Criminal and License Defense

Whenever I'm contacted by a nurse facing criminal charges related to impairment, the first question I ask is;

"Do you have a criminal defense attorney?"

As many of you have most likely answered...Well, duh! Of COURSE I do! Do you think I'm dumb enough to defend myself in court? No, I don't thing so, but there ARE a few who actually consider it.

I receive even more inquires about pending investigations by the board of nursing. Again, the first question I ask the person contacting me is:

"Do you have a LICENSE defense attorney?"

Here are the top three answers I receive to that question:

1. No, it's only the board of nursing. It's not like I'm going to prison or anything.
2. I'm a nurse facing nurses, I know how to defend myself.
3. I can't afford an attorney. Besides, it's the board of nursing, not the judges at Nuremberg.

Let me put it to you this way, there is nothing more serious you'll face in the profession of nursing than an inquiry, investigation, and/or a hearing before the licensure board. If you make a mistake...you may never practice nursing again!

This is why a nurse should purchase professional liability insurance with a licensure defense clause...as soon as you graduate from nursing school! If you don't have one now...GET ONE ASAP!!!! It's cheap compared to all the doo doo you'll face if you need one and don't have it.

I've been charged with a felony, now what?

Need a license defense attorney? Contact the American Association of Nurse Attorneys

Professional Liability for Nurses

Addicts in health professions flock to get peers' help

This article perpetuates many of the most prominent myths associated with the disease of addiction without even realizing that's what they're doing.

Just a few examples:

"Until the late 1970s, drug addiction in the health care industry was largely addressed punitively. Licenses were revoked, careers crushed and addicts jailed. That made doctors, nurses, dentists and pharmacists reluctant to confess addiction or pursue help, further endangering patients. Even now, when addiction is better understood as a disease, health workers fear coming forward."

That's STILL the way many states continue to handle impaired health care providers. They have a "Program on the books", but even if a person meets all the inclusion criteria and also clears the criteria for exclusion from the program, the board can still refuse to admit the provider if they "feel" they might not do well. That's the problem...we need to stop dealing with this disease with feelings and begin using science and evidence based practices. Yes, addicts can do some terrible things as a result of their disease, but if we can remove the stigma, maybe we can intervene and get them into treatment BEFORE they get to the point of committing illegal acts.

"It is extremely difficult to acknowledge because it is admitting to human frailty, and we as health care professionals are held to a higher standard," said Elizabeth Pace, chief executive of Peer Assistance."

Is having cancer a human frailty? Is having diabetes or heart disease a human frailty? This statement is nothing more than being judgmental and assigning blame and lack of willpower to the person with a medical disease that CAUSES the inability to just stop using. This is the very condescending and judgmental attitude that prevents people from seeking help.

Addicts are not bad people trying to become good! They are ill with a chronic, progressive and unnecessarily fatal disease and are trying to become well!

"I didn't understand I had a disease," she said. "I thought I was bad and I had let down my entire profession. I had let the world down. I really thought my punishment should be that I should die."

This is one of the correct things published in this article. Every addict feels this way...not just health care professionals. Society perpetuates this incorrect and unscientific "belief". Once you read the research and the science, looking at it as a lack of will power makes no sense.

"Experts say crushing the stigma of addiction starts with education in medical, dental, nursing and pharmacy schools."

Yes it does. And using scientific terms instead of emotion laden judgment filled words and phrases in the press coverage will also be required to change the cultural acceptance that addiction is NOT a disease.

"That education should also be directed at hospital administrators, who sometimes must choose between quietly firing a pill-plundering employee or calling for help, which can lead to public scrutiny."

There is a great example of using negative emotional words instead of scientific or neutral language. Gee, I wonder what the not so hidden agenda this writer holds when it comes to the disease of addiction in health care providers?

"There are probably people alive right now because some hospital administrators had the guts to say we are going to call in an airstrike on ourselves and fix this problem the right way," said Jeff Sweetin, agent in charge for theDrug Enforcement Administration's Rocky Mountain region."

