The Persecution of Amanda Trujillo

In the ugly, grey world of hospital balance sheets it’s almost a commonplace that physicians generate revenue while nurses represent a cost. Fancy procedures and sub-sub-specialties bring generous income streams, in terms of charging (and profiting) from the provision of a multitude of related services, such as nursing, while nursing itself, because it generates no revenue, is a burden to the bottom line.

It’s also commonplace, that in certain health care institutions, the power structure, the hierarchy of heath care, is so rigid (and fragile) that any challenges to that hierarchy — such as a nurse questioning the God-like omniscience of a surgeon — must be ruthlessly suppressed.

Amanda Trujillo

So when a nurse interferes with the revenue stream, dares to challenge the organizational power structure, hospital’s only logical recourse is to utterly destroy the nurse’s career. Take the case of Amanda Trujillo. Engaging in standard, no, gold standard nursing practice, following hospital procedures and using hospital materials, Trujillo correctly ascertained a patient facing end-stage liver disease did not understand a proposed transplant procedure or its consequences, and desired palliation instead. According to usual practice at this institution, and with the support and knowledge of her immediate manager, she requested a multi-disciplinary team consultation to create a care plan.

Amanda Trujillo tells the story herself:

My name is Amanda Trujillo. I’m a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. Back in April of this year I was caring for a dying patient whom I had discovered had no clue about what they were about to participate in when they agreed to get a major invasive surgery. When I properly educated the patient using the allowed materials by my employer they became upset that the physician never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). The patient also had no idea that they had a choice about whether they had to get the surgery or not or that there were other options. They asked about hospice and comfort care and I educated the patient within my nursing license and the nursing code of ethics. The patient requested a case management consult to visit with hospice to explore this option further in order to make a better decision for their course of care. I documented extensively for the doctor to read the next day and I also passed the info on to the next nurse taking over, emphasizing the importance of speaking with the doctor about the gross misunderstanding they had about the surgery. The doctor 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. He was successful on all counts.

Let’s be clear about this and speak plainly: when the transplant surgeon primary physician found out about this course of events, mindful perhaps of lost fees, but heedless (it seems) of any apparent conflict of interest, and in fact, of any basic recognition of the principle of patient autonomy, he threw a temper tantrum, and demanded the job and licence of Nurse Trujillo.

The administrators at  Banner Del E. Webb Medical Center, heedless both of any apparent conflict of interest on the part of the surgeon primary physician, and in fact, of any basic recognition of the principle of patient autonomy, complied with this request. In the best tradition of blame-the-nurse, these faceless administrators — and I sincerely hope there are no nurses among them, because if there are, they are a complete disgrace to our profession — fired Amanda Trujillo. They then reported her to the Arizona State Board of Nursing, on the grounds that the request for the case management team somehow constituted a “medical” order, and therefore Trujillo exceeded her scope of practice. It’s important to realize these (hopefully-not-nurses) administrators designated this particular order as a “medical” order somewhat after the fact.

Very disturbing is the sheer maliciousness of the hospital administration at  Banner Del E. Webb Medical Center. Think about it for a minute. Even if you accept — and this is a  long stretch — that Trujillo exceeded her scope of practice, is the appropriate, measured response to ruin her practice, when the “error” was made in the best interest of the patient, in way that recognized and validated the patient’s right to autonomy?

Yet at some point an administrator decided the only appropriate, measured response was to utterly destroy the career of this nurse by screwing her over so royally she could never practice again.

(Nice job, Banner Del E. Webb Medical Center! I guess the best thing about this hospital you can say is that it it’s an awesomely bad, ugly, abusive place to work, if they would throw a nurse under the bus to appease a physician having a temper tantrum. It almost goes without saying that a place that is bad and ugly for nurses to work in doesn’t do much better for patient care. The case, in the event, pretty well makes that much clear.)

