"accidental" removal of iud...

[236116]

http://www.courthousenews.com/2009/..._IUD_Without_Permission_Then_Lectured_Her.htm

ALBUQUERQUE (CN) - A clinic nurse first removed her intrauterine birth-control device without permission, says the patient in a federal action, then told her that "having the IUD come out was a good thing," because "I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them."

The patient sued Presbyterian Health Services Rio Rancho Family Health Center and nurse practitioner Sylvia Olona in Federal Court.

The plaintiff says she went to Rio Rancho to have the strings on her IUD shortened.

The complaint states: "As soon as Defendant Olona began speaking to (the plaintiff), she questioned her about her choice of contraception.

"As Defendant Olona began the procedure, (the plaintiff) felt Olona pull on the strings of the IUD. (The plaintiff) felt a distinct pulling on the strings followed by a sharp pain in her uterus similar to a very strong menstrual cramp.

"As that happened, Defendant Olona stated, 'Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.' She then explained, 'I cut the string than went back and gently pulled and out it came. It must have not been in properly.'

"Olona then stated, 'having the IUD come out was a good thing.' She asked (the plaintiff) if she wanted to hear her 'take' on the situation. Without receiving a response, Defendant Olona stated, 'I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.'

"Defendant Olona stated, 'Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it's not true, they accidentally come out when I tug.'

"At this point, Defendant Olona advised that (the plaintiff) needed to take a pregnancy test. (The plaintiff) did, and the test was negative.
"Defendant Olona told (the plaintiff) that is was better that she did not have the IUD because she could now use a "non-abortion" form of contraception. Defendant Olona suggested the deprovera (depo) [sic] shot or the pill, and made clear that she would not insert a new IUD."

The plaintiff demands damages for battery, constitutional violations and negligence. She is represented by Ryan Villa with the Law Office of Robert Cooper.

So what do we think, SDN?

Is it now ok to make this kind of choice for our patients? Would you have fired this nurse? Why or why not?

Do my uber-anti-reproductive-choice friends find this okay? Does it fall under some kind of backward reading of the conscience rule?

There's also the question of whether or not the nurse actually knows what the hell she's talking about as far as the working of an IUD.

(Special thanks to sf_d for pointing this out.)

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[Hippias]

I would fire the nurse based on a lack of professionalism. She should not be expressing her personal viewpoints on abortion with a patient.
It's the duty of the health care provider to provide the information necessary for the patient to make an informed decision on what they think is the best way to handle the matter, not to make the decision for them.

 

[lord_jeebus]

The nurse should be charged criminally for assault.

 

[cpants]

Before she is burned at the stake, I will say that it is possible that the IUD came out accidentally, or that it had not been placed correctly. That said, if the nurse has a pattern of doing this kind of thing, she should lose licensure, and be held responsible for malpractice or at least for any expenses related to replacing the IUD.

 

[Sol Rosenberg]

Before she is burned at the stake, I will say that it is possible that the IUD came out accidentally, or that it had not been placed correctly. That said, if the nurse has a pattern of doing this kind of thing, she should lose licensure, and be held responsible for malpractice or at least for any expenses related to replacing the IUD.

Nope. If it came out accidentally, she could've just said "Oops," and put it back in. Her actions are inexcusable. I'm not sure what her damages are, but this NP should be barred from further practice, at the very least.

Her supervising physician would do well to not touch her with a 10 foot pole.

 

[cpants]

I don't think you can just put it back in. Once it's out, it's out, and you would have to put in a new one.

 

[Sol Rosenberg]

I don't think you can just put it back in. Once it's out, it's out, and you would have to put in a new one.

That wasn't the point of my argument, and you know it. Fine, she could've just said "Oops," and put a new one in.

 

[cleoscat3]

I would fire the nurse based on a lack of professionalism. She should not be expressing her personal viewpoints on abortion with a patient.
It's the duty of the health care provider to provide the information necessary for the patient to make an informed decision on what they think is the best way to handle the matter, not to make the decision for them.

There are two types of IUD it looks like.

The Copper T:

In the horizontal arms of the Copper T 380A IUD there is some copper. The IUD slowly gives off copper into the uterine cavity. This does several things. Most importantly, it stops sperm from making their way up through the uterus. Among typical couples who initiate use of this IUD, just less than 1% will experience an accidental pregnancy in the first year.


and


The LNG-IUS

The LNG-IUS contains some levonorgestrel in its vertical arm. This hormone is a progestin much like the progesterone a woman's ovaries produce each monthly cycle. Each week the LNG-IUS gives off about the same amount of levonorgestrel as a woman gets when she takes one or two of the minipills called Ovrette. The levonorgestrel causes the cervical mucus to become thicker so sperm cannot get to the egg. Among typical couples who initiate use of the LNG-IUS, just one in 1,000 women will experience an accidental pregnancy in the first year.


So the nurse didn't understand how this worked.

 

[Dimoak]

That wasn't the point of my argument, and you know it. Fine, she could've just said "Oops," and put a new one in.

Just as an aside (I'm not trying to poke at you), I'm not sure if NP's are allowed to perform IUD insertions in that state, but just putting a new one in isn't that simple, as IUDs aren't exactly cheap. In this case, even if it was an accident, the NP should've apologized for her mistake and her employer should've provided compensation for the costs and inconvenience of putting a new one in (instead of going on a diatribe). But in this case, given the NP's history, it probably won't be too difficult for the plaintiff's attorney to prove that this wasn't an accident, and the pt should get a settlement for the costs of getting a new IUD, as well as the inconvenience of having her contraception interrupted.

