’t have all the facts yet,” it is sometimes only through massive public support/exposure that the facts are even uncovered. If we all sat back and waited for the “true” facts to come out before supporting her, it is quite likely that the full truth would never see the daylight of public scrutiny.

  20. JoJo626 says:

    How can a patient even get to the point of having invasive pretransplant testing done WITHOUT having had extensive education and evaluation of their suitability to be considered to receive an organ??? That is what has bothered me about this whole situation.

    Does the AZ BoN usually take so long to decide cases? Ten months more or less seems like a very long time to decide if a nurse acted in her scope of practice. Now a 2 month delay for psychological testing?! It does give, at minimum, the appearance of vindictive behavior.

    If Amanda is cleared, I hope she seeks any and all recourse available in seeking criminal and/or civil penalties against those who have damaged her reputation, taken her livlihood, and prevented her from working in her chosen profession.

    • NewNurse says:

      10 months would be an extraordinarily speedy trial for a state regulating board. I had an aggrieved colleague in my former profession create a number of malicious and blatantly frivolous allegations against me to the state board (in my case it is the licensing board for counseling professionals). This person had been someone who I believed was unfit to practice (she is an LPN) due to her constant mistreatment of patients at our facility, she was rude, abrasive, regularly said disrespectful things about other staff to patients and would gossip like crazy, would be defiant and regularly refused to carry out actions approved by all the qualified parties (of which she was not one), and on numerous occasions went so crazy with rage she brought the other LPN at the facility to tears, eventually leading to her retiring from nursing. I was actively working with HR to have her terminated, but did not feel any of her actions were so egregious as to rise to the level of the legal definition for Unprofessional Conduct requiring a report of misconduct to the state. Well, she beat me to it.

      First, the state will not provide you with the person who made the allegations as they are protected by Whistle Blower laws, second they will not even tell you WHAT the allegations were as they could identify the accuser. I received the notice of investigation in May of 2011, the investigation has drug on forever even with my attorney regularly pressing the investigator to move forward or close the investigation. I finally received a summary of the allegations (still no confirmation on the accuser) this month (9 months) and was able to make my response in writing. Of course this is after the state met with all of my co-workers, former co-workers, and patients, subpoenaed my phone records, including text messages (with content of the text) and data usage (with website history), my personnel record, my patient files, and any e-mails I sent in the course of my work. That essentially destroyed by ability to practice as a counselor, given that patients now were aware I was under investigation(all they were told was “misconduct with a patient”), my former co-workers were aware of it, and the counseling community is so small in my area that meant that every agency in town was also aware of it. Even if I am cleared I am unhireable as a counselor.

      The investigation will likely continue for at least another few months as the investigator will need to evaluate my response to the allegations (which were all demonstrably false, and most of them I had witnesses to that effect) which he will then turn over to the board. I was told that once the board has the file it can take 9-18 months for their hearings to finalize with a decision. There is no recourse for this, certainly nobody will pay my substantial legal fees even if I am cleared of all charges (I will be I have no doubt).

      So, no, 10 months is not in any way an abnormal length of time (on the long side, it would be abnormally short) for the state to take to investigate. What is strange is that the state (at least where I am) rarely places notice that an investigation is ongoing on a providers license until the investigation is concluded as they know how just being accused can completely eliminate opportunities to work for years to come. They can do an emergency suspension if allowing the person to practice would place patients at risk, which they really only do if a counselor sleeps with a patient, or say a nurse were knowingly giving un-ordered meds to patients or accusations of “angel of death” sort of stuff. Now Arizona may be different and post the existence of an investigation on the license verification, but if so that is a really shitty thing to do and AzBON has a really crappy Nurse Practice Act.

  21. amanda trujillo says:

