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Yevonne Powers, who worked at a Roanoke County urgent care center, received a reprimand. The dose given to the teen has not been definitively linked to her death.
Jessica Erin Hart
Tuesday, October 8, 2013
RICHMOND — A nurse at a Roanoke County urgent care center was reprimanded Monday for giving a 17-year-old girl more than twice the recommended dosage of a powerful narcotic just seven hours before the girl died.
Yevonne Powers, a registered nurse at MedExpress on Williamson Road, violated regulations that govern the health and welfare of patients, the Virginia Board of Nursing determined after hearing her account during an administrative hearing.
Although the dose of Dilaudid given to Jessica Erin Hart of Montvale has not been definitively linked to her death, the board still found fault with the treatment she received the night of April 4.
Powers was asked if she felt comfortable with a doctor’s order to give the petite Hart a 4 milligram shot of Dilaudid — an potent opioid with similar characteristics to morphine — after the girl’s mother brought her to the urgent care center with a severe sore throat.
“I trusted the doctor and what she was giving her,” Powers responded.
After the hearing, officials with the Department of Health Professions said Dr. Joyce Luteyn of the MedExpress center also faces a complaint filed with the state Board of Medicine. A hearing has been scheduled for Dec. 4 in that case.
Monday’s reprimand of Powers by a two-member panel of the Board of Nursing is not final. Powers has 30 days to decide whether to appeal the recommendation to the full board. If she does not, the reprimand becomes official.
The reprimand is a public notice that she violated regulations nurses are expected to follow. The punishment fell on the lower end of options that included a finding of no wrongdoing, a fine, probation or the suspension of her nursing license.
Tearful at times during nearly an hour of testimony before the board, Powers said she did everything she could to help a patient who was clearly in pain from a throat so inflamed that her tonsils were touching.
“She couldn’t talk; she couldn’t swallow,” Powers said. “She was so miserable. Being a mom, I hated it for her.”
A complaint filed in July stated that Powers administered 4 milligrams of Dilaudid to the girl “despite the medication’s known risk of respiratory depression, and in a quantity at least twice the recommended dosage.”
Other concerns raised by the board members in their questions to Powers were the young age of a patient who weighed just 105 pounds and whose previous treatment had not included powerful opioid medications like the one she received that night.
After leaving the urgent care center, Hart and her mother picked up a prescription and were on the way home when she went into respiratory and cardiac failure. She was rushed to Carilion Roanoke Memorial Hospital, where she died several hours later.
An autopsy determined that Hart died of complications from mononucleosis. It was not clear if the Dilaudid was a contributing factor to her death.
Roanoke County police had been investigating the case, but closed the matter after Hart’s death was ruled to be from natural causes.
Travis Graham, a Roanoke attorney who has been speaking for the Harts, said the family has questions about the autopsy and wants the matter investigated further.
Much of the testimony presented Monday foreshadowed questions that likely will be raised when Luteyn faces her hearing December. “I’m just there to assist the doctor,” Powers said when asked to describe her duties as a registered nurse at the urgent care center, which had been open for about five months at the time of Hart’s death.
Powers said she is normally not reluctant to confront a doctor if she has questions about the prescribed treatment. But in this case, she said, she had no concerns about the dosage of Dilaudid because of how much pain Hart was in.
An Oct. 2 notice of the charges against Luteyn, made public Monday, goes into greater detail in questioning the medical decisions that were made during Hart’s treatment.
“You failed to consider or first attempt non-narcotic medications, less potent narcotics, or the much lower usual starting dose of Dilaudid, i.e. 1-2 mg, to treat … the reported throat pain, nor did you document any pain rating scale with respect to the patient’s pain,” the notice stated.
After learning of Hart’s death, Luteyn made numerous additions to Hart’s patient records, the document also alleged.
Powers’ attorney, Chris Stevens of Roanoke, said after the hearing that a decision has not been made on whether to appeal the reprimand she received.
As part of the board’s decision, Powers must complete training on professional accountability.
Powers, who said she has been on paid leave since the incident, will be allowed to continue nursing.
“I still want to be able to help people feel better,” she told the panel. “I’ve always wanted to take care of people, and I just want to go back to that.”
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