Typical attitude of a police agency...we have to bring an air-strike in order to eliminate these horrible addicts. We certainly wouldn't want to treat the disease now would we. Of course not, it might cost them their jobs.

"We always ask (the addicted health care worker who just got "busted" instead of diagnosed) what we can tell the hospital to make their system better, and that typically leads to changes in the system."

The biggest change that needs to happen in the system is to start treting this as the disease that it is, not some lack of willpower or moral failing. Until THAT happens, not much is going to change.

Wealth, fame, and addiction

George Carlin (or Robin Williams, depending on the source) said it well,

"Drugs (cocaine) are God's way of telling you that you make too much money."

We are seeing that very thing played out with Michael Jackson. It's one glaring example of the progressive nature of the disease. Mr. Jackson had 2 things that allowed him to continue using mood altering substances until it finally killed him...

• money
• sycophantic enablers (fawning parasite; A servile self-seeker who attempts to win favor by flattering influential people)

By the very nature of the disease, an addict is incapable of stopping by their own force of will. This is why some sort of intervention is required to get them into treatment. Once they detox and their brain begins to recuperate, THEN the education and techniques provided by evidence-based treatment can actually be retained and used to stay "clean".

Intervention takes many forms. The most common type is what we see on the A&E television show "Intervention". It's a technique used to create a "bottom", that magical place and time where the addict will enter treatment. For an addict with unlimited resources and surrounded by people who will give them whatever they want, that bottom is death.

Intervention is difficult. It appears to go against all definitions of love and logic. But continuing to "rescue" the addict from the consequences of their drug misuse allows them to continue to believe they are in control. The longer it takes to get the person into treatment, the more the disease progresses and the tougher it becomes to effectively treat the disease. When you are surrounded by people who want to please you just to be near you, the intervention is unlikely to take place. Or, if someone tries to make it happen, the sycophantic enablers sabotage the very thing designed to help the addict.

Yes, there has been unethical, unprofessional, and undoubtedly criminal activity involved in the death of Mr. Jackson. However, the medical providers aren't the only people to be held accountable (although I have no doubt that's exactly what will happen). Mr. Jackson's family and employees share that responsibility as well.

I hope Mr. Jackson's life is studied closely in order to learn the valuable lessons it holds. While he was an unparalleled entertainer with unlimited talent, his troubled life and premature death could provide the positive move forward when dealing with all apsects of the disease called addiction.

Professional Liability Insurance for Nurses

As a recovery mentor, peer advisor, and consulant, I frequently come in contact with nurses who rely solely on their employer for malpractice/liability insurance. I have to confess, I did the same thing for most of my time as an emergency room nurse and certified registered nurse anesthetist (CRNA). This makes no sense professionally.

An insurance company and the attorneys they provide if there is a claim have the interest of their client(s) first and foremost. If in the process of dealing with the claim it is in the best interest of the employer to hang the nurse out to dry, then that's what's going to happen. Then, the nurse will need to hire their own attorney and pay for them OUT OF POCKET, since the insurance they relied on covers the hospital, not them.

Professional liability insurance (which should include a license defense clause!) for nurses is extremely reasonable. The claim that "it's too expensive" is lame at best. The American Nurses Association (ANA) states ont their web site; "A must have for every nurse. Protect your career by purchasing your own coverage at a reasonable price. Every nurse today should carry their own professional liability insurance to protect themselves from the costs of legal and board of nursing action -- even if they are covered by their employer."

So why is it most nurses DON'T have their own insurance, and don't seem to understand the importance of having this insurance? Read the opinion of a nurse who is also a license defense attorney.

What do you think?

Michael Jackson, Addiction, the Media, and the Medical Profession

I've been following the Michael Jackson saga since the first news alert of his "possible" death. The first thing that went through my mind was he died from an accidental overdose. Little did I realize it would take us to the "propofol" thing. And while his death is tragic, so are the deaths of all addicts. They are tragic because many, many, MANY of them don't have to happen.