    Hi there
    I have NOT been reading the numerous blogs and comments out there due to the difficult time my daughter and I are experiencing–she is a very active participant here as she has been all my life as I attended school. Staying off the blogs has been something she and I agreed on in order to keep focused on the task at hand–making sure this doesnt happen again to another nurse and her family, or that another patient is not denied their right to self determination and their right to see hospice when they request. The only reason Im responding here is to say thank you for wanting to do all you stated above. I strongly feel that getting the information from the patient involved, as well as the chart–would be gold to my situation. Im a very type a detail oriented nurse that likes to make sure all the bases are covered and that everyone is in the loop on things. I sent you an email of some things I had written down the first night i was placed on administrative leave (I went right home and wrote down everything so I wouldnt forget). I want to relay that being out in the public eye is not me–at all. I dont like attention and I hate a spotlight, but what I realize is that come hell or high water my first duty is to the patients I am supposed to protect and provide best practice to as well as the importance of working within a team oriented patient centered framework. My duty is also to preserve and protect the integrity and foundational fabric of my profession and its future. So here I am. Viral. Neato.
    What comforts me is knowing that something GOOD has to come of this, what brings me peace is that I am clinging to what I know is morally right and just no matter what people say. I took an oath. If I turn around and dance off into the sunset like something bad didnt happen here then I am part of the problem, then Im part of what is so tragically wrong with our healthcare system right now. So no matter what happens, whether they take my license or not–people know this problem exists and if you get all the records they will see it clearly in front of them (again i hope youre able to pull it off!) Most importantly, although I dont want my patient stressed, I do know they would be more than concerned about what happened to me and would be more than willing to help! As you well know, I myself cant go approaching patients :) THERE WILL BE A GOOD OUTCOME HERE BECAUSE THERE IS TRUTH AT THE HEART OF THIS AND PEOPLE WILL BE SAFER AND GET BETTER CARE BECAUSE OF THIS SITUATION!!!! In my mind, license or not, its a win.
    Best wishes in your trek to get all the info, I support you, and will be hoping you can bring it all out!!! That is, if they havent messed with my charting. I remember everything about that chart like the back of my hand so I will know if something has been tinkered with. I have a good memory with cases such as this because Im always weary of getting caught up in deposition etc. Thanks again for your candor and your spirited query!!!!!
    Sincerely,
    Amanda Trujillo MSN, RN

  22. Not just a nurse says:

    Thank you Whitecoat,for seeing this and agreeing to try to get to the bottom of it,I look forward to reading it. Oh and Shelby,there are many,many Nurses who are outraged,angry and downright livid about this. Many of us,including me, have seen appalling tantrums by doctors and surgeons with no repercussions.

  23. [...] discussion. For more in-depth summaries and opinions, please see posts by Those Emergency Blues and Emergency Physicians Monthly. This entry was posted in Health Care, Medicine, Nursing, Nursing Education and tagged Amanda [...]

  24. Lou Show says:

    Interview with Nurse Amanda Trujillo who was unfairly fired from Banner Health after educating a patient about a medical procedure.
    http://theloushow.com/2012/02/05/highlight-from-show-106-amanda-trujillo/

  25. Jill says:

    I’ve been following this case, and have many burning questions…such as, what type of informed consent does this hospital utilize? Consent is informed or it is not. When the patient is not informed as to what is outlined on that consent, everything must stop… doc’s know this.
    I am very interested to know why this doctor/surgeon was not followed up on after his public tantrum. What policy and procedures are in place at this hospital for obtaining consent?
    I read in US News & World Report that Banner Health was ranked # 11among nations best hospitals… one doctor fromBH, is up for the Top 50 Doctors lists… not sure if it’s Banner Del E. Webb or a larger Banner mothership. At the very least, TJC (JCAHO) should be looking at this…

    • Jill says:

      my bad… clarification re: the ranking of Banner Del E. Webb # 11 reflects rank within the state of AZ.

      • Stephanie,MSN 20yrs says:

        I have worked as supplemental staff at Banner Del Webb–I un-affectionately refer to it as HELL Webb. Hope that gives you some insight as to it’s ranking.

    • Beenthere! says:

      They are NOT JCAHO. In fact they claim they are attempting to get Magnet Recognition. LOL Also, there are other Banner facilities in the Valley that are NOT as toxic as Del Webb. So, the report you are referring to is looking at Banner Good Sam. Totally different atmosphere. Different CEO, administrators and upper management. Del Webb is run by some very abusive people. They get away with this behavior because they can.

  26. I am very thankful to have another doctor weigh in on this. The “Angel of Death” fellow left a bitter bitter taste in my mouth.

  27. Throckmortonsothersigns says:

    Ive done a brief search but can not find out what the surgery in question was. Can anyone elaborate or point to a site? I find it interesting in that the surgery and the indications are not listed.

  28. Kim says:

    WhiteCoat,

    Thanks so much for speaking out on Amanda’s case!

  29. What action has been taken against her license? None from what I understand. She certainly can get a job unless there are only idiots in AZ who wouldn’t hire her. A DNSc? She can go into business for herself. So the line about her only option being public aid is a little overstated.

    Where’s the outstanding lawyer in this case representing someone who, if she’s telling the truth, ought to win a lifetime of support by suing this hospital and doc.

