Johnson County Nurse Vindicated in Supreme Court Decision

The Iowa Supreme Court vindicated a Johnson County nurse who muffled an adult patient’s screams to protect the health of another patient in an opinion announced Friday.

In May 2004, nurse Kim Wyatt was working in the neuroscience unit at the University of Iowa Hospitals and Clinics in Iowa City. She was attending a patient who suffered from a subarachnoid hemorrhage, a brain condition that made the patient susceptible to light and noise, even to the point of ruptured aneurysms resulting in paralysis or death.

A patient in an adjacent room awaited brain surgery for removal of a tumor from his frontal lobe. The patient, who also suffered from a myriad of health conditions, including bouts of dementia, often resisted invasive medical procedures.

On the morning of the incident, two other nurses and a nursing assistant were attempting to provide the patient in the adjacent room with an IV. The patient resisted and began screaming. Wyatt and another nurse responded, finding four staff members trying to restrain the patient. In what was later found to be an effort to protect the patient in the next room, Wyatt placed a pillow over the distraught patient’s mouth, below his nose. When a nurse in the room objected twice, the pillow was removed and there was no sign that the action caused the patient physical or respiratory distress. The patient had no memory of the incident; however, another treating nurse filed a report with supervisors against Wyatt the following morning.

Although supervising staff at the hospital found no instance of adult abuse and Wyatt subsequently received a favorable performance review, hospital administration filed a report with the Iowa Department of Inspections and Appeals (DIA) as a possible instance of dependent adult abuse. A DIA investigation determined Wyatt had committed dependent adult abuse by punishing and assaulting the patient and the agency gave Wyatt’s name to the Department of Human Services for placement on the dependent adult abuse registry. Wyatt appealed the decision within the state agency.

The decision against Wyatt was initially reversed by an administrative law judge who stated that Wyatt was not trying to “hurt, punish, harm, cause fear or offensively contact” the patient when she placed the pillow over his mouth. The conclusion was that Wyatt acted in the best interest of the patient she was attending, a patient that could have been caused undue harm by the other patient’s screaming. The director of the Health Facilities Division of DIA, however, rejected such assertions of justification and concluded that “several options” could have been considered and/or implemented by Wyatt.

Wyatt then took the case to the district court, which reversed the director’s decision. DIA moved for the case to be heard in the court of appeals. The appellate court reversed the district court decision, finding that Wyatt committed an intentional assault on the patient and should be listed in the adult abuse registry.

In the opinion released this morning by Justice Brent Appel, the decision of the court of appeals was vacated and the judgment of the district court — including its order that Wyatt’s name be removed from the abuse registry — was affirmed. The court ruled that Wyatt did not have the “intent necessary to assault” the patient. That is, the court determined that Wyatt had no intention of harming the patient, only to muffle the noise for the protection of her nearby patient. Since such findings were not disputed by the agency and due to specifics within the Iowa Code in relation to abuse, according to the opinion, Wyatt did not assault the patient.