So why DO they continue to happen? And why do they appear to be increasing? Because our culture continues to follow the same failed ways of "dealing" with this "issue".

First of all, it's NOT an issue...it's a disease. Until we treat it that way, this kind of crap will keep happening more and more. "Dealing" with a disease in a punitive way...i.e., with the police department and jail instead of with interventions and treatment leads to continued progression of the disease and ultimately death.

"BUT TREATMENT DOESN'T WORK!"

Of course it does, when it's started as early as possible, is evidence based, and is ongoing. Currently, that doesn't happen in too many cases.

Why not? Because we approach this disease with what I call the "3 Ms" of addiction: Myth, Misbelief, and Misinformation. One of the predominant myths is known as "hitting rock bottom".

"Treatment doesn't work until the addict HITS ROCK BOTTOM!"

What is rock bottom? I'm sure there are numerous definitions. I think the most accepted one is this...the addict has to lose most (if not all) of the things that are important to them....job, marriage, family, money, car, etc. before they will be willing to enter treatment. But without an intervention of some kind...the bottom for all too many addicts is death.

Mr. Jackson is just one example of what happens when treatment is withheld until the addict "hits bottom".

Goodness, he even had a physician with him at the time of his death! It will be interesting to see what happened leading up to his death that day (if we ever really find out). But there are some clear things that DID happen.

First, Michael Jackson was surrounded by sycophants (self-seeking, servile flatterers; fawning parasites...according to dictionary.com). Some of these people were health care providers, some even (gasp) physicians! As you can see, doctors, nurses, pharmacists, etc. are not immune from all of this. There are star struck individuals in all walks of life, just as there are unethical people in all areas of business and government. When someone told Mr. Jackson no...he found someone who would say yes. My guess is the physician with Mr. Jackson at the time of his death thought he was skilled enough to prevent what happened. Guess what...MD doesn't automatically endow the person with the ability to manage an airway or prevent them from making a mistake in administering a medication they have no business administering. Combine that with administering this medication in a place where it should never be administered and you have the very situation on June 25th in his rented home.

Second, let's compare how we (meaning society and the medical community) approach other chronic, progressive, potentially fatal diseases.

Diabetes. We teach about the disease, that if there is a family history, the risk increases. We teach early signs and symptoms. We suggest early EARLY treatment, aggressive treatment, and evidence based treatment.

Cardiovascular disease. Early recognition of signs and symptoms. Immediate intervention at the first sign of possible heart attack or stroke. Get to the ER now! Education about prevention (family history, diet, exercise, check ups, etc.).

Cancer. Education about the disease, causes, risk factors...like family history (where have we heard that before?), early signs and symptoms, and early, aggressive treatment.

Addiction. How do we handle it? Don't talk about it. Ignore family history...hell, don't even THINK about talking about it! Ignore the early signs and symptoms (it's a phase, it's part of "growing up", they're in the "wrong crowd", they made "bad decisions" or "mistakes"), cover up the consequences for their "bad decisions" (called co-dependent behavior), and WAIT UNTIL THEY HIT BOTTOM. Does anyone see how completely crazy this is? Does anyone see how it makes absolutely no sense from a medical stand point? And yet we keep doing the same stupid stuff over and over hoping the outcome will be different. Didn't Einstein say that was INSANITY!?

If you don't see the idiocy, you're part of the problem. If you do see the idiocy and do nothing, you're part of the problem.

Several family members and friends have said over and over, "We tried to save Michael but we just couldn't. We did everything we could and it just wasn't enough."

BALONEY! Did they hire an interventionist? Did they require him to enter treatment and refuse to provide him with drugs? Did they hire recovering addicts to keep the sycophants away? Did they fire the doctors who were unethically and unprofessionally supplying him with addictive drugs?