    Something’s wrong here. What’s going on? Really.

    • amanda trujillo says:

      i fired my attorney who seemed to be representing the board more than me….i have a couple of teams reviewing everything now who will take over shortly…im currently in school working on my doctorate np….i have to get past the board before i can do anything else legal because the next step depends on the outcome of this one…..

      • Volunteer Nurse Advocate says:

        Amanda leave no stone unturned. My guess is this doc has some skeletons in his closet. Dig deep.

    • Beenthere! says:

      Dear Dr. Virginia, You sound very skeptical of this case. You are speaking on behalf of an administrative team that will turn on their own grandmother in a heartbeat. Do you not care that a person’s reputation has been degraded and her very ethics are insulted by this whole nonsensical incident? You state, she can go into business for herself. Really? I may not have an MBA but I do understand that one will generally require some capital to establish such a business. Not only that, you apparently DO NOT live in Arizona and are totally unaware of the economy here. Let me tell you, it is sucky. Something’s wrong here, you say? You are right on that! The facility called Banner Del Webb is one of the most abusive hospitals for nurses to work at in this Valley. They conjure up fictitious stories on the nurses that are truly Patient Advocates and then quickly get rid of them. Their M.O. is to report nurses to the Board of Nursing for ridiculous reasons. I am not talking about the nurse with her hand in the Pyxis either! So Dr. Virginia, open your eyes to what is really going on in healthcare. Be prepared because it might hurt your eyes. It ain’t a pretty site.

  30. Grateful says:

    I really admire your focus on informed consent. I wish all doctors were as thoughtful as this. The medical profession needs this consideration.

  31. Hello, I’d like to thank you for taking the time to look into the Amanda Trujillo, RN situation.

    There is a seething underbelly of bullying, intimidation, discrimination and indifference in this case which needs to be exposed.

    (Please feel free to ask your questions, request clarifications on our Twitter Hashtag “#Nurseup”)

    My name is Andrew Lopez, RN. Amanda reached out to a friend, who reached out to us for help.

    Our “Nurseup” group can be contacted from http://www.nursefriendly.com/amanda/

    For ten months, Amanda fought this battle on her own, having doors slammed in her face left and right. She received no support from her employer, her coworkers, the American Nursing Association (she is a dues-paying member) or most of her local nursing assocations.

    In Amanda’s words, every job she has applied for, did the routine licensure check, found the “active complaint” and “unrestricted” notes on her license.

    http://www.azbn.gov/OnlineVerificationDetails.aspx?id=202742&certid=230047

    She was then chastised over and over for having the audacity to advocate for her patient and not quietly go along with the doctors orders.

    It appears she is being discriminated against, for having an active complaint. She is being considered “Guilty” until proven innocent.

    We are soliciting stories from other nurses in Arizona to verify a pattern of employment discrimination based on active and unresolved Arizona State Board of Nursing Complaints.

    We are likewise researching an allegation that Banner Health in Arizona routinely files licensure complaints against nurses they fire.

    If they are fully aware that nurses with active complaints will not be hired, they are imposing severe financial harships on nurses in Arizona.

    Amanda has been forced to go on welfare because of this. She is a Masters-prepared Nurse pursuing a doctorate.

    Have identified a few issues in this case, there are many more.

    Thank you again for looking into this.

    Sincerely,

    Andrew Lopez, RN
    Nursefriendly, Inc. A New Jersey Corporation.
    38 Tattersall Drive, West Deptford, New Jersey 08051
    http://www.nursefriendly.com info@nursefriendly.com
    Twitter: @nursefriendly
    856-415-9617, (fax) 415-9618

    • Beenthere! says:

      There are a lot of nurses and prior nurses from that very same facility that have had their lives turned upside down. I’ve never met a more toxic group of people in my nursing career as I have at Banner Del Webb Medical Center. I have witnessed my share of abuses to nurses, other staff members as well as outright lying on patient charts. Management is well aware of this nonsense. They get rid of the nurses that speak up for the patients. They only want nurses that say “yes” to them and nothing about the poor care. How do I know? BEEN THERE!

      • amanda trujillo says:

        …..ive seen the outright lying on the charts–especially related to daily round progress notes. (my patient is not awake, alert, and stating he feels better thank you) i reported it. thanks for coming forward beenthere—send me an email if you wish fyrhoneybsn@yahoo.com

      • Beenthere! says:

        Amanda, I feel for you. This case has grabbed me so deeply because of reasons I personally cannot state here. I believe you 100%. BDWMC solution will be to hire more foreign nurses that will be willing to be subservient to their every whim. When Banner Del Webb is done with a good nurse, they report them to the Board. Then they put out the call; NEXT. They are well aware the economy is in the toliet in the valley. They are also well aware they have nurses outright lying on their charts claiming they have done proper nursing care yet the patient is a mess. OMG, the place needs to be investigated. However, with the various Board Members employed there, that will not happen until the public becomes involved.

