Tuesday, January 28, 2014

VacTruth Alleges Bullying in One-Sided Account of Nurse-Patient Encounter

Anti-vaccine activists have a love-hate relationship with medical providers, be they nurses, doctors, pharmacists, whatever. They love to hate any medical provider that dares to question their anti-vaccine beliefs. When they encounter someone who strongly urges them to get vaccinated or to vaccinate their children, the nurse or doctor is invariably described as a "bully", "ignorant", "ill-informed", "brain-washed", "pharma whores" and so on. They push "propaganda" are paid by "Big Pharma". Any interaction is viewed through this lens, that the parent is right and the medical professional is hopelessly benighted or even downright evil. If they happen to have a poor bedside manner, so much the worse, though given how some anti-vaccine activists respond to science-based feedback, I might be a bit short-tempered, too.

Over the weekend, an anti-vaccine blog called (why must anti-vaccine groups always use such Orwellian names?) posted a story entitled "Bully Nurse Harasses Parents of Unvaccinated Baby at Michigan Hospital". According to the account, an unidentified couple brought their child to an urgent care center in Madison Heights, MI after talking on the phone with a nurse at their pediatrician's office. Their son, called "Oliver" in the article, had cold symptoms, a low fever and an "acne-like" rash on his face. Following the advice, they reportedly went to the Detroit Medical Center at Madison Heights, where the admitting nurse, if the account is to be believed, suspected the child had chicken pox and subsequently harassed, ridiculed and bullied the parents.

The first thing to notice in the account is that the parents are described as doing everything right. They are caring, calm, rational. They have done their research and are educated, to the point that they "may indeed surpass the heights of professionals who are paid to practice medicine". "Oliver's" mother is loving and wants only the best for her son. She is a "good parent". Against that, we have the nurse, who allegedly harassed and embarrassed the couple in front of others. She used an "exasperated tone" and was "sarcastic". Her behavior was "unacceptable and traumatizing", not to mention "dangerous". In short, she is a "bad nurse".

I have no doubt that "Oliver's" parents love him very much and want what is best for him, nor do I doubt that they did a lot of searching for articles online. Based on what is reported in the article, I would venture to say that rather than being informed and educated, however, they are misinformed. Certainly, I doubt that their knowledge of vaccinations "surpass the heights of professionals who are paid to practice medicine", particularly since the mother is quoted as saying "I am active in anti-vaccine groups". That leads me to believe that much of her supposed knowledge about vaccines comes from such bastions of misinformation as the National Vaccine Information Center (there's that Orwellian naming convention again) or Things that she read, combined with the nervousness of being a new parent, likely primed her to view any information she came across as supporting a belief that the risks of vaccines outweigh the benefits, playing into her fears for her new son.

So what, exactly, did the nurse do that was so objectionable? Unfortunately, we only have the anti-vaccine side of the story, so take this with a grain or thousand of salt. When the couple brought "Oliver" in, she nurse asked if he had been vaccinated, they answered that they had not. They had also refused a vitamin K shot at birth. The nurse reportedly responded with ridicule and sarcasm, saying they'd have a lot of fun with measles and mumps, too. She then told other patients in the waiting area, including a pregnant woman, that they would need to go to the other lobby, since "Oliver" was unvaccinated and the nurse suspected he had chicken pox.

For those who aren't aware, chicken pox, an airborne respiratory illness, can pose a not insignificant risk to a pregnant woman and her fetus. For the woman, if she is not immune to the varicella virus, she runs an increased risk of pneumonia (10%-20%) and possibly death (up to 40% chance). Her fetus is also at risk, with a small (0.4%-2.0%) chance of developing congenital varicella syndrome if the infection occurs within the first or early-second trimester. Babies born with CVS "may be of low birthweight and have scarring of the skin and problems with arms, legs, brain, and eyes". It's a reasonable precaution, then, to keep a pregnant woman separated from someone with suspected chicken pox, whether they really have it or not.

The VacTruth article reports the nurse as telling the pregnant woman:
“Ma’am, you have to go to the to the other lobby. This child is unvaccinated! We need everyone to move out of this lobby and get away from him. He has chicken pox.”
We can't be certain exactly what the nurse said, given that the incident occurred several months ago (around November 23, 2013) and the mother is reporting what she recalls the nurse saying. She might have said that, or she may have said the child "may have chicken pox". She may or may not have stated the child's vaccination status. Assuming the quote is accurate, I don't see it as an unreasonable response. The other patients in the lobby deserve to know why they need to go to the other lobby, what they might have been exposed to, etc. Perhaps the "this child is unvaccinated" was unwarranted, but I don't think it violates HIPAA, as VacTruth suggests, particularly since HIPAA allows disclosure to:
individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law
While in most cases, the information regarding an individual is needed for the treatment of that individual, the HIPAA Privacy Rule also allows the information regarding one individual (e.g., a patient) to be used or disclosed for the treatment or preventive care (e.g., vaccinations or quarantine) of other persons (e.g., patients at risk).
It happens that Michigan Administrative Regulation 325.172 includes chicken pox as a "serious communicable disease" for which otherwise protected health information may be disclosed.

