The ethical and lawful prescription of medications is a fundamental responsibility of healthcare practitioners, ensuring patient safety and well-being. In situations where healthcare practitioners, such as RNs, face allegations of improper prescribing practices and lack of adherence to established protocols, seeking legal guidance becomes imperative. A nurse attorney can offer vital support by navigating the legal intricacies surrounding such incidents. They play a crucial role in advocating for the nurse’s rights throughout investigations and legal proceedings, ensuring fair treatment and effective representation.
At the time of the initial incident, she was employed as a Family Nurse Practitioner RN at a medical facility in Laredo, Texas, and had been in that position for seven (7) months.
On or about November 15, 2021, through April 17, 2022, while employed as a Family Nurse Practitioner at a medical facility in Laredo, Texas, RN prescribed NP Thyroid 60 mg to a patient, who had normal thyroid levels, and who did not have a diagnosis of hypothyroidism. RN documented in the patient’s medical record that the patient is being treated off-label with thyroid hormone and assigned a diagnosis of euthyroid syndrome. Additionally, RN provided medical aspects of care to the patient without written protocols or practice guidelines for diagnosing or treating sick euthyroid syndrome, or written protocols regarding the use and dosing of thyroid replacement medication. Subsequently, the patient reported anxiety symptoms and palpitations after increasing the dosage of the medication up to 120 mg. The patient was then assessed by endocrinology physicians who instructed her to stop thyroid medication. RN’s conduct exposed the patient to a potential risk of harm from adverse effects of unnecessary hormone dosing.
Without asking for guidance from a nurse attorney, RN states that based on the patient’s lab results and the patient’s reported symptoms of fatigue and mental fog, she was started on NP Thyroid 60 mg. RN states that while the package insert for NP Thyroid indicates the usual starting dose is 30 mg, increases over a period of weeks to a maintenance dose of 60-120 mg is anticipated and RN’s training specific to hormone replacement therapy suggests a starting dose of 60 mg. RN states that the patient specifically sought hormone replacement therapy and was educated about the use of thyroid hormone supplementation in the absence of hypothyroidism. RN discussed the risks and potential adverse side effects of each of the medications she prescribed to the patient, and specifically advised her that the thyroid hormone use would be off label, to relieve her symptoms of hormone deficiency. RN states that at her second visit, the patient reported she had more energy, did not have any jitteriness, palpitations, or other adverse reactions to the NP thyroid. RN states that she increased the doses in response to the patient’s reported improvement in symptoms. At her last visit with RN on April 17, 2022, with confirmation that the patient was not experiencing adverse effects of the medication, the NP Thyroid was increased to 120 mg. However, the patient was instructed to discontinue the medication approximately one month later when she complained of unexplained throat pain (the instruction was given even though throat pain is not associated with any medication prescribed by RN). During the time the patient was under RN’s care, she never complained of anxiety or palpitations. RN further states that despite the instruction to discontinue the medication, not only by RN in response to the complaint of throat pain but also by subsequently seen endocrinologists, the patient continued to take NP Thyroid and sought additional prescriptions for thyroid medication from multiple providers. RN states that endocrinology records from subsequent providers reflect that the patient’s multiple and varied complaints were unrelated to her thyroid. RN states that she utilizes her clinical judgement, collaboration with her supervising physician, and the recommendations about which she was educated and trained as part of the organization’s certification process.
The above action constitutes grounds for disciplinary action in accordance with Section 301.452(b)(10)&(13) Texas Occupations Code, and is a violation of 22 TEX ADMIN. CODE §217.11(1)(A),(1)(B),(1)(D),(1)(M)&(4)(B) and 22 TEX. ADMIN. CODE §217.12 (1)(A),(1)(B)&(4).
Because of this, the RN was summoned by the Texas Board of Nursing to defend her side, but the RN failed to hire a nurse attorney to help her with her case and without proper defense, the Texas Board of Nursing then decided to place her RN license under disciplinary action.
If you also received a letter from the Texas Board of Nursing regarding a case or complaint filed on you, you should hire a nurse attorney immediately before it’s too late. Equip yourself with the knowledge and expertise you need for a successful outcome by consulting a knowledgeable and experienced Texas nurse attorney. Texas Nurse Attorney Yong J. An is one of those dedicated nurse attorneys who helped represent more than 500 nurse cases for the past 17 years. Contact the Law Office of Yong J. An 24/7 through text or call at (832) 428-5679 for a confidential consultation regarding any accusations from the Texas BON.