  32. It takes little familiarity with American health care to notice just how pervasive and powerful conflicts of interest have been allowed to become – see wp.me/p278fi-8y. They are actually customary and expected, unlike any other area of the American economy.

    This is the reason so many of us suspect Amanda’s case has been handled in a suspicious fashion, in addition to many otherwise difficult to explain facets of the case’s handling by Banner and AZ BON.

  33. PolynesianNurse says:

    I support you Amanda all the way!!!!!!!!!! Don’t give up this road will not be easy. You will find out who are your true friends. You will be tested and tried in so many ways, But Don’t Give Up!!!!!! In the end you will be vindicated!!!!!!! I believe you!!!!!

  34. Christy Starling says:

    I thank you for blogging this. I am in the healthcare field, but I am more administrative than clinical. However, I remember the great RN’s that helped and stood be my family as we watched my Grandmother waste away, from an aneurysm that was not operable. Hospice and Palliative care nurse do amazing work and this makes me sick. I have worked with MD’s for almost 16 years and the ones that have the “I am GOD complex” make me sick. You are lucky to have such great RN’s to help the patients make decisions that theyy are unsure of, not to get pissy when the scared patient questions a diagnosis/decision. I back her
    and am sick on my stomach what happened to her.

  35. [...] Talking about Amanda Trujillo. But a few doctors have chimed in on the issue. ER physician blog White Coat’s Call Room wants to dig deeper into the subject. While at least one, Your Doctors Order, has gone on the [...]

  36. Thank you for writing your post. I hope we get more answers soon.

  37. [...] Amanda Trujillo | WhiteCoat’s Call Room. Share this:TwitterFacebookMoreTumblrPrintEmailLike this:LikeBe the first to like this [...]

  38. Woo Hoo! I wish I had a supervisor just like you.

    • Some clarification, all from public record:
      AZ BON is not a jury of peers – although their listed credential are impressive, it’s members are political appointees within purview of the AZ executive branch. See wp.me/p278fi-8y
      2) At least three of AZ BON’s members have financial ties and/or are employees of Banner, the source of the complaint against Amanda – see wp.me/p278fi-8y
      and wp.me/p278fi-9v
      3) If we wait for all the facts, we decide in favor of Banner and AZ BON BR default – such facts may never fully emerge into the public record, as they are under the authority of Banner HR and current Banner employees on a seemingly punitive culture. We have adequate facts about the process, as well as reasonable surmises and unproven allegations, to feel confident making a public stand on Amanda’s behalf. See
      4) “Team player” is a concept with a very mixed record, used by ethical leaders and by despots, bullies, criminals, and those two timid to take a take a stand, instead rationalizing their way into comfortably deciding against an individual in a case they know too little about to reasonably voice such confidence. Those certain they would ‘never hire such a Nurse’ based a few lines of text do well to tell us, so we can avoid such cognitively and ethically lazy coworkers. Physicians, I assume, would not wish to publicly display limited use of critical reasoning skills. Of course, I cannot know what preparation others put into their comments – nor can they with the rest of us – so I would feel rather stupid and mean-spirited if I judged others on this point. We can each judge for ourselves, and perhaps allow ourselves to learn and grow if appropriate.

  39. Orfyn RN says:

    In over 30 years of OR practice, I have seen many, many patients with little or no idea of what they have consented for. Sometimes it is that “You just do what you have to do Doc” attitude, most often little or no effort has been made to get a truly “Informed consent”. There are many surgeons out there who do a good job in this area and many who are very sloppy. As well, I have witnessed or been the subject of many “temper tantrums” some of which included threats, both physical and to employment status, and several that actually involved assaults (punching, kicking, thrown bloody instruments). In nearly all of these instances the nurse involved was intimidated or threatened by hospital authority figures when redress was sought. Furthermore, Nursing Boards typically do not have to grant many of the most basic rights that the courts do. For example, hearsay evidence is admissable, defense witnesses and discovery periods limited, and they have little or no oversight. As another commenter has posted, the boards are also made up principaly of political appointees, often with little or no actual patient care experience. The Amanda Trujillo case has a very bad smell about it.