Let's stop the insanity and actually start doing what needs to happen. Education, early recognition, intervention, aggressive treatment, and long term follow up...just like we do for other chronic, progressive, potentially fatal disease.

I hope Michael Jackson's death won't be in vain.

Punishment vs. Treatment

I'm speaking tomorrow (Tuesday June 9, 2009) at the College of Mt. St. Joe here in Cincinnati. A student had the courage to contact a complete stranger to discuss this highly charged, extremely unpopular topic. Her class is having a debate between disciplinary measures to deal with an impaired nurse vs. "alternative to discipline" methods of dealing with the disease and the nurse who suffers with it.

I'll post the results tomorrow. It should be an interesting day.

Thanks for having the guts to take the less than popular stance, Samantha!

The Unethical and Unprofessional Response by the Health Care Community in Lebanon, Ohio

"Two Caretakers Indicted for Allegedly Stealing Drugs in a Warren County, Ohio Nursing Home"

That was the headline in Cincinnati newspapers and on TV and radio news in the tristate area. As I read the story, I thought back to my experiences over the past 19 years.

The first thing that jumped out at me was the comment by the executive director of the nursing home. He stated they contacted the police who then watched the nurses over the next 2 years.

Excuse me? WATCHED them for TWO YEARS!?

Why? To gather evidence in order to make an arrest and seek a successful prosecution. Why would you not intervene sooner? If these nurses were addicted to opioids, why would you allow the disease to continue to progress, risk the well being of those entrusted to their care, and possibly allow the nurse...your employee and colleague...to possibly cause a potential auto accident or die from an accidental overdose?

Would they watch an employee with signs of tuberculosis, swine flu, MRSA, or other illness to see if they would steal antibiotics or other medications to deal with their illness? Would they put the residents at risk for infection or harm to catch the nurse steeling medications or other hospital equipment? Of course not. So why is it permissible to allow them to continue diverting opioids in order to get enough evidence for an arrest and conviction?

Easy answer. Few people, including doctors and nurses, believe addiction is a disease. They receive little education regarding the disease during training. Few nurses recognize the signs and symptoms in a colleague. Even if they do they rarely intervene for fear of being wrong, or harming the nurse's career. They wait until they can no longer ignore the signs and then they terminate them, report them to the police or both. Instead of intervening in order to get them out of the clinical area and into treatment, they eliminate the "problem" by firing them. This allows the disease to continue to progress. It also allows an impaired professional to go to another facility where they may harm clients or themselves.

The Code of Ethics for Nurses is very specific about the impaired nurse. Statement 3.6 says the colleagues of an impaired nurse are ethically required to intervene in order to protect the patients and to advocate for the appropriate treatment and rehabilitation of the impaired nurse. This advocacy also includes appropriate and fair legal response.

None of this happened in the incident in Lebanon, Ohio. They placed residents at risk in order to gather evidence for prosecution. They allowed a chronic, progressive, potentially fatal disease to progress. They placed the lives of innocent bystanders AND the lives of the nurses in jeopardy in order to look tough in the "war on drugs".

There are no winners when this happens...only losers. he biggest losers are the nurse, their family, and society at large.

The only real casualty in the war on drugs are those unlucky enough to have the disease.

A Tribute to Bill Wilson, Co-Founder of AA

(Author Unknown)

We died of pneumonia in furnished rooms where they found us three days after when somebody complained about the smell.

We died against bridge abutments and nobody knew if it was suicide and we probably didn't know either except in the sense that it was always suicide.

We died in hospitals, our stomachs huge, distended and there was nothing they could do.

We died in cells, never knowing whether we were guilty or not. We went to priests, they gave us pledges, they told us to pray, they told us to go and sin no more, but go. We tried and we died.

We died of overdoses, we died in bed (but usually not the Big Bed). We died in straitjackets, in the DT's seeing God knows what, creeping, skittering, slithering, and shuffling things. And you know what the worst thing was? The worst thing was that nobody ever believed how hard we tried.

