Deeper Than the Headlines: Nurse Arrest Prompts Policy Change

Most of us have seen the emotionally charged video of University of Utah nurse, Alex Wubbels, being arrested by Salt Lake City Police after refusing to allow the police to draw blood from an unconscious patient. Since the July 26th event, both the mayor and chief of police have apologized and the police officer’s lawyer has recently said his client would like an opportunity to apologize, too. The FBI was asked to investigate and it is unknown if the nurse will eventually file suit against the city. Those of us in health care, and in the compliance field in particular, have probably asked ourselves, how did this happen (and how could it have been prevented)?

From a general compliance perspective, one has to ask themselves:

• Were there written policies in place?
• Were the policies updated on a regular basis with current and accurate information?
• Were people trained on the policies?
• Was the training effective enough to actually modify or change behavior?
• And now, many will wonder if transparent and appropriate disciplinary action will be taken once all the investigations have run their full course and wrongdoing has, or has not, been determined.

Some initial investigations have been completed and offer some answers to the general compliance questions I posed above.

As far as the blood draw policies of the police department are concerned, it’s been reported that the police department has changed and updated their policies to reflect those of the university which the nurse so bravely followed. If this is true, a compliance officer might ask, why did it take a public event like this to update the policy. Was the policy being tracked for regular review and updates?

As for other policies, the internal affairs investigation states that the arresting officer violated the following Department policies (with some key verbiage of those policies included):

Department Policy II-150 (Conduct Unbecoming)

Conduct unbecoming by a police employee is any conduct that has a tendency to adversely affect operations or efficiency of the Department or any conduct that has a tendency to adversely affect public respect and confidence in the Department or any employee. Conduct unbecoming also includes any conduct that brings the Department or any employee into disrepute or brings discredit upon the Department or any employee.

Department Policy II-150 (Courtesy in Public Contacts—Personal Contacts)

Employees will treat all persons with respect. Employees are expected to be courteous and dignified at all times as the circumstances allow. The personal prejudices or attitudes of the employees must not influence their decision to take police action other than is justified or expected within the constraints of discretion.

Department Policy III-030 (Arrests – Misdemeanor Citations)

Whenever possible, officers will use a misdemeanor citation in lieu of arrest. It is departmental policy to issue a citation to all persons charged with a misdemeanor or infraction instead of arresting them unless the person is under 18 years of age or there is positive reason to make an arrest.

Department Policy III-680.4 (Reports—Situations Requiring a Report)

A report must be made: when any person is physically detained with restraint devices or subjected to the use of physical force, as defined in section III-310 Force, Use of, the incident requires a General Offense report and Use of Force Detail field.

Department’s Law Enforcement Code of Ethics:

All citizens will be treated equally with courtesy, consideration and dignity. Officers will never allow personal feelings, animosities or friendships to influence official conduct. A police officer will use responsibly the discretion vested in the position and exercise it within the law. The principle of reasonableness will guide the officer’s determinations and the officer will consider all surrounding circumstances in determining whether any legal action shall be taken. Consistent and wise use of discretion, based on professional policing competence, will do much to preserve good relationships and retain the confidence of the public. There can be difficulty in choosing between conflicting course of action. It is important to remember that a timely word of advice rather than an arrest – which may be corrected in appropriate circumstances – can be a more effective means of achieving a desired end.

Compliance Policies to Implement

Though most of us work in healthcare organizations that won’t have compliance policies consisting of the exact same words or phrases found in these police department policies, much can still be learned from the principles found in following policies and a Code of Ethics.

For example, in highly complex environments, such as police work and even health care, a detailed policy for every possible situation that might arise is not always possible. For this reason, organizations rely on a Code of Conduct or Code of Ethics to give employees general principles that can be applied in all situations. The OIG has stated, “unlike the more detailed policies and procedures, the Code of Conduct should be brief, easily readable, and cover general principles applicable to all members of the organization.” Furthermore, they’ve said, “a Code of Conduct is fundamental to a successful compliance program because it articulates the organization’s commitment to ethical behavior.”

Reread the excerpt I provided from the Police Department’s Law Enforcement Code of Ethics. It provides general principles of guidance, which, had they been followed in this particular situation by the arresting police officer, it probably would not have escalated to the point that it did.

This same concept can be applied to your healthcare organization’s compliance program. If you have a good Code of Conduct for all employees to follow, ethical principles and guidelines can be promoted regardless of the specifics of any situation.

When the police officer arrested the nurse, most of us felt a visceral reaction that something wrong was happening. These “gut reactions” can almost always be relied upon. But when uncertain, knowing where one can find the actual policy that spells out the answer, like this nurse actually did, (love that it appeared she was reading directly from the policy itself) can lead to much better employee behavior than when written policy is available but not followed (as concluded in the internal affairs report of the police officer’s behavior).

Lesson (hopefully) learned: Have written policies, update them regularly, train employees on them and make sure the training was effective.