OAKLAND -- The 66-year-old cancer patient whose death has become a flash point during a Bay Area-wide lockout of nursing staff may have succumbed to the most basic of treatment errors: A replacement nurse apparently gave her a nutrient solution intravenously instead of through a feeding tube.
Judith Ming's death originally was blamed on a medication error administered Friday evening by a temporary replacement nurse hired by a contractor to fill in for regular staff that was locked out after a strike Thursday at Alta Bates Summit Medical Center.
A nurse hired by the same contractor, Alabama-based Advanced Clinical Employment Staffing, said that Alta Bates Summit administrators told her and other replacement nurses that Ming died because a dietary supplement was put mistakenly into an intravenous tube.
The replacement nurses then were asked to demonstrate that they knew how to perform the procedure, considered to be a basic nursing skill.
The tragedy has worsened relations between the nurses' union and hospital administration.
Union leaders have blamed the hospitals' lockout for the error, while hospital officials have criticized the union for politicizing Ming's death.
On Thursday, more than 20,000 nurses from the California Nurses Association staged a one-day strike to protest cuts in employee benefits and patient services. Hospitals in the Bay Area bought in replacement nurses, including Alta Bates, which hired and signed 500 replacement nurses to a five-day contract. The regular nurses are due back to work Tuesday.
Some research suggests that around the country, patients are often imperiled by such strikes.
The contract nurse, who spoke on condition of anonymity, is licensed in four states, including California. She is listed as an RN with an active license on California's Board of Registered Nursing website. She asked not to be identified by name until she clarifies the terms of her contract with the staffing company.
Her replacement contract shows she began work Sept. 22, the day of the strike.
"Everything was complete chaos," she said, adding that the replacement nurses were given very brief orientations. "We were thrown in."
In contrast, she said she had nearly a week of orientation before starting a temporary stint this summer at Johns Hopkins Hospital in Baltimore. Spending at least one shift with a regular nurse is customary, she said.
The replacement nurse was working in the intensive care unit Friday night and would have been assigned to care for Ming had she made it to the ICU ward.
Ming, a cancer patient at the medical center since July, died early Saturday, a few hours after investigators say one of the replacement nurses administered a "nonprescribed dosage of medication."
Sources familiar with the multiple investigations into the death said Ming may have been given a dietary supplement called Glucerna, which should be administered to patients through a feeding tube or orally, according to the company's website. It is not clear whether Ming had a feeding tube.
An autopsy will not be performed until Tuesday at the earliest.
Alta Bates spokeswoman Carolyn Kemp would not comment directly but said Ming's death was a "medical error."
"There is a great deal of investigation going on," Kemp said.
She also said the hospital uses "rigorous criteria" for deploying replacement nurses. They also received two to three rounds of orientation depending on which ward they were assigned before their shift began Friday, Kemp said.
The nurse who made the error has not been identified. Oakland police questioned the woman and released her. She came from Louisiana.
Besides Oakland police, investigations are being conducted by Alta Bates and the California Department of Public Health.
Strikes can affect care
Nursing strikes can pose a risk to patients, according to a 2010 study for the National Bureau of Economic Research.
Researchers from Carnegie Mellon University and the Massachusetts Institute of Technology examined nurses' strikes in New York state from 1984 to 2004. They found a 19 percent increase in death rates for patients admitted during strikes, regardless of whether the hospitals brought in replacement workers.
"Our results imply that strikes were costly to hospital patients in New York," the study said. "In our sample, there were 38,228 patients admitted during strikes, and we estimate that 138 more individuals died because of strikes than would have died had there been no strike."
A striking nurse at Children's Hospital Oakland questioned whether the replacement nurses had adequate training for the units they worked in.
Martha Kuhl, who typically works in the hematology oncology transplant unit at Children's, said new nurses in her department must have at least eight weeks of specialized training before they are allowed to work on their own.
"What is required is demonstrated competency," she said. Flying in temporary nurses from around the nation, she argued, "is a setup for mistakes."
Bruce Fagel, a California medical malpractice attorney who is also a licensed medical doctor, likened putting a dietary supplement into an IV to putting food directly into a patient's blood.
Ming's husband, James, left the couple's home in Oakland on Monday without speaking to the media. Neighbors said the couple kept to themselves.
Should Judith Ming's family decide to sue the hospital for medical malpractice, the amount of monetary damages they could receive would be limited in large part because of a 36-year-old state law that protects medical providers from lawsuits.
The Medical Injury Compensation Act of 1975 caps at $250,000 the amount of noneconomic damages a family or patient can receive from a medical provider that causes negligent injury.
Noneconomic damages are usually damages associated with pain and suffering caused by a loss of life, said John Nockleby, a professor of law at Loyola Law School in Los Angeles.
The law does not cap the amount of economic damages that can be recovered. Since Ming was 66 years old, the amount of future earnings lost by her death probably are not substantial, Nockleby said.
"The economic losses are likely very small in a case like that," he said.
Staff writers Sandy Kleffman, Paul Rosynsky, Sean Maher and Jeanine Benca contributed to this report.