  40. FutureRN123 says:

    Wow, I don’t know what to say about this. I am a nursing student and to read about her case makes me so nervous about being a nurse now, like I really would prefer to work in the hospital but I am so open to other options, now….Amanda was doing her job; I think the surgeon got upset because he wasn’t going to get paid for the surgery after the pgood patient change his/her mind. Check out http://www.cpmc.org/advanced/liver/patients/topics/finance.html to find out how much a liver transplant cost, I assume the surgeon was going to get a good chunk of his salary from the patient’s insurance. And I was reading that liver transplants, you have to be on lots of med, so your body won’t reject it. So, there is nothing wrong with Amanda giving the patient other options. This world is sad, everything is always about money…

    • kjindal says:

      transplant surgeons make a ton of money (maybe like $1 million or more/year), have had umpteen years of training and are gravely in short supply, so i highly doubt any transplant surgeon would operate except for the best possible patient outcome. He or she is not going to ruin their career for, let’s say $25,000. They are often the only such surgeon providing care for a group of local hospitals, and thus on-call 24/7 all the time.

      Let me ask you: If you had liver failure (not sure the specifics of this case) and your doctors told you that you needed a transplant and one was available, then your nurse came in and said you should consider hospice, how would you feel?

      • Marla says:

        This nurse never went in and told the patient to consider hospice. Read the statement. The patient was unclear of the expectations after the surgery. The patient requested more information. If I were told I needed a Liver Transplant? First I would ask what would my prognosis be without one. Then what exactly would my life be like with one. Not to mention a thousand plus more questions. Read the case, doesn’t sound like this patient knew what they were getting into.

      • amanda trujillo says:

        Hello Doctor. Im assuming you are a doctor. You are correct in saying there are specifics of this case that would send people way through the roof but because of the privacy act I cannot disclose them. More importantly though, they have no bearing on the issue at hand–which was the patient’s troubling knowledge deficit and request for more information so that they could ask some questions and also ask questions from the doctor before proceeding forward. Please, a word of caution, do not put words in my mouth—”you should consider hospice.” I take exception to that because I have many years under my belt with respect to end of life teaching and support and one of the core principles of this type of patient interaction is allowing the patient to “tell you” their stories, wants, needs, goals. Leading a patient to hospice and palliative care is not something I approve of nor is it ethical practice–simply put, it is harming to the patient because they are being swayed. One of the very central goals to a robust and therapeutic end of life experience is “assisting” a patient in discovering what they desire and what they envision as a good quality of life and a meaningful end of life experience—this is done by broad and open ended questioning and alot of listening on the part of the nurse. Ill put it in a simpler manner—I do not lead anyone to hospice, I do not say anyone to hospice, and I dont use the words “you should or you need to” with ANY patient. Its just mean and insensitive. So I will tell you how I feel when I read that statement above—I feel labeled.

  41. Mark says:

    As many already know psych evals are often used by employers to silence anyone who goes against them.

    Did anyone read about the recent tragedy involving Josh Powell whose wife went missing in the middle of winter during a camping trip? Josh was a suspect in the disappearance of his wife and was recently ordered to under go a psycho sexual evaluation based on the allegation that pornography was found on a computer in a home where he was living with his father. While that investigation was pending, the courts allowed him supervised visitation. He then took an ax to his two sons during that supervised visit, blew up the house killing himself and his two boys.

    Amanda’s case is similar to the Powell case in one respect only——-if the Board truly suspects Amanda is suffering from a psychiatric illness that would affect her ability to safely practice as a Nurse and put the public in harms way, why is her license still active during the period of time when they strongly suspect she is mentally ill? After all you don’t order a psych eval for no reason, right? Do they or do they not believe she suffers from a mental illness? Make up your mind. You cannot have it both ways. Their actions are incongruous.

    If what I have read is true, I hope Amanda receives a large financial settlement so she can start her own patient advocacy business and be a true patient advocate. I am convinced you cannot work for any health care organization full of competing and conflicting interest, and be a true advocate without losing your job. I have never ever been happier working as a nurse as I am now, where I am truly able to advocate for patients. I have no financial ties to any local health care organizations. When I fully document issues and/or am vocal about complaints, hospitals hate it. They cannot control me, thy cannot fire me, they cannot order a psych eval. I am untouchable. Nurses make great patient advocates but they CANNOT SERVE TWO MASTERS. The ONLY way patient advocacy will work is if it is a separate specialty that operates without any competing or conflicting interests. I applaud all of you who are trying but you are spinning your wheels.

