Edgemoor Nurse’s Defense Assails County Health Chief

Gertrude Shaw vividly recalls the morning of Dec. 10, when, making her rounds as a supervising nurse at Edgemoor Geriatric Hospital, she was summoned to a tub room in ward B-2 of the hospital’s Santa Maria Building.

There, Shaw found 66-year-old Josephine Noonan on the floor in a puddle of water. Noonan, a partially paralyzed multiple sclerosis patient, was not breathing. Regina Stanley, a registered nurse, was trying to revive her. Pearl Martin, a nurse’s assistant, stood nearby.

Shaw moved quickly to a phone and called for paramedics. She yelled for chief nurse Jackie Webster. She asked someone else to reach Dr. William Bailey, the hospital’s medical director. Then Shaw ran for an oxygen tank. Returning, she saw firefighters arriving and directed them to the dying patient.

Within moments, firefighters and paramedics were working on Noonan. Bailey was kneeling at her feet. The others had moved out of the cramped tub room to make way for the emergency crews. Standing in a doorway, Shaw confronted Martin, who had been bathing Noonan.

“I asked her what happened,” Shaw said. “I said ‘Mrs. Martin, did you leave the patient?’ She said ‘Yes. I left the patient to get a comb.’ ”

Efforts to revive Noonan proved fruitless. She was pronounced dead that morning at Grossmont Hospital.

Two months later, amid mounting public concern about Edgemoor, Health Services Director James Forde suspended Shaw for eight weeks. Forde said Shaw should have told the paramedics treating Noonan that the patient had been left alone and found with her face under water. He said Shaw tried to cover up for Martin’s violation of state regulations and hospital rules. He also charged that Shaw had knowingly allowed Noonan and other Edgemoor patients to go as long as 11 days without a bath.

Now, Shaw is appealing her suspension in a county Civil Service Commission hearing, throwing the inner workings of Forde’s Health Services Department open to public view. The hearing, which began June 13 and is expected to conclude this week, has become a spectacle at which the county seems to be on trial almost as much as Shaw.

Shaw’s labor union representative contends the 50-year-old nurse has been made a scapegoat for all the county’s problems at Edgemoor--the county-run Santee hospital where elderly and disabled patients go when they have nowhere else to turn. Investigations by the county grand jury, the state Department of Health Services and the state auditor general have concluded that Forde and his Health Services team have mismanaged Edgemoor and other health programs.

Pat Vetere, Shaw’s representative with the County Employees Assn., has made it clear he hopes to use Shaw’s hearing to bring down Forde and his top management staff.

“Our objective right now is to let the public know what a shabby operation Forde is running,” Vetere, a former truckdriver and Teamsters member, said in an interview.

To do so, Vetere has called a string of witnesses to vouch for Shaw’s integrity and her talent as a supervisor. He has presented documents and testimony that cast serious doubt on the validity of Forde’s accusations against Shaw. And throughout the hearing, Vetere has tried to go beyond the Shaw case to show Forde as a director out of touch with his department, a man more concerned about the public’s perception than the welfare of Edgemoor’s patients.

His own job threatened by the hospital’s mounting problems, Forde chose nurse Shaw to prove he could be a man of action, Vetere says. Forde, he says, chose the wrong nurse.

The health department’s case against Shaw rests almost exclusively on the testimony of Martin, who admitted leaving Noonan alone in the bathtub to search for a comb. When she returned, Martin said, Noonan’s face was under water. Her eyes were quivering, her breathing had stopped and she was unresponsive.

Martin, who left Edgemoor that day and never returned to work, testified that Shaw told her not to say she had left the patient unattended.

“She (Shaw) asked me what happened,” Martin told Commissioner Darlee Crockett, the hearing officer. “I said ‘I left her.’ And she stamped her feet at me . . . And I said, ‘Only for a little while. I wasn’t gone long.’ And I asked her, ‘What do you want me to do? Do you want me to chart? Do you want me to do an E-9 (incident report)? What do you want me to do?’

