Text of Complaint Issued to Board of Registration in Nursing
By Barry Adams, RN Against Ann T. Poster and Joan Coyne

This complaint is the second complaint issued involving Ann T. Poster R.N. and Joan Coyne R.N.. The first complaint was received by the Massachusetts Board of Nursing (BORN) in October of 1996.  This is a complaint of: 

1. Unprofessional conduct 
2. Unethical conduct 
3. Patient neglect 

and is being issued against both Ann T. Poster and Joan Coyne, registered nurses licensed by the state of Massachusetts. 

This complaint is based, in part, on my understanding of:

1. The Mission Statement of the Massachusetts Nurse Practice Act and the legislative mandate of the Board of Registration in Nursing which is to “protect the health, safety, and welfare of the citizens of Massachusetts”... “ by investigating and taking action on complaints concerning the performance and conduct of licensed nurses.”

2. The Massachusetts Board of Registration in Nursing’s regulation:

A. CMR 3.01 Definition-Registered Nurse which states is, “an individual who is licensed to practice professional nursing holds ultimate responsibility for direct and indirect nursing care”

B. CMR 3.02 Responsibilities and Functions-Registered Nurse which states, “A registered nurse (.e.g., Directors of Nursing), within the parameters of his/her generic and continuing education and experience, may delegate nursing activities to other registered nurses and/or health care personnel, provided, that the delegating registered nurse shall bear full and ultimate responsibility for the outcomes of that delegation”... “and make informed judgements therefrom as to the specific problems and elements of nursing care mandated by a particular situation.”  Responsibilities and Functions also state a registered nurse will “collaborate, communicate and cooperate as appropriate with other health care providers to ensure quality and continuity of care” and will “serve as patient advocate.’

3.  The Code For Nurses with Interpretive Statements of the American Nurses Association:

A. Section 3.1 Safeguarding the health and Safety of the Client which states “As an advocate for the client, the nurse must be alert to and take action regarding...any action on the part of others that places the rights or best interests of the client in jeopardy.”

B. Section 3.2 Acting on Questionable Practice states “When factors in the health care delivery system threaten the welfare of the client, similar action should be directed to the responsible administrative person”;  “There should be an established process for the reporting and handling of incompetent, unethical, or illegal practice within the employment setting so that such reporting can go through official channels without causing fear of reprisal”; and  “When incompetent, unethical, or illegal practice on the part of anyone concerned with the client’s care is not corrected within the employment setting and continues to jeopardize the client’s welfare and safety, the problem should be reported to...the legally constituted bodies concerned with licensing of specific categories of health workers or professional practitioners.”

C. “Upon entering the profession, each nurse inherits a measure of both the responsibility and the trust that have accrued to nursing over the years, as well as the corresponding obligation to adhere to the profession’s code of conduct and relationships for ethical practice.”

**This complaint is also based on the absence of any language or other differentiation in the above laws, regulations, and codes that would absolve some licensed registered nurses in Massachusetts of expected conduct that would serve the best interest of patients or the public in general.  Therefore, it seems a licensed registered nurse who assumes a managerial or administrative position (or any role that indirectly affects the care or safety of a patient) is also accountable by the same laws, regulations, and professional codes to which all other licensed nurses are held accountable.  That is to say that institutional policies and role expectations (e.g.,employers of nurses) can not render a licensed registered nurse exempt from laws, and other guidelines, which protect the patient and the essence of the profession of nursing, or relieve him/her of expected professional ethical standards.

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To support the complaints I have attached the following documentation:

1. The Decision and Order issued by the National Labor Relations Board in response to the appeal requested by Youville Health Care Center, Inc. dated August 27, 1998.

2. The Decision and Statement of the Case of Arthur J. Amchan, Administrative Law Judge (cases 1-CA-34663 and 1-CA-34699) tried in Boston on May 21 and 22, 1997. Dated November 10, 1997.

3. Massachusetts Department of Public Health Investigative Report Reference #: 96-1099.

4. HCFA survey dated 10/14/97, HCFA survey dated February 3, 1997, HCFA survey dated  January 21, 1998.

5. DPH Investigative Reports #’s 96-1177, 97-0454, and 97-0748.

6. All other supportive documentation (e.g., meeting minutes, notes, etc.) will be identified at  the time cited.

• The examples of unprofessional and unethical conduct against Ann T. Poster R.N. in this complaint are by no means an exhausted review of the events that occurred at Youville Healthcare Center in 1996.  Many involved other nurses (e.g., Marie Waters R.N., Meredith Scannell R.N., Lois Hunter R.N., and Lorraine Leeman L.P.N.). 
• All references that support my claim of unprofessional and unethical conduct in the Decision of Judge Arthur J. Amchan have been highlighted for the sake of convenience.
•  The protected concerted activities referred to in the NLRB decisions were largely  addressing conditions that registered nurses believed to be having adverse consequences for patient safety and care.