 

[Miami_med]

If it's truly an accident, then it's an accident. If it was intentional, then it's assault. We do not really know enough to tell which one it is.

 

[236116]

If it's truly an accident, then it's an accident. If it was intentional, then it's assault. We do not really know enough to tell which one it is.

Oh, I think we can determine based on past history and the NP's reaction.

There was nothing accidental.

 

[Miami_med]

Oh, I think we can determine based on past history and the NP's reaction.

There was nothing accidental.

Well, I personally wasn't there, and I'm a bit reluctant to convict people based on the information in a news article. I'll grant you that it's very fishy. I almost wonder how this particular woman ended up going to see this NP to cut the string on her IUD?

For everyone else, burning at the stake has been largely done away with, so we could just consider that this might possibly be a legitimate use of the court system.

 

[dpmd]

So the nurse didn't understand how this worked.

There actually is a small way in which you could consider the IUD an abortifacient. If sperm is able to make its way through the obstacles to meet with the egg, the IUD makes the uterine environment inhospitable to implantation as well. Therefore, there is a very small chance of a fertilized egg being lost. To some folks this is an abortion. There is also a small chance of this occuring with the progesterone only pill (since it does not prevent ovulation). There are people out there who are strongly against contraceptive methods that have this as a possibility. This NP appears to be one of them.

I have no idea why anyone would think it would be appropriate to speak about something in such a biased manner after accidently (or purposefully) removing the device which the patient was obviously comfortable with (given that she had one inserted). If she was counseling someone who was deciding whether to get one or not, I think it would be fine for her to tell them about the chances of loss of a fertilized egg. However, I don't think it would be appropriate for her to exaggerate the truth as it appears she did (assuming she was not misquoted). I wouldn't want her working for me.

As for the poor woman who now has to get another IUD, she should get more than just a free replacement one (if it can be shown that this was intentional). IUD insertion can be painful, and menstrual cramping can be worse the first few months after insertion. Not saying she should get millions, but there should be some compensation for this and the inconvenience.

 

[Sol Rosenberg]

.

 

[cleoscat3]

There actually is a small way in which you could consider the IUD an abortifacient. If sperm is able to make its way through the obstacles to meet with the egg, the IUD makes the uterine environment inhospitable to implantation as well. Therefore, there is a very small chance of a fertilized egg being lost. To some folks this is an abortion. There is also a small chance of this occuring with the progesterone only pill (since it does not prevent ovulation). There are people out there who are strongly against contraceptive methods that have this as a possibility. This NP appears to be one of them.

Thanks for the info I didn't realize that.

 

[NonTradMed]

If what they say is true, then the nurse was acting unprofessionally. The nurse should have apologized for taking the IUD out (accidently) and offered to have another one placed in at no cost.

As for her abortion speech, she should have used less biased language if she felt that strongly about IUDs. Maybe she should have said, "I don't know if you are aware of this, but IUDs may be considered an abortionficent by some persons such as myself". Then the nurse should have used clinical terms ('fertilized egg', 'implantation') to explain how IUDs work.

I don't begrudge a practitioner's choice to give patients their professional advice, but it needs to be done in a objective way.

 

[Regnvejr]

As for her abortion speech, she should have used less biased language if she felt that strongly about IUDs. Maybe she should have said, "I don't know if you are aware of this, but IUDs may be considered an abortionficent by some persons such as myself". Then the nurse should have used clinical terms ('fertilized egg', 'implantation') to explain how IUDs work.

Actually, she shouldn't have said anything AT ALL. It is not her place to push personal beliefs on clients. Highly unethical.

I don't begrudge a practitioner's choice to give patients their professional advice, but it needs to be done in a objective way.

Ah, but a personal objection toward abortions is not professional anything. Working in that environment, with an obvious political agenda is a set-up for lawsuits. The clinic is apparently aware of this, as there seems to have been discussion about this in the clinic. As such, the clinic ought to be liable as well, If this happened in the past more than once and she wasn't fired or other steps taken to make absolutely sure it wouldn't happen again, then the clinic should lose its medical business license.

I would recommend the woman getting ACLU involved, as her right to have healthcare delivered without proselytizing inflicted on her, directly going against helthcare that her physician clearly must have prescribed, that right clearly has been violated.

What ought to happen is at least the following. The nurse loses her license. The nurse pays damages per civil suit of violation of civil rights. The clinic pays damages for malpractice and shows remedial plans to prevent future occurrences.

 

[cpants]

I would recommend the woman getting ACLU involved, as her right to have healthcare delivered without proselytizing inflicted on her, directly going against helthcare that her physician clearly must have prescribed, that right clearly has been violated.

I don't remember reading that right in the constitution.

 

[michaelrack]

I don't remember reading that right in the constitution.

It's in there, right after the part that gives the Federal government the power to nationalize major portions of the economy.

 

[Miami_med]

It's in there, right after the part that gives the Federal government the power to nationalize major portions of the economy.

I think I read that somewhere in French Law, and our supreme court seems to believe that's a reasonable source for interpreting US policy.

 

[Taurus]

Let's all pray that this nurse practitioner is stripped of her license and legally barred from touching another patient ever again.