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Negligence justifies suspension, even without link to patient death

A Delaware nurse who successfully appealed a decision by the state’s department of health and human services to place her on an adult abuse registry lost an appeal of the suspension of her license stemming from the same incident, in a July 16 decision by the state’s supreme court (Jain v. Delaware Board of Nursing).

In 1999, Madhu Jain, a nurse at the Delaware Psychiatric Center in the city of New Castle, noticed a patient lying unconscious in the facility, half-undressed and in a puddle of urine. Either concerned for her safety if the patient was undergoing a potentially violent psychiatric episode or—Jain appears to have supplied conflicting accounts—simply to find help to move the patient, who was larger than Jain herself, she decided to seek help before attempting to approach or physically examine the patient.

When Jain returned, the patient, who was, in fact, suffering from a blood clot in her lung, no longer had a pulse, and died while other nurses attempted to revive her with CPR.

After the state’s Department of Justice filed a professional complaint, the nursing board held a hearing on the matter, and concluded that, although her lack of medical action when she left the patient’s side did not lead “in any way” to the patient’s death, her failure to act was nevertheless sufficiently negligent to be a professional violation. The board suspended her license for three years, and Jain appealed.

Meanwhile, the Delaware Department of Health and Human Services instituted its own action against Jain and eventually placed her on the state’s Adult Abuse Registry. However, Jain successfully appealed this order, winning a decision in the state supreme court by arguing that the department had improperly found her guilty of neglect without proving that she acted either recklessly or intentionally.

Although she won that earlier decision, and although her appeal of the board’s suspension of her license also reached the Delaware Supreme Court, Jain did not meet with the same success as in her earlier arguments.

Her most cogent argument on appeal was that, because the board ruled that her actions had not contributed to the patient’s death, it had erred in finding that she was negligent. That lack of causation, she believed, exonerated her behavior.

The court did not agree. Justice Jack Jacobs, writing for a unanimous majority, noted that neither of the board’s rulings depended on the other: “The board’s finding that Jain was negligent,” he wrote, “did not mandate a showing of causation and was properly supported by substantial evidence.” The suspension was upheld.