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Reduced discipline upheld for RN who let patient walk to his death

Credit: Pat Kammer Credit: Pat Kammer https://flic.kr/p/956NvF

Credit: Pat Kammer
https://flic.kr/p/956NvF

The Supreme Judicial Court of Maine, in a February 27 decision, upheld the reduction––from revocation to suspension—of discipline imposed on a nursing supervisor who let a potentially impaired patient walk out a hospital and to his death during a winter blizzard (Zablotny v. State Board of Nursing).

Although the tragic and unusual circumstances of the case seemed to call for strict sanctions, the court acknowledged that the entire context of the nursing supervisor’s actions significantly mitigated his liability for the patient’s death.

The nursing supervisor, John Zablotny, was working a night shift at a hospital in Machias, Maine, in 2008, when a patient being treated for severe abdominal pain and on large doses of narcotic painkillers, requested to leave the premises against medical advice. Although a nurse believed that the patient was confused and needed restraint, a daytime nursing supervisor had found the patient to be rational and mentally competent.

However, when the patient initially requested to leave—to walk to a friend’s house without winter clothing—the nursing supervisor refused, based on the patient’s mental state and the blizzard conditions. Sometime during the day, a nurse had noted suicidal comments made by the patient on a daily report, but the report was misfiled.

When Zablotny arrived that evening to take over as nursing supervisor, he decided to let the patient leave. Zablotny consulted with the on-call physician, but failed to mention that the patient wanted to leave the hospital on foot in clothing not suitable to the weather conditions.

After signing a release form, the patient left the hospital, walking into a blizzard dressed only in pants, a shirt, and slippers. Shortly after, Zablotny came across the misfiled daily report containing information about the patient’s suicidal comments. He then called the patient’s wife and the local police to inform them of the situation. The police found the patient the next day, buried in the snow less than 400 feet from the entrance to the hospital, dead from hypothermia and opioid toxicity.

Following the death, the state’s nursing board brought a disciplinary action against Zablotny, revoking his license for two years. Zablotny appealed, and the case went up to the Supreme Judicial Court of Maine, which reversed and remanded a lower court’s decision to uphold the revocation on the grounds that the lower court had conducted an improper review.

On remand, the lower court determined that Zablotny had engaged in unprofessional conduct by inadequately informing the patient of the risks he faced by leaving the hospital against medical advice. It reduced Zablotny’s discipline to a suspension, the board appealed, and the case went up to the high court again.

On appeal, the board argued that the facts of the case showed that Zablotny had committed unprofessional conduct by failing to fully inform the on-call physician of the patient’s condition and by not immediately informing the police after the patient left the hospital.

However, the Court, looking at the evidence as a whole—including the missing report that noted the suicidal comments and the fact that Zablotny did not have any legal authority to stop the patient from leaving—deferred to the trial court’s decision to reduce the suspension. “The District Court,” wrote Justice Jeff Boyd, “was not compelled, as a matter of law, to find that Zablotny violated Board rules or professional standards of care.”