Amanda Trujillo’s hearing at the Arizona State Board of Nursing was supposed to have been yesterday. It was postponed for two months for a psychiatric evaluation because — wait for it — defending one’s self publicly on the Intertubes constitutes “retaliatory behaviour.” No, seriously. In the old Soviet Union, dissidents used to be labelled insane to discredit and marginalize them. Pretty well much the same obtains in modern nursing. Defy a physician, you get fired, you get investigated, and you get labelled crazy. And the Arizona State Board of Nursing facilitates the abuse, because as we all know, health care institutions never lie, and never have ulterior motives.

Nice.

So you want to be a nurse?

__________

Amanda Trujillo’s full story can be found here at Vern Dutton’s site.

Her Twitter feed is here.  Trujillo’s Twitter account seems to be deactivated this morning (26/01/12).  

Amanda’s new Twitter feed is here.

A Facebook page in her support is here.

Email the Executive Director of the Arizona State Board of Nursing, Joey Ridenour, RN, MN, FAAN: jridenour@azbn.gov

Complain to Banner Health here.

Nerdy Nurse’s perspective is here and here.

Please spread Amanda’s story as widely as possible. Every nurse is vulnerable to mistreatment.

UPDATE: 

Minor spelling corrections. Anyone know where I can purchase a hobbit to proofread?

Also:

Emergiblog:

Nurses not only eat their young, but God help you if the almighty Medical Establishment gets ticked off.
Nurses talk a great game. In the Halls of Academia and the Ivory Towers of Those Who Claim to Advance The Profession, it’s all “Nursing Is An Independent Profession” and we tirelessly “Fight For Our Right To Practice To The Full Extent Of Our Education And Training”.
Unless you’re down in the trenches doing patient care every day and someone gets angry that you have dared to advocate. And if that Someone is a Doctor, well, the bigwigs scatter to the four corners of the ring.
Musn’t create controversy.
Hell, they aren’t even standing on your side of the arena.

From Kim we also learn that the president of the Arizona Nurses Association (email the Executive Director, Robin Schaeffer: robin@aznurse.org) is the nursing director of Banner Del E. Webb Medical Center. Hence the deafening — and telling — silence of that organization.

And also Jennifer Olin. And NurseKeith.

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  1. #1 by Shelley R on Wednesday 25 January 2012 - 1358

    On what planet is this surgeon allowed to have that much power??? This makes me happy that i work in a public health care system, where RN’s aren’t just tossed aside because physicians bring in money to a hospital! GRRRR

  2. #2 by Jessica Ellis on Thursday 26 January 2012 - 1824

    lol…I can function as a proofreader, but I’m afraid you’ll have to find hobbits elsewhere! :-)

  3. #3 by Anonymous on Friday 27 January 2012 - 0845

    This entire story made my mouth hang open wider and wider… I can’t even count the hundreds of times a physician ran into a room, made a devastating announcement to a patient and then ran out. The patient always then looked at me and said “Huh?” in one way or another. This scenario always led to me (the RN) explaining the diagnosis, the treatment and all the consequences. I was apparently even stupid enough to consider these some of the best moments of my career.

  4. #4 by Theresa L.... in BC on Friday 27 January 2012 - 1313

    ….. Wow !!! Unbelievable that this continues to happen despite the advances of modern medicine !! The almighty dollar rules far too often, much to the detriment of mankind !! Thank God for people like Amanda that stand there ground and do what’s right ! She may have been fired, but that patient and their family will never forget tLhe nurse who helped them make an informed decision. I know our team of nurse’s on OUR unit would love to have someone like you to work with Amanda !!

  5. #5 by Amanda G on Saturday 28 January 2012 - 0617

    from Banner Del E. Webb Medical Center

    Our Values

    Banner’s Values define the culture of Banner Health and how these values are demonstrated through actions and behaviors.

    People Above All … by treating those we serve with compassion, dignity and respect.

    Excellence … by acting with integrity and striving for the highest quality care and service.

    Results … by exceeding the expectations of those we serve and those we set for ourselves.

    yea, guess we know that is a big lie now don’t we!