Unprofessional and Unethical conduct on the part of Ann T. Poster R.N.- Ann T. Poster threatened, attempted to intimidate me, and retaliated against me when I expressed and supported my concerns for the safety of the patients at Youville Healthcare Center. 

1. After sending an internal memo to nursing administration (see attached dated July 22, 1996) offering to meet with nursing administration I was informed by Lois Hunter R.N. that Ann T. Poster’s response was “She told me she is not going to put up with any nonsense from you and if you want to keep your job you will not do that again.”  No attempt to meet with me was made by Ann T. Poster or Joan Coyne.  Additionally, at a later date, Lois Hunter informed me that while riding to a meeting with Ann T. Poster in her car, Poster informed Lois Hunter that she intended to “get rid of Barry Adams and Lorraine Leeman.”  Ann T. Poster and I had never met at this time

2. I first met Ann T. Poster on September 13, 1996 at a meeting I requested in her office. She refused to shake my hand upon introduction. She was openly hostile to me and immediately stated that “there are no unsafe working environments, only unsafe nursing practice.”  When I presented her with a written narrative of my concerns related to patient care with supporting documentation, she told me I would have time to provide better patient care if I “stopped writing novels and diatribes.”  She then stated I had violated a medication policy myself, referring to a medication error I had made one month prior to this meeting.  It appears, based on the investigative report by the Massachusetts DPH that she then generated the policy the same day. Also based on the same DPH report Poster prepared an “incident Review” on 10/15/98 while preparing a punitive disciplinary action against me. If in fact I had indeed violated a medication policy in August, it seems she should have addressed it at that time to assure patient safety, rather than waiting two months.  (See notes dated September 13, 1996 and the DPH report #96-1099)

3. On October 16, 1996, Ann T. Poster prepared a punitive “development plan” based on false allegations made by her.  This plan stated I could be terminated from my employment if I failed to meet her “goals.”  The same plan and allegations were issued to Merridith Scannell, after I was terminated.  I was vindicated of the charges the following day by parties she named and again during trial by Youville’s own witness.  (See: Judge Arthur Amchan’s decision, (2) development plans, notes dated October 16, 1996, notes dated October 17, 1997.) 

4. On August 26, 1997, Ann T. Poster prepared a complaint to the BORN (Docket No. RN 98-056), again based on false allegations.  The fact that these statements are false is supported by correspondence between me and the Massachusetts Department of Public Health and the BORN in October of 1996 and a Report of Investigation (attached) issued by the DPH following the accidental death of a patient the month I was terminated.  Also, the BORN dismissed the charges due to “lack of evidence.”

This charge of Unprofessional and Unethical conduct is issued based on the numerous false statements made by Ann T. Poster against me.  Some of the statements were issued to intimidate me into silence and punish me when speaking about patient safety and quality of care issues at Youville Healthcare Center.  In doing so, Ann T. Poster R.N. violated BORN regulations, as well as, the code of ethics for registered nurses.  Rather than collaborate with and address the concerns of registered nurses (see attached minutes of meeting recorded by Poster dated October 2, 1996), ultimately she took no action that may have protected patients and improved the quality of care at Youville.

Patient Neglect on the part of Ann T. Poster - The charge of patient neglect is supported by the above charges, HCFA survey dated February 3, 1997 (attached), and the  Investigative Report issued by the Department of Public Health #96-1177 (attached). The reports reveal a scenario of chaos within the facility and the Department of Nursing which I had addressed.  They specifically address the overdose death of a patient by a new graduate nurse inexperienced with intravenous morphine infusion.  I specifically addressed my concerns related to the practice of inexperienced new graduates in my conversation with Ann T. Poster on September 13, 1996 (see notes dated same)  and in my meeting with her (and others) in the human resources office on September 24, 1996.

Unprofessional and Unethical conduct on the part of Joan Coyne R.N. -Although I attempted several times (via memo and telephone) to meet with Joan Coyne R.N. related to the above, she never contacted me to address my concerns which were shared by many nurses at Youville Healthcare Center.  Additionally, although we have never met in person to this day, Joan Coyne authorized my termination after collaborating with Ann T. Poster (see Judges decision).  I believe that to terminate a licensed registered nurse who has been expressing concerns for patient safety and quality care issues (who is within the BORN regulations in doing so) with out making any attempt to meet with me, is in itself a violation of the BORN regulations and the code of ethics of the American Nurses Association.  In engaging in the actions above, Joan Coyne R.N. also failed to take any action that may have protected vulnerable patients in the facility or improved the quality of care they were receiving.

Patient Neglect on the part of Joan Coyne-In addition to the above I refer to the HCFA surveys and Massachusetts DPH reports (attached) to support this charge.