Category: Uncategorized

By Alexys King

It’s January 22nd, 1929. Mrs. Alice Byrd had just
given birth to a baby boy four days prior. Alice should have been the picture
of a perfect new mom: exhausted, but happy and content with her life. Instead,
she had suffered severe third-degree burns, and her skin had sloughed off, causing
permanent damage. Alice received these injuries from a Burdick cabinet, a sweat
cabinet sometimes referred to as a radiation cabinet or baking cabinet. The
Burdick cabinet was designed to help patients “sweat out” electrolyte
or chemical imbalances. Dr. James F. Miller, and his wife, nurse superintendent
Jean F. Miller, owned and operated the cabinet.

On January 22nd, Alice developed convulsions, so Frank rushed her to the
hospital to be treated in the sweat cabinet. Dr. Bingham called ahead to the hospital,
asking for Dr. Miller, but was informed that he was out of town. Dr. Bingham told the hospital that
the nurses should prepare a sweat cabinet and be prepared to receive Alice’s ambulance
when it arrived. When Alice arrived at the hospital,
she was unconscious and having convulsions about every 5 minutes.

Though Dr. Miller was out of town, his wife Jean Miller, was available
to receive and prepare Alice for her sweat cabinet treatment. Jean removed
Alice clothes and replaced them with a hospital gown, vest, and abdominal
binder. The vest and binder were to help Alice maintain her posture while in the sweat cabinet.
Alice’s hands and feet were tied together to eliminate the possibility of injury
via broken lightbulbs inside the cabinet. Alice was administered a sedative and then placed into the cabinet, and her treatment began.

At this point, the testimonies diverged. Jean and the other
nurses stated that Dr. Bingham was present when Alice was given the sedative and
placed in the cabinet. There were other witnesses present that also testified
and agreed with Jean and the nurses. Frank Byrd testified that he couldn’t remember,
but later stated, “…I think I saw my wife in the sweat cabinet before
Dr. Bingham got there¹.” A neighbor of the Byrds, Mrs. Davis
Bright, arrived at the hospital with Alice and testified that Dr. Bingham was
present when Jean Miller administered the sedative and when Alice was placed in the sweat cabinet.

The Byrds sued the hospital. According to an outside physician, “… if
plaintiff [Alice] had been properly prepared, ‘covered with Turkish towels, you
couldn’t burn her.'”¹ The court determined that Dr. James F.
Miller, Jean’s husband, was at fault for Alice’s injuries, even though he was
not present at the time of the incident. Based on the jury’s evaluation, the
Byrd family received $29,975 in damages, based on the lasting injuries she
received¹.

Burdick Ultraviolet Lamps. 1930s Burdick Physical Therapy Equipment Catalog. Jeff Behary; Internet Archive.

Byrd versus Marion General Hospital is a landmark case for nurses and
physicians in North Carolina. The verdict of this case prompted questions about
what duty a nurse owes a patient and who is liable when something happens to the
patient. In theory, nurses don’t routinely make patient care decisions; instead,
they are considered to act only under a physician’s orders. Therefore, nurses
are legally considered hospital agents. In the case of Bryd v. Marion General
Hospital, the liability was placed on behalf of Jean Miller onto her physician
husband, Dr. James F. Miller, because they privately owned the sweat cabinet.

There are apparent structural power differences between nurses and
physicians: the nurses must obey the physician’s orders in charge of a
patient’s care. This principle holds under nearly all circumstances, except when a
physician’s order is so negligent that a reasonable nurse could anticipate that
substantial injury or harm would come to the patient. The Nursing Practice Act,
ratified after the Byrd v. Marion General Hospital verdict, states that the physician will be held “solely responsible for the diagnosis and treatment of his patient¹.” Thus, due to their lack of expertise in diagnosis and treatment, nurses acting under physicians’ orders carry no responsibility for patient harm¹. The Nursing Practice Act protected nurses from prosecution due to medical error, when acting under a physician’s orders².

These protections ended when the North Carolina Supreme Court overturned the
long-standing Nursing Practice Act on August 19th, 2022. The reversal of the Byrd v. Marion General Hospital precedent stemmed from the case of a three-year-old child from North Carolina
who suffered permanent brain damage during a heart procedure. The three Supreme
Court judges that voted to repeal the Nursing Practice Act stated that
“…due to the evolution of the medical profession’s recognition of the
increased specialization and independence of nurses…we determine that it is timely and appropriate to overrule Byrd…³. The fact that the North
Carolina Supreme Court overturned the Nursing Practice Act has radically
changed the legal landscape for nurses in the state, and their future is unknown. Many
nurses have decided to seek new employment elsewhere, while others have chosen
to be proactive and fight for their ability to do the work they were called to do
with adequate legal protections⁴.

I believe overturning the Nursing Practice Act was a radical move on the North Carolina Supreme Court’s part. There were other options that the Supreme Court could have taken in the face of the evolving healthcare profession. Insurance companies and employers can offer liability insurance as a workplace incentive or offer discounts on out-of-pocket liability insurance that nurses might need to purchase. Physicans are already responsible for purchasing their own malpractice insurance, should nurses be placed under standard when it comes to liability? Another path the Supreme Court could have taken was to maintain the law and put amendments in place that ensure that nurses can be held liable for actions not directed by the physician. Despite the recent efforts of the North Carolina Supreme Court, nursing is a hard enough profession without considering taking liability for every mistake made on the job. By changing the law that governs how nurses are able to follow physicians’ orders, are more lives being put at risk or is the future of nursing in North Carolina at risk due to nurses having to watch their every move while on the job?

