JOHNSON CITY, TN (WJHL) — Despite an arrest warrant and grand jury filing against her five months ago, Ballad Health fired a travel nurse last July for stealing drugs intended for patients, took another out-of-state job and allegedly did the same — and remains Questions about the case that put dozens at risk.
Ballad acted on evidence that Jacqueline Brewster had stolen drugs from Johnson City Medical Center (JCMC) – shooting and reporting her and sending about 100 patients telling them to test for bloodborne diseases because of Brewster’s alleged actions.
Ballad also sent out a press release saying the hospital system had fired a travel nurse “for improper handling of controlled substances. But Brewster’s name was not made public until a similar case was filed against her last month in West Virginia.”
Channel 11 News is compiling the limited information it has so far, while trying to obtain more documents and speak to law enforcement officials and the state Board of Nursing.
So far, only an attorney representing eight potentially ill people at JCMC has spoken, along with the CEO whose firm maintains databases of disciplinary actions for healthcare clients.
Attorney Robert Bates said the lack of information is deeply troubling, and in the event Ballad Health fails to disclose Brewster’s name to him – a potential violation of Tennessee law. Meanwhile, Verisys’ John Benson said it’s common for nurses and other practitioners to slip through the loopholes of a system comprising 50 different bureaucracies, many of whom are understaffed and drowning in a variety of organizational work.
“The healthcare system is so overburdened with administrative requirements today that for there to be any kind of improvement around this, it’s really going to take a quantum leap in applying automation and technology to the system, which isn’t happening.”
John Benson, CEO of Verisys
“This nurse is not far away,” Benson said. With drug abuse spreading across the country and 15 million people working in health care, access to the drugs it provides in many places creates opportunities that people with abuse problems tend to seize, he said.
Bates, the Kingsport-based attorney, wants to know how Brewster was able to get another job and alleges a similar violation. It is possible that his clients had been exposed to HIV and hepatitis because Brewster’s drug tampering affected the vials from which their drugs could have been extracted.
“Every time they take a test, they are frightened to death by the test results,” Bates said Monday. “Why would this happen again to someone else? Shouldn’t this have been prevented? Sad thing.”
Now that he knows Brewster’s name, Bates said she and the Florida agency that hired her as a travel nurse would become part of any suit he might bring in the case.
News Channel 11 asked the Tennessee Department of Health (TDH) if it could suspend Brewster’s license to practice as a volunteer last year when the case came up. As of late last week, the board had scheduled a full disciplinary hearing for August and not until after the West Virginia case.
“The board has the authority to take summary action against Licensee,” TDH spokesman Bill Christian told Channel 11 news in an email.
“Given additional information that has recently emerged in this case, the Board of Directors will hold a public meeting on April 29 to consider suspending Mrs. Brewster’s multi-state franchise to practice nursing in Tennessee,” Christian wrote. “Because she is a licensed nurse in Kentucky, the Tennessee Board of Nursing cannot discipline her license, but it can limit her ability to work in Tennessee with her multistate franchise.”
Patients represented by Bates have been under constant stress from regular testing since last summer, Bates said. And although Brewster’s name is included in a warrant and injunction dated November 4 and signed by 1st District Attorney Ken Baldwin, Brewster’s name wasn’t until her arrest in Kentucky last week and news of a similar incident in West Virginia. He surfaced in Johnson City.
He said this delay was not due to Bates not trying. He began calling Ballad’s attorney to inquire about the nurse’s identity and who they work, an application that was denied.
Bates then sent Ballad a certified letter notifying him of a possible lawsuit. Bates said that Tennessee law requires Ballad, as a potential defendant, to provide his office—as the potential plaintiff—”written notification … of any person, other entity, or health care provider who may be a properly named defendant” within 30 days. He said Brewster was certainly a potential defendant.
Bates said he believed Ballad was protecting Brewster and was concerned about similar incidents. “If you don’t tell us who she is,” he said, “this kind of thing will happen again.” “Look, I did.”
Protection, maybe not – slipping through the cracks, sure
Jon Benson said Verisys’ “secret sauce” is its daily research into disciplinary reports and other actions such as penalties, exclusions and denials that can serve as red flags for the systems of hospitals, pharmacies and other healthcare-related businesses that hire.
“Our client can make a decision about whether they want that person to come to work and be in front of the patient again,” Benson said.
These purveyors pay for this sauce and it contains many of the ingredients Verisys can find, but Benson said it still has its limitations.
State health boards work on thinking budgets and have to spend a lot of time on things like continuing education credit checks. They don’t necessarily have the time to quickly pursue every case, and people accused of violations like Brewster’s still have a right to due process.
Many of the accused attorneys arrive quickly, Benson said, and those attorneys often say the procedure resulted from a medical problem (addiction), “and they will usually try to shut it down because of HIPAA (the federal Health Care Privacy Act).”
Add to this the fact that not all of the country’s systems connect and the two major EHR systems in the country, Epic and Cerner, are not interoperable and cracks in the system begin to appear.
There is only one federal system. It’s called the National Practitioner Data Bank (NPDB) and is overseen by the Department of Health Resources and Services, the same agency of the Department of Health and Human Services that helps fund health care in poor, rural, and underserved areas.
Hospitals and malpractice insurance companies are obligated to report.
“In theory, when something like this happens, the information should be reported to the NPDB, and if you’re properly inquiring about the NPDB … you’ll be notified so you can take action,” Benson said.
But this is difficult. This requirement, Benson said, is difficult to apply to the already overburdened Board of Nursing, doctors and other practitioners.
“If you as a state don’t routinely report because you don’t have employees, the feds are really powerless to take action,” Benson said.
Taken together, the lack of resources, the myriad of states, agencies, and systems, and the massive workload above trying to run hospitals or government health departments leave specific flaws in the system.
“The healthcare system is so overburdened with administrative requirements today that for there to be any kind of improvement around this, it would really take a quantum leap in applying automation and technology to the system, which it just isn’t,” Benson said.
In cases like Brewster’s, Bates said, more patients could end up at risk.
“Nurses trust doctors, doctors trust nurses, patients trust nurses and doctors,” he said. “There has to be that trust. When that trust is betrayed, it makes them all look bad.
“This condition hurts good nurses as much as it hurts patients. There must be systems in place to prevent this from happening.”
Seeing that this had happened again, he said that passing this news to his clients was heartbreaking. He said his clients are still living with the damage Brewster did and that only opens back wounds that never really healed in the first place.
The answer, Benson said, is not simple. He said the debate still rages even over whether drug use is a criminal or a medical problem. Some states use amnesty programs that allow practitioners who apply the opportunity to obtain assistance without immediately losing their licenses.
“I applaud it because it helps some people, and if it can protect patients, that’s great,” Benson said.
He added that patients are the most affected.
“The one who is harmed at the end of the day is the patient, and we must do everything we can to protect the patient from harm,” he said.
In response to a request for comment, Ballad Health declined, saying the case was still pending. Channel 11 News has also reached out to the Office of District Attorney Ken Baldwin on this issue several times and has yet to return our calls. Emails have also been sent to the West Virginia Board of Nursing as well as the company responsible for issuing interstate nurse licensing charters, and News Channel 11 has still not heard back from any of these agencies.
