Monday, May 07, 2007

KC’s Levicy posts: Some Reactions (Post 1)

I hope you've read KC Johnson’s posts (here, here and here) concerning DUMC nurse Tara Levicy, who on the morning of 3/14/06 was in the ER and had contact with patient Crystal Gail Mangum? At the time, Levicy was in training for SANE certification which she subsequently obtained.

KC’s posts detail and discuss not only Levicy’s actions on 3/14/06, but subsequent statements Levicy’s reported to have made to various parties concerning her involvement in the ER medical services provided Mangum that morning, as well as statements Levicy is alleged to have made relating to such matters as DNA testing and women’s truthfulness when making rape allegations.

KC reports that subsequent to 3/14, Levicy met a number of times over the course of many months with investigators who perpetrated the frame-up of three innocent Duke students as well as with at least one attorney who defended the them.

If you’re going to read further, I assume you’re very familiar with KC’s posts.

Full disclosure: I’m a health care professional trained at DU and DUMC.

Most of my professional service has been in private practice or at other institutions,but from time to time I've participated in DUMC research activities and staff training as part of grant programs or on a fee for service basis.

Now, except for limited consultation to service providing agencies, I’m retired from active practice and have no expectation of ever again providing service at DUMC. I have many friends and former colleagues at DU and DUMC.

Important qualifications to this post: 1) As far as I can recall, I’ve never met Nurse Levicy. I have not discussed Crystal Mangum’s care with anyone at DUMC who either had direct patient care responsibility for Mangum or supervisory responsibility for those who did. I’ve also never discussed Mangum’s patient care at DUMC with any attorney employed by DUMC or DU.

2) The remarks I’m about to make are stimulated by the contents of KC’s posts, but do not represent informed judgments regarding them. The posts’ contents reminded me of important principles of health care practice. It’s those I really want to share with you in order to affirm them and further embed them in the minds of health care professionals and the public. In a world where much is nonsensical, those principles are part of that rare resource: wisdom.

At the end of this post, I’ll also say a few things in response to some comments folks have made about DUMC and staff there.

Now let’s begin:

As many commenters at KC’s posts have pointed out, on day one or two of training, a health care professional (HCP) learns: “Always chart it.” “If it’s not on the chart, it didn’t happen.”

There’s more that goes with that advice: “Unless your 100% sure, don’t answer without checking the chart. And if the question is really important, check the chart anyway. That’s good for the patient and for you.”

“You’re only responsible for your part of the chart or what you sign off on. Other parts of it, let other HCPs explain”

“If you leave something off the chart, you can update. Don’t fudge. Make sure your supervisor knows you’re updating. Best practice: get your supervisor to sign with you on the update. Briefly give reason(s) for update. When it matters, let the patient or family know you’ve updated.”

And then there’s this ----

“Don’t ever speak to police or attorneys without the chart at hand. And then, for God’s sake, don’t ‘go off the chart’ and start talking about things that aren’t there. Best practice: before speaking with police or attorneys, ask your supervisor to review the chart. Review with your supervisor everything on the chart you were responsible for or signed off on. Ask also about reviewing what you’ll be saying with an attorney employed by your institution . ”

Of course, there’s a very good chance (almost a certainty) an HCP asked about a patient’s care even a few days afterwards by police or attorneys will already have had contact with an attorney representing his/her employing institution.

(This series continues tomorrow with thoughts about attorneys representing HC institutions, companies which provide malpractice insurance, and professional organizations; and how they most often interact with HCPs involved in the kind of complicated case Nurse Levicy was and is involved in.)

11 comments:

Anonymous said...

"Better to be silent and thought a fool then to open your mouth and remove all doubt."

and, engineering rule #1:

"If it's not documented, it didn't happen and won't happen again."

-AC

Anonymous said...

John - Alleged and reported accussations does not make it so. That is one of the issues here - Presume innocent until proven quilty is the byword. No one goes back and charts on someone who has been discharged. This case was done in the ED when Crystal left on her own two legs at 1:30PM. Glad you have someone from DUMC on the case.

AMac said...

"Sceptical" started thread at LieStoppers with a list of fourteen-plus potential problems with DUMC's treatment of Mangum that morning, and its aftermath (too long to copy).

Much later in that lenghty thread, Chris Ford noted four mysteries about Levicy that require additional information to solve. Excerpts--

"1. DUMC should have a well-oiled litigation machine that comes into action when medical malpractice and negligence is suspected... Yet they did nothing when the Lacrosse case dragged on 10 months and potential damages to Duke compounded. Why?

