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The Texas Board of Nursing (BON) has the jurisdiction to hear and decide cases involving the practice of professional nursing in Texas. Any RN or LVN found guilty of violating the state laws and regulations may be subjected to a disciplinary case if not properly defended by a nurse attorney. 

At the time of the initial incident, an RN was employed as a Registered Nurse at a health facility in Houston, Texas, and had been in that position for four (4) years. 

On or about May 27, 2016, through February 28, 2020, while employed as a Registered Nurse, the said RN failed to completely and precisely document the medical record of Patient SN, including current medications and treatment plans, routine progesterone prescriptions, increasing doses of progesterone, and mammogram dates. The RN’s conduct resulted in an incomplete medical record and was likely to injure the patient in that subsequent caregivers would not have accurate and complete information on which to base their care decisions. 

It was on or about January 30, 2020, through February 29, 2020, while employed as a Registered Nurse, the said RN failed to collaborate with a supervising physician and/or gynecologist when the aforementioned Patient SN experienced heavy bleeding after insertion of BioTE pellets containing estrogen and testosterone, and instead continued to increase the patient’s progesterone dose up to 600 mg without further assessment. The conduct of the RN exposed the patient to a risk of harm from adverse effects of hormone dosing and continued uterine bleeding. 

In relation to the situation that occurred, the said RN states that he has been treating this patient since June 2016, including administration of BioTE pellets at doses determined by the patient’s history, symptoms, lab results, and the dosage recommended by BioTE’s dosage calculator, bleeding is one of the possible side effects of the pellets, which is listed in the informed consent documentation that was discussed with the patient prior to each pelleting procedure. The RN also stated that the clinic records reflect that the patient called the clinic on February 6, 2020, to report that she was bleeding, and a prescription for 200 mg progesterone once a day was sent to the patient’s pharmacy, in order to address the bleeding, the clinic records reflect that the patient called again on February 20, 2020, and reported that she was still experiencing bleeding, the clinic records show that he told her to increase the dose to 300 mg for two days, and if it did not get better, then to increase it to 400 mg. The said RN states and clinic records reflect that while he was out of the office, the patient visited the clinic on February 24, 2020, and saw another nurse practitioner trained in BioTE. At that visit, clinic records show that the patient reported that she went to the hospital the previous day for continued bleeding, that an ultrasound of her lower abdomen and uterus was performed that was negative, that lab work showed she was anemic, and that she was advised by the hospital ER physician to take iron for the anemia. Clinic records reflect that the patient reported during February 24, 2020, visit that her bleeding had subsided, she felt better, and that she had a follow-up visit with her gynecologist the next month. Clinic records show that the RN reviewed the notes of the February 24, 2020, clinic visit and asked his medical assistant to follow up with the patient by phone to advise that she could increase progesterone to 500mg if necessary to slow her bleeding. Clinic records reflect

The RN’s medical assistant spoke to the patient on February 26, 2020, to convey the RN’s recommendation and the patient again reported her bleeding was lessening. Clinic records show that the patient’s husband contacted the clinic on February 28, 2020 (a Friday) in the afternoon asking to speak to a clinic physician who was not in the office that day. According to the RN and clinic records, it shows that the RN spoke to the patient the following day, February 29, 2020 (a Saturday). During that conversation, clinic documentation shows the patient reported to the RN that she had been having a normal cycle flow with some clots, that she was taking 400mg of progesterone, and that her bleeding was improving. The RN further stated that clinic records reflect that the RN advised the patient that she could increase the progesterone to 600mg to stop any further spotting, she should continue iron supplements and get plenty of fluids, and they would then taper her progesterone down slowly as her estradiol levels fell. The RN states that clinic records indicate that he gave the patient his personal cell phone number so she could contact him over the weekend with any additional concerns and that he asked her to touch base with him the following Monday. The RN states that the patient did not report any side effects at any of her five previous treatments and one booster treatment, nor did she report any issues with spotting or bleeding prior to her pellet treatment on February 4, 2020. The RN also states that he diligently responded to the patient’s reports of bleeding and recommended appropriate treatment with increasing doses of progesterone as recommended by BioTE’s protocol, either speaking to her directly or through his medical assistant on at least five (5) separate occasions after the patient received BioTE pellets on February 4, 2020. The said RN further states that no consultation with his collaborating physician was necessary since the patient’s bleeding was a known side effect of BioTE treatment. 

As a result, the Texas Board of Nursing placed her RN license to disciplinary action. It’s too bad that she failed to hire a nurse attorney for assistance, knowing that she had every reason to defend herself in the first place. Her defense would have gotten better if she actually sought legal consultation from a Texas nurse attorney as well.

So if you’re facing a complaint from the Board, it’s best to seek legal advice first. Texas Nurse Attorney Yong J. An is willing to assist every nurse in need of immediate help for nurse licensing cases. To contact him, please dial (832)-428-5679 for a confidential consultation or for more inquiries.