“She said, ‘Don’t say you left her.’ ”

So when Martin filled out Noonan’s medical chart and a hospital “incident report,” she failed to mention that she had found Noonan with her face partially submerged in the bath water. She said only that Noonan had become “unresponsive.”

Deputy County Counsel Susan Boyle, representing the health department, has also called Dr. Bailey and El Cajon paramedic David Richardson. Both men said Shaw never told them Noonan might have drowned. But both men also said that whatever may have been the cause of Noonan’s heart failure, it had no effect on the type of treatment she received.

Vetere has called five witnesses in Shaw’s defense, using their testimony to paint a portrait of a dedicated nurse who knew state regulations well and followed them strictly. The morning Noonan died, several witnesses said, Shaw did everything she could to help those treating her. Later, they said, she documented the details of the event as best she could, and encouraged others to do the same.

Bailey, the medical director, and Webster, Shaw’s supervisor, said Shaw did nothing wrong as paramedics worked on Noonan.

In response to the department’s accusation that Shaw should have filled out more complete reports on Noonan’s death, Webster testified that those reports were sent to the hospital administration at noon the day of the drowning and never returned to the nurses’ station. Still, on the incident report, Shaw wrote “patients not to be left in tub unattended,” and Forde admitted under questioning that he didn’t understand why Shaw wrote that if she intended, as he charged, to cover up for Martin.

Shaw’s case was further supported by the revelation that she had written her own account of Noonan’s death--including mention of Martin’s error--and sent it to Deputy County Counsel Paul Bruce, who was conducting his own investigation to prepare for a possible lawsuit against the county. Forde said he never saw that report.

Several Edgemoor nurses who testified also said Shaw never allowed patients to be left unattended while bathing, as the department has alleged.

“If she caught you (leaving a patient alone), she’d read you up one side and down the other and plaster you up against the wall,” said Joan McNeese, a nurse’s assistant. “She was very strict about that. You do not leave patients.”

The final charge against Shaw was that she allowed patients under her control to go for extended periods without proper baths. But Forde himself conceded that he wouldn’t have included the charge had he better understood state and hospital regulations on patient bathing.

Vetere has spent almost as much time in the hearing attacking the health department as defending Shaw. Despite Boyle’s repeated objections, Vetere has managed to introduce as evidence or elicit from witnesses several points embarrassing to the health department. Among them:

- Vetere presented a letter written to him by Noonan’s sister in Pennsylvania complaining that the county never told her of the circumstances of Noonan’s death. She said she learned of the drowning from a newspaper clipping.

- Forde admitted he was wrong to reprimand Webster, the chief nurse, for giving Shaw a rare “outstanding” evaluation. Forde’s reprimand chastised Webster for giving Shaw the high marks two days after Noonan drowned. Actually, Webster completed the evaluation two weeks before the death.

- Testimony detailed the chronic under-staffing at Edgemoor, and witnesses said the shortage of personnel affected patient care--charges that have been documented by state health inspectors. Witnesses also said that patients frequently missed their scheduled tub baths because the water at Edgemoor was not the required 104 degrees.

- Forde testified that he had known for several years that Edgemoor needed more staff, but he never asked for it because he wanted to work within budget limitations presented him by the Board of Supervisors and Chief Administrative Officer Clifford Graves.

- Nurse’s assistant Martin said Paul Simms, deputy health services director, called her “an asset to Edgemoor” and offered to pay her for a written account of problems she observed at the hospital. Martin said she gave Simms the report but was never paid. Forde also testified that Simms suggested Martin be given a job in health services away from Edgemoor. Forde declined, and Martin resigned in February.

- Dr. Bailey, the hospital’s medical director, testified that his memory of Noonan’s death was vague because 18 months had elapsed since the incident. The drowning occurred six months ago.

Although Forde said he would have fired Shaw had it not been for her excellent employment record, he revealed in testimony the details of a deal he proposed to avert Shaw’s hearing and the poor publicity that has come with it.

“I was interested in having as little public flak as possible,” Forde said. “Any publicity at this time is more than we need to have.”

Forde said he offered to reduce Shaw’s suspension to 10 days if she would agree to drop her appeal and keep the deal secret. Shaw refused.