    Hospitals have already tried to silence and “buy” nurses by calling them “PATIENT” representatives all the while having those nurses report to their legal department. During the patient complaint process the “PATIENT” representative gathers and documents information about the patient’s complaint under the guise of helping them. Then if any legal actions are filed by the patient against the hospital, the hospital will use the information against the patient so they can defend themselves in a lawsuit.

  42. I was alerted to this story by a reader on my own blog in a post I wrote today (http://thehappyhospitalist.blogspot.com/2012/02/death-with-dignity-quote-that-helped.html) about the incredible value palliative care in patient centered care.

    Failure to provide adequate informed consent (including post surgical prognosis and expectations) is failure to inform. It is also, my understanding, that this failure to inform is one of the fastest growing forms of malpractice action being brought against physicians.

    My own opinion? If doctors aren’t providing complete informed consent (and this would be well known by many in a hospital culture) and nurses are being told they shall not inform, then it appears hospitals should be held liable in malpractice actions brought by patients for failure to provide informed consent.

    • Please correct me if I’m wrong, but I see much confusion: informed consent is a physicians responsibility. That does NOT at all mean that a nurse can offer no relevant education regarding the same proposed treatment – that is not providing informed consent outside of a Nurse’s SOP, it is in fact education expected of Nurses. If on assessment the informed consent seems inadequate, our duty is go advocate for adequate consent – the doc makes the call but the Nurse must try to influence the process adequately. People seem to think that because two professionals both have a conversation with the same patient related to the same topic, then they both must be performing the same function – not so.

    • Perhaps such malpractice fears contributed to the heavy-handed and emotionally charged alleged reaction in this case. One (no especially ethical or professional but potentially quite convenient )way to address liability concerns associated with less than thorough informed consent: intimidate Nursing staff away from routine education, so that patients are much less likely to realize what they’re missing. It would also (again ignoring ethics) be very useful to fire and ruin any Nurse so bold and professional as to offer education and advocacy anyway. Even better, one could take advantage of having current employees on the Board of Nursing, as Banner does today. Such tactics might make wasting time on revenue-free activities like Informed Consent far less necessary.
      For specifics see wp.me/p278i-gc , wp.me/p278fi-9v

      • Volunteer Nurse Advocate says:

        There is a possibility this doctor was already sued and might explain his behavior.

  43. Beenthere! says:

    I read this case with such disgust and yet NOT surprised to learn the facility is; Banner Del Webb Medical Center! OMG, they have done it again. How many more nurse’s careers and life do they need to ruin before the public gets involved? How many more patients do they need to deprive of their required information on all procedures? Why is their management team and the Administrators allowing such behavior and abuse of nurses to continue? I will tell you why………BECAUSE THEY CAN. They are a greedy toxic bunch of individuals that are out to protect their own high paying salaries and pacify the outrageous antics of certain physicians. The community (Sun City West) deserves better than BDWMC. It is one scary toxic place to be for a nurse and a patient. Been THERE, never going back. Heaven help us all.

  44. Orfyn RN says:

    I read beenthere’s comment that BDEWMC is not JCAHO accredited. I tried to check this out, but could only find JCAHO’s list of top performing hospitals, BDEWMC is not on it. Which proves very little. In my own experience, I have found that even very poorly performing hospitals pass JCAHO. I am sure every nurse out there can tell many stories of the last minute clean-ups, blizzards of policy memos etc that come out in the week before a JCAHO inspection, all of which have been unaddressed since the last JCAHO three years before. There are a lot of potemkin villages out there where JCAHO accreditation is concerned. Something I did find disturbing when I visited BDEWMCs own website was an assertion that they were a US News and World nationally ranked hospital. Upon further checking the details, they “performed at nearly the level of” nationally ranked hospitals according to themselves, not USNWR. Buyer beware!

    • Beenthere! says:

      Hospitals do not have to be JCAHO any longer. Some are going with International Accredidation such as DNV or the more well known Magnet. The Banner that has been on the Top Hospital list is Banner Good Sam. Totally different administration and climate.

  45. SC says:

    This entry and the others linked in the article seem to show only one account – that from Ms. Trujillo herself. There doesnt seem to be anything from the hospital, the patient, or the physicians involved. It seems to me, as if the patient was waiting for a pre-transplant evaluation – It doesnt seem as if they were awaiting surgery the next day or something – and Ms. Trujillo took it upon herself to page a consult for hospice, a completely different treatment plan. The patient was in bad enough condition to possibly require transplant. And this was at night. How do we know he wasnt delirious and not in the right state of mind when Ms. Trujillo unilaterally engaged him on this issue? Something like that should definitely be discussed with the physician overseeing the patient’s care. Surely it wasnt necessary to do all this overnight and could have waited until the morning when she, the patient, and the physician could have all discussed this.

