Hospital to Take Extra Steps to Halt Phony Calls

A Santa Monica hospital said Tuesday that it would tighten its procedures after an AIDS patient slipped into a coma when he was given medication ordered by a telephone caller posing as his doctor. And state regulatory officials said such phone calls to dispense medication are common procedure at many hospitals.

Officials of St. John’s Hospital said that “our investigation confirms that the procedure followed by St. John’s personnel was consistent with California state law.”

A hospital spokesman added that the facility will “go beyond” those state guidelines and implement new procedures which “cannot be compromised.” He would not say what those new guidelines would be.

Insulin Dose Ordered

The case, which came to light earlier this week, involves a patient who nearly died after a man claiming to be his doctor called the nurse’s station and ordered that he be given insulin, police said.

The patient, after being given the insulin, slipped into a coma and was in critical condition before medical personnel realized what had happened. However, the medical staff was able to revive the man, who Tuesday was listed in serious condition.

Police, meanwhile, said the caller was obviously well versed in medical procedure, but they still had not determined a motive in the case. The patient’s real doctor denied he had made such a call, said Santa Monica Police Detective Shane Talbot, who is conducting the investigation.

No Suspects Yet

So far there are no suspects, Talbot said, adding that the investigation is not focusing at this time on hospital personnel. In response to reporters’ questions, Talbot said the possibility that it might have been an attempted mercy killing is “strictly that--speculation.”

The 49-year-old patient was admitted to the hospital Sept. 18 suffering from a digestive ailment related to his AIDS condition, Talbot said. He had been in the hospital several times before. (The patient, his physician and nurses have not been identified by authorities.)

The caller claiming to be a doctor telephoned at about 11:30 p.m. Saturday, shortly before a shift change for the nurses, Talbot said. The nurse wrote up the orders for the new medication, and nursing personnel on the next shift administered the insulin. At about 4 a.m. the staff noticed that the patient was slipping into a coma.

“The caller was obviously well versed with medical terminology and was familiar with medical protocol and treatment procedures involving the patient in question,” the hospital said in a statement released by spokesman Armen Markarian. “The caller gave very specific and very detailed instructions as to the administration of medication to the patient.”

Ruth Terry, nursing supervisor for the state Board of Registered Nursing, which licenses registered nurses, said, “It makes your heart drop to hear of such a case, considering the vast number of verbal orders that do take place.”

Take Verbal Orders

In accordance with state law, most hospitals allow their nursing staff to take verbal orders from physicians, including those by phone, Terry said. However, the physician must later authenticate the order, usually within 24 hours, by signing an order book or patient chart. The registered nurse has the responsibility to question any order that seems out of line, Terry said. Some hospitals call doctors back to verify phone orders.

“It is standard practice for nurses not to give a medication without knowing what its ramifications might be. They can look the medication up, and if they question the type or the quantity ordered, call the doctor back or check with their own supervisors,” Terry said.

No other such cases have come before the nursing board that she is aware of, she said. Other professionals also indicated that the case was highly unusual.

“It’s never been a problem, but it evidently is now, “ said Ted Fourkas, spokesman for the California Hospital Assn., a trade group for 475 hospitals. In light of the case, the group will review existing guidelines for possible legislative change, he said.