State regulators said Butler Hospital failed to protect patients’ right to receive care in a safe setting when the psychiatric hospital on Providence’s East Side allowed an unlicensed medical assistant to insert an intravenous catheter into three patients.
Rhode Island requires that insertion of an IV catheter only be done by a registered nurse.
The deficiencies cited follow a June 17 inspection for compliance with the federal Centers for Medicare and Medicaid Services, or CMS. The inspection report was provided to The Public’s Radio in response to a public records request.
“At Butler Hospital, patient safety remains our top priority,’’ Mary E. Marran, the hospital’s president and Chief Operating Officer, said in a statement. “A prompt investigation revealed that there were no adverse patient outcomes, and appropriate mitigation mechanisms have been implemented.”
The hospital, Marran said, is “committed to full transparency and accountability.”
On June 13, an anonymous tip came into the Rhode Island Department of Health about an employee identified as a phlebotomist who was seen inserting an IV catheter into a male patient in the hospital’s Electroconvulsive Therapy (ECT) Department. The treatment involves electrical stimulation of the brain to treat severe mental health conditions.
A phlebotomist typically draws blood for tests, transfusions or donations. Like a medical assistant, a phlebotomist typically receives a certificate from a training program but has no state license.
Butler’s policies and procedures for ECT treatment, in effect since May 2023, state that insertion of an IV line is to be performed by a registered nurse, the inspection said.
Inserting an IV catheter is one of 14 procedures the state specifically prohibits under the scope of practice for medical assistants.
The findings come as some 800 unionized nurses and other Butler employees are entering their seventh week of an open-ended strike. The hospital initially said it was relying on travel nurses and other temporary staff to keep the hospital operating. By June, however, Butler said it planned to hire permanent replacements for the striking workers – a challenge given the ongoing hospital staffing shortages and competition for health care workers in Massachusetts and Connecticut.
As of Tuesday, Butler’s website listed 329 job openings, including 109 for registered nurses.
It’s unclear whether staffing shortages or the hiring of out-of-state staff who are unfamiliar with Rhode Island regulations may have contributed to the violations.
The medical assistant who was also a phlebotomist told investigators that “if there were many patients scheduled to receive ECT, she was asked by the nurses to assist in inserting the IV catheters.”
The hospital’s Director of Nursing Education told investigators that the employee had been inserting IV catheters while working in the ECT Department and she had observed her doing so about 10 times.
Butler has 15 days to submit a plan of correction, said Joseph Wendelken, a spokesman for the state Department of Health. If the corrective plan is adequate, he said, no disciplinary action is expected.
Though Rhode Island prohibits phlebotomists and other unlicensed practitioners from inserting IV catheters, Wendelken said, other states permit it.