  6. #6 by Christine Domask on Saturday 28 January 2012 - 2236

    http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

    Nursing Code of Ethics:

    Please see Provision 2 “The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.”
    And, Provision 3 “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”

    Also, review the case of the two nurses in Texas who ultimately were criminally prosecuted for “whistleblowing” on a physician – they were ultimately acquitted of all charges and given their jobs back at the hospital where they were previously employed, however, I’m not sure they went back to work there after the hospital administrators were fired them even when it was obvious the physician in question committed malpractice.

    I do hope there were no nurses were among those decision makers. However, if there were not, the hospital could be in violation of Joint Commission Standards requiring a Registered Nurse represent the department of nursing at the board level.

    I hope Amanda appeals the decision of the Board of Nursing as the decision is clearly wrong.

  7. #7 by Penelope Rock on Friday 03 February 2012 - 2258

    “So you want to be a nurse?”

    haha. Nursing have both advantages and disadvantages. Yet, what Nurse Amanda had experience is I’m sure a disadvantage of a nurse in comparison with a doctor. What was done to her is definitely a no-no and injustice. If this will continue, the nursing industry is in great danger to peril. Let some of the worst doctors be nurses so that they may know how difficult it is to experience the doctor tantrums. No offense to those who are really good doctors, eh.

    Thanks for sharing,
    Peny@An Update on AZ Nurse Amanda Trujillo Case

  8. #8 by Richard Willner on Wednesday 22 February 2012 - 1402

    The Center for Peer Review Justice is interested in receiving a copy of your posts and Lettters of support of Amanda. Please send them to:

    Legal@PeerReview.org
    Info@PeerReview.org

    website: http://www.PeerReview.org
    http://www.PeerReviewSolutions.org

    Please feel free to re-post. Thank you.

    Richard Willner, CEO

  9. #9 by Treva Morgan on Friday 16 March 2012 - 1747

    This saddens me greatly but I can’t say I’m surprised. I have been a nurse for almost 20 years and worked in various states and I seen things similar to this but not as devastating. I am so sorry Amanda and I pray diligently that those that sit on the Arizona BON will see the error of their ways. I work in the emergency room and have for 13 years. I know what it means to advocate for your patient and I commend and respect what Amanda did. We all have to make a living but why does it need to turn to arrogance and greed because of this physician cared at all about the patient and not his pocketbook, none of this would have happened.

  10. #10 by Andrew Lopez, RN (@nursefriendly) on Sunday 30 December 2012 - 1240

    The latest on the case:

    Facing a Crossroads, #AmandaTrujillo, MSN, RN & the Arizona State Board of Nursing:”At the heart of Amanda’s case is Patient Advocacy. Her patient was having second thoughts about a Liver Transplant evaluation, and Amanda helped fill in the gaps. The doctor, Dr. Keng-Yu Chuang (Source AZBON public records), who had only offered the liver transplant, went ballistic when the patient asked for Hospice info instead. He demanded the hospital serve Amanda’s head up on a platter and that the Arizona State Board of Nursing be contacted.”
    http://nurseup.com/wordpress/?p=2850

  1. Fellow Nurse in Jeopardy: Amanda Trujillo, MSN, RN, DNSc-NP(s)
  2. Arizona Nurse Has License Threatened By Doctor After Providing Patient Education | The Nerdy Nurse
  3. How to Support Amanda Tujillo (Arizona Nurse Fired for Patient Advocacy) | The Nerdy Nurse
  4. Nursing Network
  5. Stand Together » The Makings of a Nurse
  6. The Best In Nurse Blogs: Amanda Trujillo Edition! | The Millionaire Nurse Blog
  7. Amanda Trujillo, RN, Arizona Nurse and Patient Advocate | Nurse Up!
  8. Del E. Webb Medical Center, Sun City Arizona AKA Banner Health Nurse Incident @BannerHealth – vdutton’s posterous | Nurse Up!
  9. Arizona’s attack on nurses: the Amanda Trujillo case goes viral - Three Sonorans
  10. Nurseup.com, A Nursing Advocacy Organization | Nurse Up!
  11. The Persecution of #AmandaTrujillo,@JayDoe, RN @torontoemerg #nurseup #nursefriendly #healthcare | Nurse Up!

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