She’s no lady—she’s not a nurse, either

By Joan M. Resk, DO
Family Physician/Roanoke, Va

Julie seemed the perfect LPN: skilled, personable, experienced. Then this doctor checked her background.

"Channel 7 wants to talk to you," my practice manager announced, obviously concerned.

I opened the door to our waiting room, dreading what I’d find. Sure enough, there was the accusing eye of the TV camera, the mike thrust in my face, and the familiar face of the local news anchor. "Dr. Resk," he asked, "is it true that you allowed a nurse to practice in your office without a license?"

You could have heard the Sprint pin drop. Patients were moving for a better view, straining to hear what I’d say. "You must be talking about Julie," I replied. "Sorry, no comment." The report appeared on the evening news that night.

I thought of the many times I’d seen physicians on TV accosted by the press at their office doors, their faces pale and terrified. I remembered my initial reaction to their "no comment" response. If they really had nothing to hide, I’d wondered, why not just tell the truth? But my years studying law (I’m also a law school graduate) and my experience with Julie have taught me that nothing is that simple.

After 25 years practicing in Southern California, I moved to Roanoke, VA, in 1998 and opened a holistic family practice. When Julie (not her real name) applied for a job with us in February 1999, she brought an impressive resume. It noted that she’d graduated from Roanoke Memorial Hospital’s School of Practical Nursing and had worked for nearly 10 years as a nurse at two local hospitals. She was a licensed LPN and an experienced phlebotomist, with broad experience in nursing, good computer skills, the works. Not wanting to risk losing her, I hired her on the spot without checking her references.

Julie excelled immediately: front office, back office, anything I wanted. With her pleasant personality and easy disposition, she quickly became a hit with our patients. She was a valuable addition to our small staff, which consisted of Dorothy, my office manager, and one medical assistant. We even featured Julie in one of our weekly ads in The Roanoke Times.

After Dorothy received her radiology technician license, she hung it proudly on the office wall. She left a spot for Julie’s LPN license and asked her to bring it in. Over the next several months, Dorothy and I reminded Julie several times, but the license never appeared.

Eventually I became concerned and insisted that Julie bring in her license. That pressure elicited a litany of creative excuses, but no document. Finally, feeling grumpier than usual one hot August morning, I demanded that she produce the license or a certified copy that day. Julie promised to get it during her lunch break. She never returned.

I wasn’t totally surprised. After my morning tirade that day, I had called the Virginia Board of Nursing and learned that they had no record of Julie’s license, LPN or otherwise. When she failed to return that afternoon, we thought we’d heard the last of her.

We couldn’t have been more wrong.

The viper strikes back—with a vengeance

About two weeks before her dramatic exodus, Julie had apparently lost her footing on the stairs leading to our second-floor offices and wrenched her shoulder as she grabbed the railing. When I examined her, she told me, "I didn’t fall. I just lost my balance." I checked her over carefully, and had Dorothy take several X-rays of the shoulder, which revealed no evidence of injury. Nevertheless, I referred Julie to her own workers’ compensation doctor to be safe.

Dorothy reported the incident to our workers’ compensation carrier, and directed Julie to send us the bills for any treatment. She was back at work the next day, wearing an arm sling the orthopedist had given her. She soon shed the sling, however, and proceeded to work as usual. I asked her several times how her shoulder was doing, and she replied that it was a little painful, but improving.

So I forgot about it. Unfortunately, I had also let Julie run up a sizable bill for other medical care at our office, which she never paid. I sent her bill to collection right after she left, and tried to forget a costly mistake in money and pride.

Two months later, I received notice of a forthcoming workers’ comp commission hearing on Julie’s accident. She had filed a complaint alleging that she had tripped and injured her shoulder because our stairs were in poor repair. I was shocked. At the time of the incident, she hadn’t mentioned any problem with the steps.

For two months, I agonized over the impending hearing. Then a letter arrived from a local law firm, and my stomach knotted. However, the letter was from a lawyer hired by my workers’ comp carrier to represent me. Along with announcing her assignment to the case, the attorney revealed some interesting details she’d discovered about Julie’s background: a 1990 indictment for embezzlement from a local convenience store, a 1998 conviction for credit card theft; and a six-month sentence for drunken driving with a stolen license.

On the day of the hearing, Dorothy and I sat across from Julie, who was preening and smirking. Dorothy recounted the events of the day of Julie’s accident in detail. After determining that Julie hadn’t required emergency treatment, Dorothy had asked her whether there was anything on the steps that had made her lose her footing. Julie had denied any impediment, saying only that she had "lost her balance." Dorothy had then inspected the location of the accident and found nothing unusual about the steps.

Julie’s lawyer tried to discredit Dorothy, arguing that as my close friend and employee she would obviously be biased. He also questioned her qualifications and doubted her thoroughness in investigating the accident site. Dorothy smiled pleasantly, and described her 25 years as an industrial engineer, during which she often investigated factory accidents. Embarrassed, the lawyer sat down, saying, "No further questions."

My attorney went through the details of Julie’s criminal record, and her lack of nursing credentials. Julie slumped in her chair, head bowed, shoulders sagging, face turning rose red. Our attorney also produced records from two orthopedists Julie had seen. Both reported she had never suggested that her accident had been caused by hazards on the steps.

The rest of the hearing was routine, since we all knew who had won. In his decision, the judge wrote: "Upon this evidence, we hereby find that the claimant is not credible, and that her injury did not arise out of the employment."

An embarrassing, but valuable, lesson

We’d notified the state medical board about Julie’s deception, and several months later the state caught up with her. She pleaded "no contest" to a charge of "practicing nursing without a license" and received a suspended sentence. Just when I thought this episode was finally over, a news article about Julie’s conviction appeared in The Roanoke Times, and then the TV camera crew showed up.

Looking back on the experience, I regret not having checked Julie’s references and license before hiring her. I had never encountered a similar situation in 28 years of practice, and I had fallen into a habit of trusting colleagues and employees.

Ultimately, though, it’s my responsibility to verify the character and qualifications of the people who represent me as they care for my patients. No judicial ruling can remove that responsibility.

I’m thankful that my office manager knew how to investigate accidents and that my insurance carrier chose a competent attorney to represent me. During her short stay in my office, Julie didn’t cause any actual damage, except to embarrass me among my patients. Fortunately, most of them understood what had happened, and none complained.

Don’t count on being as lucky as I was. Despite her convictions, Julie is still out there, probably doing what she does best. You could be her next victim.

Joan Resk. She's no lady--she's not a nurse, either.

Medical Economics

2002;13.