Porter v. Department of Employment Security

430 A.2d 450, 139 Vt. 405, 1981 Vt. LEXIS 481
CourtSupreme Court of Vermont
DecidedApril 7, 1981
Docket368-78
StatusPublished
Cited by11 cases

This text of 430 A.2d 450 (Porter v. Department of Employment Security) is published on Counsel Stack Legal Research, covering Supreme Court of Vermont primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Porter v. Department of Employment Security, 430 A.2d 450, 139 Vt. 405, 1981 Vt. LEXIS 481 (Vt. 1981).

Opinion

Underwood, J.

Gloria Porter had been employed at the Medical Center Hospital of Vermont in Burlington as a registered nurse for over two years. On June 15, 1978, she came on duty at 3:30 P.M. on Patrick 4 (the neurosurgery floor) as the nurse in charge on that floor for the evening shift. It was her duty to check on each patient and to administer the 4:00 P.M. medications. Patrick 4 was at capacity that afternoon, with 24 patients, and was a very active unit.

During the course of her rounds, nurse Porter noticed that the nurse in charge of the previous shift had neglected a doctor’s order to administer a certain medication at 12:30 P.M. to a patient suffering from a brain tumor. The medication ordered was Decadron, to be administered by the intravenous (IV) drip method starting immediately at 12:30 P.M.

Nurse Porter was concerned because 3 hours had elapsed without anyone having followed the doctor’s order. She knew that the doctor had ordered Decadron for this patient in order to reduce the swelling in the brain and perhaps bring the patient out of a coma. She was faced with a dilemma which was not of her own making. The day shift had already started *407 an antibiotic medication on the patient using the same equipment nurse Porter would need if she were to administer the Decadron by the IV drip method. The antibiotic medication was running very slowly, and there were 100 ccs left in the drip chamber of this IV equipment.

By 4:30 P.M., nurse Porter felt that the patient’s best interest required immediate administration of the prescribed medication. As there was no doctor on Patrick 4 at that time and there were still 50 ccs of the antibiotic medication left in the drip chamber of the IV equipment, she improvised so as to simulate the IV drip method as closely as possible. She injected the Decadron by the IV push method into the main IV line which was already in place so that the Decadron was diluted with the approximately 50 ccs of fluid being carried in the main IV line by the drip method. Sixty ccs of Decadron were administered by her to the patient over the next 10-15 minutes while she monitored the patient for any untoward effects. She was assisted in the administration of the medication and the observations of the patient by a licensed practical nurse.

The patient suffered no adverse effects, and nurse Porter’s conduct was later condoned by two doctors, a pharmacist and a resident physician. The patient’s own doctor, a neurologist, stated: “It is my neurological opinion, that in this patient, the intravenous injection did not constitute a hazard to the patient. This route of administration is fairly standard and is rarely associated with problems.”

The hospital’s nursing service policy is set forth in a large manual kept at the nurses’ station on Patrick 4. Under the section of the manual entitled “Administration of Medications” appears the following:

Definition: An IV push medication is any medication administered in less than 25 cc of fluid over the period of 5 minutes or less. An IV drip medication is anything over this quantity.

The Vermont Employment Security Board found that nurse Porter honestly believed that the nurse’s manual authorized her to administer Decadron by the IV push method, in spite of the doubt expressed by the attending licensed practical nurse. After she had given the patient the 60 ccs of Decadron she *408 checked the manual and found that she had been mistaken. The manual did not authorize a registered nurse to administer Decadron by the IV push method without a specific order from a doctor. It was then that she sought advice from the doctors, a resident and a pharmacist, each of whom informed her that the procedure she had followed was acceptable and that she had not endangered the patient by doing so.

In what may have been an attempt by nurse Porter to cover for the day shift’s oversight, she charted the administration of the Decadron on the patient's record as if it had been administered by the IV drip method pursuant to the doctor’s order to the day shift staff. The licensed practical nurse assisting her immediately reported the incident to the nursing-supervisor. That same evening, at the suggestion of the nursing supervisor, nurse Porter filed a medication error report setting forth that she had in fact administered the Decadron by the IV push method rather than by the IV drip method. She signed this report, as did the nursing supervisor, and two doctors countersigned the report.

Nurse Porter’s employment was terminated, and she filed a claim for unemployment benefits. The claims examiner denied her benefits and she appealed. The appeals referee concluded that she had been discharged by her employer “for gross misconduct connected with her work” which constituted “a substantial disregard of the employer’s business interests [and] gross misconduct within the meaning of the Unemployment Compensation Laws.” He sustained the decision of the claims examiner and she again appealed, this time to the Vermont Employment Security Board.

The Board concluded that she was discharged by her employer for misconduct, rather than gross misconduct, connected with her work. It determined that she was disqualified for unemployment benefits on the ground that her misconduct demonstrated a substantial, culpably negligent disregard of her employer’s business interests. It is from this decision that she appeals to this Court.

Pursuant to V.R.A.P. 13(d), the Employment Security Board certified the following three questions for review:

1. Whether the Board erred by failing to find that claimant administered the medication in question con *409 sistently with the definitions contained in the employer’s nursing policy.
2. Whether the Board’s conclusion that the claimant’s conduct demonstrated a substantial, culpably negligent disregard of the employer’s business interests is supported by the record in light of the Board’s finding that claimant acted in what she thought was the best interest of the patient.
3. Whether the Board properly construed the conduct complained of as a series of acts of misconduct.

We will address these questions in order.

Appellant argues that she did not contravene the hospital’s policy when she administered the Decadron into the main line of the IV drip equipment. She points to the hospital’s definition of the IV push method to support her position. The method she used was to introduce 60 ccs of Decadron, over a period of 10-15 minutes, into the fluid in the main line of the IV equipment. The Decadron was thereby diluted by the 50 ccs of fluid already in the drip equipment. Such a procedure, she insists, does not place it in the category of the IV push method as defined in the manual. She contends that she was only trying to simulate the IV drip method, and succeeded, and denies that she was using the IV push method.

This is fallacious reasoning. She admitted that there was a three-way stop cock in the main IV line and also a diaphragm into which one could inject needles and pull them out without causing leakage. It was at this point that she inserted the needle carrying the Decadron medication.

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Bluebook (online)
430 A.2d 450, 139 Vt. 405, 1981 Vt. LEXIS 481, Counsel Stack Legal Research, https://law.counselstack.com/opinion/porter-v-department-of-employment-security-vt-1981.