Nursing and Practicing Medicine

Re the 22-year-old woman who bled to death in her Panorama City home in 1981 after a nurse failed to diagnose a tubal pregnancy (Jan. 24), I want to focus on several issues and to set the record straight.

1. Nurses are not licensed to diagnose medical conditions. A nursing diagnosis, yes. A diagnosis made by a professional nurse describes actual or potential health problems that nurses by virtue of their education and experience are capable and licensed to treat.

2. California law says that, when a nurse fails to act as the average nurse would act in like circumstances, that constitutes gross negligence. The average nurse would not diagnose a tubal pregnancy, particularly over the telephone. That is considered practicing medicine without a license.

3. Neither nurses, doctors nor paramedics presume to diagnose a tubal pregnancy over the telephone or even by a cursory glance at the patient.

4. Physicians usually confirm the diagnosis of tubal pregnancy using their expertise, physical examination of the patient, patient's history, lab tests, ultrasound and often culdoscopy.

5. Usually pain and bleeding into the peritoneal cavity occur following rupture of the Fallopian tube.

6. Severe abdominal pain can be attributed to any one of a myriad medical conditions which do not necessarily lead to rupture of the tube. There are many that would instinctively prompt a nurse to urge a person to seek care at the local hospital or doctor's office. Evidently, the nurse said "he did advise Mrs. Williams to go to a local emergency room." I'm puzzled by the fact that the nurse was expected to recognize the life-threatening condition over the telephone, when the paramedics didn't recognize the same life-threatening condition at the scene and furthermore couldn't convince the lady to go with them to the hospital.

Unfortunately, the end result hasn't changed. The woman died, and it all adds up to $450,000 of tragedy by telephone.


Panorama City

Lipman is a nurse at Northridge Hospital.

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