Nights in the ICU 

When St. Joseph Hospital placed five night-shift nurses from the intensive care unit on unpaid administrative leave in June, no one was told why, including the nurses themselves. As hospital administrators launched an internal investigation, rumors inevitably began to circulate ("Locked Out," July 2). Whatever happened, people whispered, it must be serious. Suspension without pay is a measure rarely taken. (Their salary was later reinstated for the duration of the suspension after a union representative intervened.) As the weeks passed without explanation, the rumors grew louder and more outlandish, even incorporating a physician whose transfer from the position of ICU medical director at around the same time was apparently unrelated.

Late last month -- a full six weeks after they'd been suspended -- the nurses were finally called in and presented, one by one, with evidence of their alleged misdeeds, and the charges were indeed serious. According to two of the nurses, they were accused of over-sedating patients to keep them docile, disregarding medication schedules and operating outside their scope of practice, among other infractions, all while maintaining a "party-like atmosphere" with live music, potluck-style dining and excessive Internet use.

Four of the five nurses were fired last Monday, with only the non-union clinical supervisor still waiting to learn her fate. St. Joe's administration would not confirm this information, but the Journal recently spoke with two of the fired nurses. Both vehemently denied any wrongdoing, particularly with regard to over-sedating patients. That's simply not possible, they said, since nurses cannot give more medication than what doctors have prescribed. They did, however, admit to trying to liven up the ICU.

"Part of the reason we get paid more is to be up all night," registered nurse Wesley Thornton said in a phone interview last week. "There is a lot of slack time. We read books, play games, watch the Internet, go check eBay. ... We're known for bringing in food." And the live music? "Two nurses have small travel guitars," Thornton explained. "They'll sit in the break room and strum on guitar. It's not loud at all. ... It's actually very soothing."

His colleague, who asked to remain anonymous so as not to jeopardize future job prospects, said the crew was simply trying to improve what he characterized as a miserable environment. "It's hard to describe [the ICU] unless you're part of it and you've seen what it's like," he said. "It's a narrow hallway, always dark at night. The only sound is the sound of moaning, groaning and ventilators. It's like a dungeon or a prison, full of death, despair and disease. ...Can you even imagine how depressing that would be, having to do that for a living?" (One suspects his opinion of the place may have been tainted by his recent termination.) He, too, was unapologetic about the music. "Yeah, it's a little loud, but these people are on ventilators," he said.

According to Thornton, a day-shift doctor grew suspicious after noticing that ICU patients were often difficult to wake up in the mornings. Thornton's colleague, meanwhile, suspects it was the ICU's new interim manager who disapproved of the laid-back atmosphere and complained to the administration.

In their meetings with management, the nurses said, they were told that since their departure narcotic delivery to ICU patients had decreased by 45 percent -- implying that the nurses had been over-medicating by that margin. They were also presented with reams of Internet history data and confronted with hospital records showing when and how each of them had allegedly violated protocol, with charges (or at least inferences) ranging from inadequately filling out paperwork to religious intolerance to patient abuse -- a potentially criminal offense.

The anonymous nurse reached by the Journal claimed responsibility for the religious intolerance charge. (A self-described "agnostic with pagan tendencies," he'd made the mistake of challenging a co-worker who brought in religious literature to read at night.) But he said the other allegations were baseless, and he presented several theories on the hospital's motives. Among them: that the administration was trying to quell potential insurrections by keeping the staff intimidated; that a supervisor was compensating for her lack of bedside experience by persecuting the more-knowledgeable crew; and that representatives from outside firm Navigant Consulting were trying to increase St. Joseph Hospital's profit/loss margin by purging veteran nurses. Whatever the case, he said, infractions can be found in any nurse's record if you look hard enough. "Half our charts look like when you go to buy a house," he said. "There will always be holes."

The hospital, which is owned by the Catholic Sisters of St. Joseph of Orange, near Anaheim, has maintained a virtual vow of silence on the matter, issuing press releases that stick to high-minded generalities. "We honor the dignity of each worker by not discussing or sharing information that is considered confidential," said one such release, issued last Thursday. Hospital spokesperson Courtney Hunt-Munther politely declined to elaborate.

This tight-lipped approach could become more difficult to maintain as the firings -- and the circumstances surrounding them -- attract more outside attention. The California Nurses Association plans to file a grievance on the nurses' behalf to ensure due process was observed, said Liz Jacobs, a spokesperson for the union, in a phone conversation Monday. Thornton said such a challenge could drag on for months. So far, however, no complaints have been filed with the state Board of Registered Nursing or its parent organization, the California Department of Consumer Affairs. District Attorney Paul Gallegos told the Journal last week that nothing has been reported to law enforcement, either.

"It doesn't seem like there's any proof [of wrongdoing]," Thornton said. "We do good patient care. We're some of the best nurses there. The problem is we speak our mind about policies we don't agree with."

Both nurses said they had never been disciplined in any way prior to their suspension and were given no warnings ahead of time. During their interrogations, they said, management warned that they were reserving the right to report the infractions. "They said, 'We don't know if we'll turn this over to the state board, but if we keep hearing about this in the paper, we will," the anonymous nurse said. "It wasn't even subtle. We were threatened. ... And the rest of the staff are living in a climate of fear."

St. Joseph Hospital Vice President/Chief Operating Officer Bob Brannigan last week sent a memo to the staff, physicians and volunteers of both St. Joe's and Redwood Memorial Hospital in Fortuna (also owned by the Sisters of St. Joseph of Orange) that seemed designed to quell the nerves of anyone reading reports of the firings. (A copy of the memo was leaked anonymously to the Journal.) "It is likely local media will report on a recent situation involving the employment of five ICU nurses. ...," the release stated. "As with all cases involving questions or concerns about employee performance, St. Joseph Hospital treats each employee situation with utmost respect and we follow a thorough individual review process to ensure fair and consistent treatment for each employee."

Thornton and his colleague deny that claim and are counting on their union to shed light on St. Joseph Hospital's secretive personnel practices. Of greater concern to past and future patients and their families, of course, is the hospital's quality of care. St. Joe's administrators and the fired nurses alike insist that has always been their top priority.