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.)