From The Floor
The Curious Case of Amanda Trujillo and the Arizona Board of Nursing
“Cry ‘Havoc,’ and let slip the dogs of war...”
– William Shakespeare, Julius Caesar, Act III Scene I
This is the age of social networking. So many Americans (including nurses) receive the majority of their information via the Internet that it is no longer a phenomenon but a way of life, affecting everything from social trends to political movements. As a result, it has become very easy for even minor incidents to “go viral” almost overnight, garnering thousands of hits and hundreds of followers on websites like YouTube and Twitter.
Some of these viral trends have brought about positive change, promoting awareness of social ills or legal wrongdoings, but Internet activism also has a dark side, which rears its ugly head whenever the masses take up a cause without knowing all the facts. Soon, there are cries for action based on innuendo and knee-jerk responses.
What happens when the facts do come to light and show that the situation is not what it initially appeared? What if the “wronged” individual turns out not to be so blameless or an accused person proves to be genuinely innocent? How do we un-ring that bell?
Most of the time, the public’s short attention span seems to remedy such situations, quickly relegating the offending incident to the junk pile of history, but there are some cases that refuse to disappear, taking on a life of their own. One such case is Amanda Trujillo, an Arizona nurse whose story has become a cause célèbre in the online nursing community.
Meet Amanda Trujillo
For those who may be unfamiliar with the Trujillo case, here is a brief recap. In April 2011, Amanda Trujillo, an RN at Banner Del E. Webb Medical Center in Sun City West, Ariz., clashed with a staff physician after Trujillo provided a patient with information about the ramifications of liver transplant surgery and discussed the patient’s options for hospice care. The hospital fired Trujillo in May and filed a complaint against her with the Arizona State Board of Nursing (AZBN), claiming she had practice outside the scope of her duties and failed to uphold expected standards of care.
In December, Trujillo sent an email about the situation to various popular nursing bloggers. In her email, Trujillo said she was dismissed for attempting to educate a terminally ill patient who had consented to liver transplant surgery without ever being told about the details of the surgery and its aftermath or even that the patient might have other options for care. Trujillo maintains that all the information she provided was from the hospital’s approved materials and that she had documented everything for the doctor to follow up later. However, she said that after hearing that the patient was having second thoughts about their course of treatment, the doctor “threw a well-witnessed tantrum,” demanding that the hospital fire Trujillo and have her license revoked.
Trujillo said that she was fired without even receiving a hearing before the hospital ethics committee, and that because of the complaint against her, she has been unable to find other work, forcing her and her teenage daughter to go on welfare. She also said that the Arizona Nursing Association had been unwilling to support her, and that the blot on her record undermined her efforts to work with State Senator Nancy Barto (R-Scottsdale) on legislation intended to protect the rights of terminal patients and “define the role of the nurse in end-of-life teaching/counseling.”
Trujillo said that after reviewing her case, the AZBN’s nurse investigator had recommended that the complaint against her be dismissed, but the board had decided to go forward anyway, ordering her to face an administrative hearing in January of this year. Trujillo closed her email with a plea for readers to share her story as widely as possible.
Needless to say, Trujillo’s much-publicized letter evoked passionate responses from nurses. Who among us hasn’t worked with a doctor with a big ego who objected if a nurse so much as questioned his or her orders? I’ll never forget a neurosurgeon I once worked with who constantly yelled, threw tantrums and even hurled surgical instruments at nurses in the operating theater, but had never been disciplined because none of the nurses he abused were willing to report it. He was finally sanctioned after he slapped a patient, who had no problem filing a complaint against him. (After that, his behavior changed for the better!)
Hearing Both Sides
Naturally, Nurse Trujillo soon found many champions on the various nursing blogs, which is how I first learned of her story. As compelling as it was, I found much of her tale somewhat one-sided; at that point, the Arizona Board of Nursing had remained silent on the matter, as they were legally obliged to do. I decided to monitor Trujillo’s case closely, both online and in the formal proceedings.
That’s why my daughter found herself driving me to Phoenix in March to watch Trujillo’s administrative hearing. (The hearing was originally scheduled for late January, but was delayed two months after the AZBN demanded that Trujillo undergo a complete psychiatric evaluation.) The hearing room was packed, and although not everyone was there for Trujillo’s case, quite a few had come to show their support. You can imagine our surprise and dismay when we learned that Trujillo wouldn’t be attending, having requested a postponement because she had changed attorneys — something of which she’d failed to inform her many loyal followers and supporters.
The hearing room sat in stunned silence as a board member read the lengthy list of charges against Trujillo. Afterward, some interesting things began to take shape in the online community. Some of Trujillo’s defenders quickly renewed their condemnation of the “horrible and corrupt” board members, but others began to quietly question their support for a nurse they knew only through the Internet, email and telephone conversations. Expressing such doubts was risky: the supporters were quick to turn on those nurses who dared suggest that perhaps Nurse Trujillo was not the blameless martyr they had thought she was.