    Instead, the physician comes in and is blindsided by a patient questioning his treatment plan and a nurse going over his head to involve another team. Certainly he should not have thrown a tantrum, but I’d understand why he would be upset. I doubt going over a physician’s head like that are against hospital policy, which is why she was canned.

    I am also disturbed by the tenor of the discussion in the two linked blogs. With only one account of the incident – Ms. Trujillo’s – the general consensus seems to be decidedly against the “greedy surgeons” who “coerced” the patient without “adequately informed consent” into an “unnecessary procedure”. By most accounts, the surgeon wasnt even involved yet, and the aggrieved physician was on the primary team that working up possible transplant. I submit that Ms. Trujillo unnecessarily went above and beyond her duties as a night nurse, which in many ways is commendable, but certainly should have elicited the rest of the treatment team’s participation especially the physician before proceeding to educate the patient and implementing a hospice consult. The hospital’s subsequent actions may be extreme, but I do believe that Ms. Trujillo is not entirely in the clear on this matter.

    • Beenthere! says:

      You must not work around many surgeons. That particular hospital has implemented with their very own computer system that YES nurses can request certain consults. Nurses MOST CERTAINLY are within their scope of practice to give their patients educational information. Banner has their own Educational Patient Information site which they ABSOLUTELY expect their nurses to utilize when educating their patients. If it was something a nurse could not request, the system itself WOULD NOT ALLOW IT. Face the facts, you piss off some doctors and they are in a bad mood; they run to administration. Period. To think that doctors are NOT greedy? What are you smokin? Not all are. I know and work with many that do care about the best interest of the patients. Over the decades of my vast career I’ve also met way too many that don’t have the time to talk with the patient.
      There is more to this story. But obviously MOST of you posters have not worked there. Been there! Patients beware.

    • Beenthere! says:

      There is more, for one look at the facility. Major problems. Too big to discuss here. Beenthere!

  46. peggy zuckerman says:

    Basic to this situation is the meaning and impact of “informed consent”. The inherent nature of the form is that of a doctor (or nurse) extracting an approval for a decision already made by the doctor without active involvement by the patient. The language used, the protections for the doctor and the timing of the so-called consent creates an coercive contract. What is truly needed is the obligation of the medical professional to EDUCATE the patient at the level required to let the patient make an educated choice. Having no such obligation to give the skills to the patient to make such decisions makes a farce of the whole relationship between doctor and patients. Ms Trujillo apparently did attempt to provide the needed education, exactly the ethical, and I daresay, legally correct obligation.

    • Need to make a quick clarification. Informed Consent, never was an issue in this case.

      The patient was scheduled for an evaluation, not a procedure. The patient didn’t understand what the evaluation entailed, when educated by Amanda Trujillo, quickly changed their mind.

      The doctor when he discovered the patient had changed their mind, demanded Amanda’s termination and charges to be filed wit the state board. The hospital was only too happy to appease.

  47. [...] are the bare bones of the story. Further details can be found on WhiteCoat’s Call Room and on Nurse Up for Amanda Trujillo. The debate among nurses — sometimes heated — has common [...]

  48. brs says:

    I’m glad there is so much support for Amanda Trujillo, and I sincerely hope justice is served and her license and reputation are reinstated. If the story, as I’ve read it, is correct, the surgeon should lose his license for failing to obtain fully informed consent from his patients before subjecting them to highly invasive procedures necessitating permanent lifestyle changes and resulting in lifelong risk of severe complications. I can’t help wondering what happened to the patient. Did the patient have the liver transplant? If so, was s/he able to speak with the hospice counselor or another disinterested party beforehand? Was the procedure done against the patient’s will based on her/his previous, uninformed consent?

    • Complaints were filed by Amanda Trujillo with the State Medical Board against the physician, and dismissed.

      The “hospice” consult was canceled, the patient was denied care they asked for and did not, have the liver transplant to our knowledge.

      We do support Amanda, on Nurseup.com and will continue to spread word of her situation. It could happen to any nurse in any state. We need nurses to know this.

