Less than a month after Orange County grand jurors told Health Care Agency officials to improve nurse training and equipment at county jails, management officials created a plan that forced nurses to violate state laws for prescribing medications, nurses said.
The policy, first unveiled at the Theo Lacy Facility in Orange, asked nurses to offer inmates packets of over-the-counter medications such as Tylenol and acetaminophen to reduce their calls for assistance.
In the May 23 memo handed out to nurses at the facility, officials also instructed nurses that "no lists are to be made and no inmate medical charts are to be pulled for any documentation of the request."
The letter drew almost immediate opposition from many nurses.
Health Care Agency officials called the policy an experiment they abandoned when nurses protested.
Ann Shuman, a supervising nursing education consultant with the state's Board of Vocational Nursing and Psychiatric Technicians, said requiring licensed vocational nurses to hand out medications, even over-the-counter ones, "smacks in the face of patient safety."
Licensed vocational nurses, according to the state panel, do not have the necessary training to assess a patient adequately and prescribe medication.
Though people can walk into any convenience store and buy Tylenol, medical personnel should not hand out over-the-counter pills without doing a medical evaluation. People can have conditions that can be made worse with over-the-counter medications, Shuman said.
"It would be jeopardizing the licensed vocational nurse's license if they did it," Shuman said.
"I was very angry," said Carol Alumbaugh, who has worked with the county as a licensed vocation nurse for 12 years. "They're asking me to do something that could jeopardize not only my license, but my whole life."
Alumbaugh said many new hires came to her with concerns on the policy. She told many to refuse. "But they were too fearful of losing their jobs," she said.
The Orange County Register interviewed nearly a half-dozen nurses who had direct experience with the medication policy and said its implementation and the battle to end it showed how the Health Care Agency's approach to cutting costs leaves nurses in a vulnerable position.
"Everybody was standing around with their mouth open," said Marilyn Stanfield, a county jail registered nurse with 14 years of experience. "This is insane."
"It is so against policy; it's so against everything," she said. She said the policy made many "feel extremely vulnerable."
Health Care Agency Assistant Director David Riley called the inmate self-medication policy a trend in prison health care. Many prisons offer over-the-counter medications through vending machines or at prison commissaries, Riley said, adding that the Health Care Agency's approach of having licensed vocational nurses hand out the medications was only an experiment.
"It was a two-week pilot, and when concerns were voiced, we discontinued the approach," Riley said. "We're listening very carefully to the issues that our staff raised."
Yet many nurses said management was less than cooperative. Despite voicing concerns, Stanfield and others said they had to contact state regulators before the practice ended in late June.
"Management did not go along with it at all, until they were presented with the information from the nursing board," Stanfield said.
The difference in viewpoints illustrates a long-standing rift between nurses and Health Care Agency managers. That schism came into view last week during the in-custody death of Michael Patrick Lass, who died after deputies used a Taser gun to subdue him at the county jail. While nurses say they didn't make mistakes in treating Lass, they pointed out equipment problems at the time of treatment.
Grand jury members also noted similarities to the June 11, 2006, death of Vicki Avila in the women's jail and expressed frustration that their recommendations weren't taken to heart.
County supervisors have asked Orange County CEO Tom Mauk to investigate the nurses' concerns and report back to the board. (source) |