We went to doctors and they gave us stuff to take that would make us sick when we drank on the principle of "so crazy, it just might work," I guess, or maybe they just shook their heads and sent us to places like Drop kick Murphy's. And when we got out we were hooked on paraldehyde or maybe we lied too. And the doctors and they told us not to drink so much, just drink like me. And we tried, and we died.

We drowned in our own vomit or choked on it, our broken jaws wired shut. We died playing Russian roulette and people thought we'd lost, but we knew better. We died under the hoofs of horses, under the wheels of vehicles, under the knives and boot heels of our brother drunks. We died in shame. And you know what was even worse was that we couldn't believe it ourselves, that we had tried. We figured we just thought we tried and we died believing that we hadn't tried, believing that we didn't know what it meant to try.

When we were desperate enough or hopeful or deluded or embattled enough to go for help, we went to people with letters after their names and prayed that they might have read the right books, that had the right words in them, never suspecting the terrifying truth, that the right words, as simple as they were, had not been written yet.

We died falling off girders on high buildings, because of course ironworkers drink, of course they do. We died with a shotgun in our mouth, or jumping off a bridge, and everybody knew it was suicide.

We died under the Southeast Expressway, with our hands tied behind us and a bullet in the back of our head, because this time the people that we disappointed were the wrong people.

We died in convulsions, or of "insult to the brain," we died incontinent, and in disgrace, abandoned. If we were women, we died degraded, because women have so much more to live up to. We tried and we died and nobody cried.

And the very worst thing was that for every one of us that died, there were another hundred of us, or another thousand, who wished that we could die, who went to sleep praying we would not have to wake up because what we were enduring was intolerable and we knew in our hearts it wasn't ever going to change.

One day in a hospital room in New York City, one of us had what the books call a transforming spiritual experience, and he said to himself "I've got it" (no, you haven't, you've only got part of it) "and I have to share it." (Now you've ALMOST got it) and he kept trying to give it away, but we couldn't hear it.We tried and we died.

We died of one last cigarette, the comfort of its glowing in the dark. We passed out and the bed caught fire. They said we suffocated before our body burned, they said we never felt a thing, that was the best way maybe hat we died, except sometimes we took our family with us.

And the man in New York was so sure he had it, he tried to love us into sobriety, but that didn't work either, love confuses drunks and he tried and we still died.

One after another we got his hopes up and we broke his heart, because that's what we do. And the worst thing was that every time we thought we knew what the worst thing was something happened that was worse.

Until a day came in a hotel lobby and it wasn't in Rome, or Jerusalem, or Mecca or even Dublin, or South Boston, it was in Akron, Ohio, for Christ's sake.

A day came when the man said I have to find a drunk because I need him as much as he needs me (NOW you've got it).And the transmission line, after all those years, was open, the transmission line was open. And now we don't go to priests, and we don't go to doctors and people with letters after their names.

We come to people who have been there, we come to each other. And we try. And we don't have to die.

Nursing Workshops

LaTonia and I are are looking forward to providing these workshops for the nursing community in the Greater Cincinnati Area. Substance abuse and chemical dependence are a growing problem, not only in nursing, but in all areas of our society. With the current economic downturn and no end anytime soon, we can expect to see an increase. Using alcohol and prescription medications to "cope" with stress can start off as a short term remedy until the crisis is over, but for a percentage of individuals, this can turn into chemical dependence. It's an unintended consequence of genetics, exposure, and inadequate or innapropriate coping skills. This is a disease that creeps up on you. NO ONE decides to become addicted to mood altering substances. As health care professionals, it's our responsibility to assist our patients AND our colleagues when faced with a chronic, progressive, unnecessarily fatal disease. Come and learn more about the medical, professional, and legal consequences of turning a blind eye to this major public health problem. If you're interested in attending, contact me at jack@jacksem.com to ask questions or reserve your seat. Space is limited.