Not that these facts stop VacTruth from claiming that the nurse "may have violated this federal law in favor of pushing her vaccine agenda". Yep. The nurse was clearly just operating to advance her "vaccine pushing" agenda, rather than having the health and well-being of the other patients in the waiting area in mind. I mean, what was that nurse thinking, blurting out to other patients that they may have been exposed to a highly contagious respiratory illness? Clearly, she should have kept "Oliver's" privacy foremost and remained silent. Who cares if the pregnant woman was put at increased risk of infection while "Oliver" waited to be seen?

At any rate, after waiting nearly twice as long as the urgent care center guarantees for seeing a physician (the reason for the delay is unclear: it may be due to extended discussion between the nurse and the parents; perhaps the staff were working to ensure that other patients already being seen were moved to locations where they would be protected from possible exposure if it turned out "Oliver" did have chicken pox; etc.), the parents left the center and drove to another facility where he was reportedly diagnosed with a slight cold and skin irritation.

Overall, the impression is that the nurse was the sole cause of the bad encounter. The parents are depicted as near-saints. However, I suspect that the parents' attitudes were not all cordial and calm-discussion-inducing, based on the mother's comment that:
“Honestly, if my husband weren’t right there next to me reminding me to be calm, I would have clawed that nurse’s eyes out. I was ANGRY! I still am. I am so grateful he was there because me reacting any differently … this would end up being a very different story.
Angry words and demeanor can quickly drive a conversation into a bad experience for all.

One other problem with this article that may have escaped the attention of the VacTruth editors are the potentially libelous remarks:
She violated moral guidelines. She violated principles of common sense. She failed to respect patient confidentiality. She may have even violated federal law. She negligently recommended a vaccine that was contraindicated for a child who was too young to receive that vaccine.

Would you also agree that she failed to adhere the standards her employer, DMC Surgery Hospital, and her colleagues in the nursing field, likely expect her to meet?
In the end, I strongly suspect that the encounter was not exactly as depicted by VacTruth contributor Missy Fluegge. Unfortunately, I'm not sure how likely it is we'll hear all of the details from DMC's side of the story. You know, HIPAA and all that. I have reached out to the Detroit Medical Center Urgent Care facility at Madison Heights to see if they have any comment on these allegations. They are bound by laws that the parents are not, though, so they may be limited in what they can and cannot say. This enables the sort of spin we see time and time again, where disgruntled parents who believe anti-vaccine misinformation promulgated by organizations such as NVIC, Age of Autism,  The Thinking Moms Revolution or VacTruth can paint medical providers as evil, uncaring, child-abusing monsters. That kind of rhetoric engenders distrust of medical providers in general, to the point that otherwise reasonable parents may, in a misguided attempt to protect their children, unwittingly put them at greater risk of harm. At the very least, it encourages a confrontational attitude toward medical providers, jeopardizing the kind of cooperative relationship crucial to good medical care.

Edited to add (Jan. 31, 2013): I contacted the Detroit Medical Center for comment. They are investigating the situation. If I receive any additional information, I will add it here or in a new post.

1 comment:

  1. Thank you, Todd, for a most reasoned and measured response to a very emotionally charged subject. In that most folks have neither the patience nor interest in reading a rather long dissertation to its end, you subject yourself as well to the unreasonable criticism that comes from a lack of comprehension of the totality of what you present.

    That is most unfortunate, for as we all know, there ARE real and present dangers in vaccination. No medical procedure is without some risk. And the greater the volume of vaccinations, the larger the number of abberations will be. Statistical fact of life, unfortunately.

    But as one who has been actively engaged in supporting global vaccination against the wild polio virus for nearly 30 years, we can state with some certainty that that common good far outweighs the few thousands of cases of polio derived from vaccination ( and far more imortantly, the vastly reduced proportion of paralytic cases than has traditionally been recorded in polio outbreaks). When one considers the BILLIONS of doses of polio vaccine that have been delivered to BILLIONS of children that has prevented well over TEN MILLION cases of polio against those few thousand cases of vaccine-caused polio, the greater good must be recognized. And the anecdotal cases of nurses isolating an unvaccinated child from other children, or of tragic individual cases of harm and even loss of life, albeit regrettable and fully worthy of universal sympathy, do not detract from the millions or even billions of lives that have been protected.

    In the case of polio, since the befinning of the Rotary Polio Plus campaign in 1985, we have
    seen the wild virus eliminated from 130 countries - and there have been no cases this year in Afghanistan and only a few dozen cases in the war-torn region of NorthWest Pakistan in 2015. Vaccination works. This volunteer-driven project, supported by United Nations, national and regional health agencies, and by the USAID and CDC and more recently by the
    Gates Foundation as worked collaboratively to almost completely wipe a dreaded crippling disease from the face of the vaccinating on a scale never before ever attempted!


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