2. No higher ups at DUMC or the Nurse Management Leadership team [have stated] whether they knew about the SANE exam and Levicy problem -- or if they passed such concerns onto law enforcement, President Brodhead, and BOT. All we know now is Arico and Levicy knew, no one else. We know that no one talked to Dr. Manly before the defense deposed her in October...

3. What the ER team knew about Mangum from her medical files... is mostly unknown because her files are sealed...

4. Nothing is known on any internal disciplinary action that may have arisen from the Lacrosse case, if any..."

(AMac again) Time and again, Hoax reporting reveals institutional procedures for dealing with trouble that are straight out of Alice in Wonderland.

At DUMC, it turns out that the consequences for professional advanced-practice nurse-trainees not following basic standard-of-care protocols are...

... exactly nothing.

Who knew?

Anonymous said...

SANE is not Advanced Practice Nursing(which requires a minnimum of a Master degree)-Goggle on internet for full disclosure. SANE is a simple 84 hour certification course open to any Rn. It does not even require a BSN.

AMac said...

Anon 10:54pm --

Thanks for the correction.

Though that subsitutes better-informed questions for my wrongly phrased one. Why was a newly-minted RN who was partly through her 84-hour SANE certification so loosely supervised on the morning of this exam? What oversight of her charting was (ought to have been) provided? Why did DUMC allow her to take the lead in dealing with the Durham Police and the D.A.?

Anonymous said...

Amac - I have always held a lot of respect for your writting - BTW, I read you are a woman - Good for us. I am anxious to read the DUMC poster. My view - the checklist is Q and A - any RN do that without supervision and do in most hospital ED. The Physician did the physical exam and collected specimens- the nurse assisted. I have not read the anyones charting to date. But have read numerous unsubstationed accusstions. That is just one nurses view and am not going to clog up the board - I want to see what his DUMC poster has to say.

AMac said...

Anon 12:39am --

In my family, "the women of today, smarter than the man in every way. So I take your gender assignment as a compliment, but alas, an undeserved one.

Re. DUMC poster: I'd offered to post anything SANE nurse 'Mrs. DK' wanted to write; she's critical of points KC Johnson made in his 3-parter on Levicy's performance. But she's not from N.C. or connected with Duke, to my knowledge. It may take her longer than anticipated to get her essay finalized. I understand wanting to get things right... it'll come when it comes.

Anonymous said...

quick note-Your respone to AG Rud was excellent and I have fallen in love with essai.

kbp said...

I too enjoyed KC's posts on Levicy.

The new information was helpful, though there was not a great deal of it.

The job KC did putting it together was superb.

bill anderson said...

John,

I think that Tara Levicy very well may be criminally liable for what she did. This was not a series of mistakes on her part; it was a series of willful acts in which she clearly stepped over her bounds, tried to give medical "evidence" that did not exist, and met in secret strategy meetings with the prosecutor.

Furthermore, because her supervisor, Teresa Arico, met with Nifong and Levicy in a meeting where no notes were taken, we can only assume that they were up to no good. With Arico in attendance, now we have DUMC management involved in the Hoax.

At not time in this sorry affair did DUMC's management attempt to set the record straight. It is clear that they were hoping this case could limp to trial, and that maybe the hospital would be off the hook.

So, we have a number of people either assisting through commission or omission, but in both cases DUMC provided the fuel for the Hoax. I can only hope that they will have to answer for their actions in a court of law.

sceptical said...

Here is the summary of my post at Liestoppers about the care of Crystal Mangum at Duke University Medical Center and the aftermath:

"To summarize, DUMC did not have adequate SANE staffing on March 14, did not have adequate supervision for a SANE-in-training that day, did not have adequate oversight of Levicy's actions on March 14 or afterwards, and did not correct the lie that the SANE exam supported charges of rape.

Dr. Manly did not properly document her findings on March 14, failed to diagnose a cause for Crystal's vaginal discharge, improperly signed the SANE report as the assistant instead of the examiner, and to our knowlege did not correct the false impressions given by Levicy until months later in Manly's discussions with defense lawyers.

Nurse Levicy inadequately documented her part of the SANE report, improperly signed the report as the examiner, misrepresented the findings of the SANE exam to LE, incorrectly made or concurred with a diagnosis of "blunt force trauma," failed to correct the false statements made by prosecutors and police based on her statements to them, acted in a partisan instead of objective fashion, and led to the indictments of Reade Seligmann, Collin Finnerty, and Dave Evans based on her inexperienced subjective evaluation of a hysterical sociopath."