When blogger “Not Nurse Ratched” posted the complete notice of charges, she received a barrage of comments casting aspersions on her integrity and even implying that she had come by the document through nefarious means. (I found such comments rather ludicrous, since I had obtained a copy of the same document simply by requesting it from the AZBN — the list of factual allegations became public information after the charges were presented at a public meeting of the board.)
The Events in Question
When reading a tale of woe like Nurse Trujillo’s, it’s easy to have a visceral response. Trujillo presents herself as a caring nurse dealing with a dying patient who seemed lost and confused because the doctor had not provided enough information. Many of us have experienced something like this with our own patients or know of a colleague with a similar experience.
Trujillo says she did her best to educate and advocate in accordance with the core principles of nursing, only to be verbally assaulted by the doctor for her supposed interference, and then discover that hospital management was unwilling to stand by her. However, the allegations presented by the board paint a very different picture. According to the official list of charges, the patient in question was actually being treated for a head laceration and fractured hip, and hadn’t even undergone an evaluation for liver transplant surgery; the doctor had postponed that evaluation until after recovery.
The complaint against Trujillo alleges that she attempted to educate the patient in the middle of the night (between 1:00 and 3:00 a.m.) while the patient “was under the under the influence of narcotics, recovering from hip surgery and exhibiting abnormal psychosocial status” and that as part of that “teaching,” Trujillo told the patient that after a liver transplant, “the transplant people will ask you things and hound you and hound you and you won’t be able to live alone anymore.”
That incident is only one of many cited in the board’s list of factual allegations, which also includes complaints related to Trujillo’s previous jobs at the Mayo Clinic and Valley Home Care in Phoenix and Mountain Vista Medical Center in Mesa, Ariz. Trujillo resigned from all three jobs in 2010 and is ineligi Hble for re-hire at either Mayo Clinic or Mountain Vista. Trujillo is also accused of violating Arizona’s Nurse Practice Act by identifying herself as a DNSc-NP(s) “when [she] had not graduated with a DNSc degree, was not studying for a DNSc degree and was not licensed as a Nurse Practitioner in Arizona.”
Victim or Villain?
So, here we have two very different pictures. Which is the more accurate? If you are a supporter of Nurse Trujillo’s, the AZBN is on a witch hunt, out to destroy a good nurse who is guilty of nothing more than advocating for her patient and doing what any nurse is expected to do. Her detractors see a nurse with a checkered past who engaged in questionable actions against hospital policy, and who is now manipulating the Internet to sway public opinion.
If you believe that Nurse Trujillo is completely blameless, you might ask yourself this: Even if the hospital is determined to get Trujillo’s license pulled, as her supporters claim, what about the patients, whose stories suggest that Nurse Trujillo might indeed have overstepped her authority? The patients don’t have a dog in this hunt, so what motive would they have to corroborate the AZBN charges?
Then there’s that pesky allegation that when Trujillo and her attorney were provided with the names of fellow nurses who had given statements to the board about the complaints, Trujillo contacted three of those witnesses by phone, text or email and threatened to sue them for defamation. Perhaps those nurses had an axe to grind, but if so, wouldn’t it have been simpler for them to tell the investigators nothing, rather than risk a defamation lawsuit?
To Be Continued
Amanda Trujillo’s tale is far from over. Her case was not on the docket of the AZBN meeting in April, but she has whipped up such a frenzy in the nursing community that the board has been bombarded with calls, letters and emails — many of which have been described to me as heated and impolite. Trujillo’s story has truly lit up the nursing blogs, websites and LISTSERVs in a fashion rarely seen. But is she a victim or is she an artful dodger, tugging at our collective heartstrings to further her cause?
Some observers have speculated that Trujillo’s aggressive use of the Internet to publicize her plight may have caused the AZBN to pursue her case with extra diligence, which may or not be true. However, just as everything Trujillo has posted can be used to advance her cause, much of it can also be used against her. In fact, several of the charges against Trujillo are directly related to her online publicity campaign, including allegations that her public statements violated the confidentiality of her patients.
At this point, we can only sit back and wait for the next AZBN hearing and Trujillo’s next salvo. Whichever side you may fall on in this discussion, it’s quite apparent that Nurse Trujillo has successfully cried “Havoc” and let slip the Internet’s dogs of war. Whether she will be successful in her defense — and what will happen afterward — we must all wait and see.
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Amanda Trujillo Has Gone Viral
An early post about the situation:
A copy of Trujillo’s original letter and a letter from her first attorney:
An update following the AZBN meeting in March, including a copy of the formal charges against Trujillo:
Geneviève M. Clavreul RN, Ph.D., is a healthcare management consultant who has experience as a DON and as a lecturer on hospital and nursing management.