  49. FickleFinger says:

    I wonder if any of this would have transpired if the informed consent discussion between the surgeon and the patient (and between the nurse and the patient) had been, by hospital policy, recorded, given to the patient to review with family members later, AND placed into the permanent medical record. Please see:
    http://www.ficklefinger.net/blog/2012/03/30/should-physicians-record-and-share-conversations-with-patients/
    FickleFinger

  50. [...] Amanda Trujillo, Whitecoat, Emergency Physicians Monthly, February 6, 2012:”I finally took the time to read some other blogs today. One of the issues that I found disturbing was the case of Amanda Trujillo. There are a lot of bits and pieces out there about what actually happened in this case. This blog post was reportedly an e-mail from Amanda describing the events. A summary of the post follows. Amanda was a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. In April 2011, she was caring for a dying patient at Banner Del E. Webb Medical Center who had agreed to a major invasive surgery recommended by a staff surgeon. Amanda used materials from her hospital to educate the patient about the details of the surgery and the aftercare. The patient became upset, stating that the surgeon never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). Amanda also discovered that the patient “had no idea” that surgery could be refused or that the patient could enroll in hospice care. She educated the patient on those options as well.” http://www.epmonthly.com/whitecoat/2012/02/amanda-trujillo/ [...]

  51. Thank you Whitecoat for following Amanda’s case, here is the latest:

    The War Against Amanda Trujillo, April 25, 2012, Mother Jones, RN, Nurse Ratched’s Place:”I still support Amanda Trujillo and some people who have read the allegations against Amanda have questioned my judgment. Frankly, I don’t believe these allegations because I personally know two other nurses who have been reported to their nursing boards by their former employers. One of my friends was reported to the BON after she spoke up about unsafe nursing practices at a shady nursing home, and the other was reported after he chastised hospital administration for placing psychiatric patients and staff in an unsafe environment. Their former employers cooked up all kinds of false allegations against my friends who are both stellar nurses. Their former employers crucified their character, but in the end they were both cleared of any wrongdoing by their respective state nursing boards. There is an escalating pattern of abuse as more unscrupulous employers are using nursing boards as the ultimate scare tactic to keep nurses “in their place. ” Amanda is just another victim of this ploy.”
    http://www.nurseratchedsplace.com/2012/04/the-war-against-amanda-trujillo/

    Kindly leave comments, encourage the bloggers supporting Amanda to keep on blogging!

  52. suki says:

    This is happening all across the country. Greed is running the show today for healthcare. Nurses are not respected. Nurse takes the hit. Nurse is the one fighting for her license and reputation. People need to open their eyes and see who is actually running these hospital corportions and the people in charge of the State Board of Nursing. You can pretty much guarantee, nurse speaks up, in regards to patient safety…………nurse is gone!

  53. Educator says:

    As an individual who has been employed by the public education system, I realize that the “grass is not greener on the other side.” I left public education to pursue consulting. And, while consulting is starting to pay very well, I am bored to death! Writing reports all day, every day, and speaking to clients a bit can be a bit depressing. Thus, I have began to look at health care careers. But if nursing is like teaching, and nurses are not treated well or can be allowed to think for themselves, I will stick to consulting. I might be bored, but at least I can think for myself, not be forced to face the “dumbed-down corporate giant.”

    On a side note, education is all about the almighty standardized test, where bubble filling is a highly transferable skill from grade to grade. And, critical thinking is unappreciated. Public, even private, education has its grips in corporate America. And, executives seem to love young people who don’t question their misteps. Thus, I see a mass exodus, or firing, of any nurse over 35 who can think. Good bye patients, hello more money.

  54. Nothisnurse says:

    FYI, Banner Del Webb continues to report the nurses to the State Board for frivilous reasons. I know a nurse very recently reported for not giving a pt an antibiotic that the pt refused! They reported this nurse claiming she should have called the doctor; in the MIDDLE OF THE NIGHT. Pt refused the antibiotic. Pt was totally with it. Pt’s have rights. What is wrong with this picture? Banner Del WEbb must feel awful powerful to continue this insane behvior against nurses.

  55. Andrew Lopez says:

    The latest:

    Facing a Crossroads, #AmandaTrujillo, MSN, RN & the Arizona State Board of Nursing. #nurseup #nursefriendly:”At Amanda’s (Attorney Gag Order) request, we have been silent for the past few months on her complaint filed by Del E. Webb Medical Center. The case has continued, legal maneuvering has occurred and a Settlement Conference was held recently – no decision yet.”
    http://4nursing.blogspot.com/2012/11/facing-crossroads-amandatrujillo-msn-rn.html

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