Sources

1. Brogden J. Byrd V. Hospital. Legal research tools from Casetext. https://casetext.com/case/byrd-v-hospital/. Published March 1, 1932. Accessed April 21, 2023.
2. Chamlou N. What the NC Supreme Court ruling means for nurses’ civil liability. NurseJournal. https://nursejournal.org/articles/nc-nurses-sued-for-following-doctors-orders/. Published September 15, 2022. Accessed April 21, 2023.
3. Schreiber E. North Carolina Supreme Court rules that nurses can be help criminally liable for medical errors. World Socialist Web Site. https://www.wsws.org/en/articles/2022/09/13/vlcl-s13.html Published September 13, 2022. Accessed April 21, 2023.
4. Falcone S. Nurses Can Be Sued for Following Doctor’s Orders, NC Court Rules. Nurse.org. https://nurse.org/articles/north-carolina-overturns-nurse-ruling/#:~:text=On%20Friday%2C%20August%2019%2C%202022,evolved%2C%20the%20decision%20was%20necessary. Published September 2, 2022. Accessed April 21, 2023.

Image Sources

1. Burdick Cabinet Physiotherapy at Walter Reed. Radio-Vitant: 1920. Shorpy. https://www.shorpy.com/node/4138. August 4, 2008. Accessed November 28, 2023
2. Chapter V. Electric Light Bath Cabinets, p. 56-62. In Burdick Light Therapy Equipment. (1931) Burdick Corporation, Milton WI, USA. Internet Archive. https://archive.org/details/Burdick/page/n29/mode/2up (Accessed on 11/28/2023).
3. North Carolina State Supreme Court, Modified from original by Alexisrael, https://commons.wikimedia.org/wiki/File:NC_Supreme_Court.JPG. Creative Commons CC BY-SA 3.0.
4. @NCNursesAssociation. H149- which includes the #SAVEact language in its entirety- just passed Senate Rules. Next step: a vote on the Senate Floor. Full Practice Authority for #APRNs is on the move in North Carolina!!. Posted May 31, 2022. Accessed November 7, 2023. https://twitter.com/NCNA/status/1531678030975868929

Over the past 150 years the role of women in American society has changed drastically. Women have gained the right to vote, fought for equal rights and representation, and made other great strides towards equality. Today, women still do not have equal representation in Science, Technology, Engineering, and Mathematics (STEM), including in the medical field. Historically only men were believed to have what it takes to be a physician, leaving women the role of nursing. In the early 1860s, only 0.6% of physicians in the United States were women. This number has changed over the years, and in 2020 thirty-six percent of all physicians in America were women (3,5). However, even within this growing percentage the numbers are not still representative of the United States demographics today.

Allow me to introduce you to Doctor Rebecca Lee Crumpler, the first Black woman to earn a medical degree in the United States. Despite the prevalence of slavery at the time, Rebecca was born free in 1831 in Christiana, Delaware (1). She was raised by her aunt in Pennsylvania. Her aunt, known as the community nurse, found great joy in tending to her sick neighbors, which ignited a spark in young Rebecca’s heart. Rebecca stated in her book, A Book of Medical Discourses: In Two Parts, “Having been reared by a kind aunt in Pennsylvania, whose usefulness with the sick was continually sought, I early conceived a liking for, and sought every opportunity to be in a position to relieve the sufferings of others” (4).

At the age of seventeen Rebecca attended a progressive private school in Massachusetts called West Newton English and Classical School, or the “Allen School” (2). Four years later she went on to join the medical field, stating “I devoted my time the best that I could, to nursing” (4). Rebecca worked tirelessly as a nurse for eight years, and colleagues began to notice. She was highly talented at her job and managed to gain the favor of several doctors. Despite it never having been done before, these prestigious colleagues of hers recommended her to attend medical school at The New England Female Medical College in Boston, Massachusetts to acquire the training equal to her talents and work ethic. 

Elated with this new opportunity, Rebecca matriculated at New England Female Medical School in 1860. She was the first and only Black woman to attend this medical school (2). Even though she was accepted, it was revolutionary for this school to teach a woman medicine, and Rebecca likely faced racism from her classmates, professors, and bystanders for being an outlier among revolutionaries…a Black woman training to be a doctor. Despite the trials that she surely faced, Rebecca graduated four years later in 1864 at the age of thirty-three, upon her graduation becoming the first Black woman to earn her “Doctress in Medicine” (2). 

Rebecca practiced medicine in Boston upon her graduation, but longed for more challenges. In 1865 the Civil War ended, bringing new opportunities for her to pursue “the proper field for real missionary work” (2). She moved to Richland, Virginia where she cared for newly freed African Americans at the Freedmen’s Bureau. It was evident that Rebeccas’s heart was dedicated to caring for the underprivileged and underserved, and very quickly her colleagues in the Bureau began to notice this. Towards the end of 1866, Rebecca was given “access each day to a very large number of the indigent, and others of different classes, in a population of over 30,000 colored”; people who likely had little access to healthcare during this time (2).

Once her time in Virginia was up, Rebecca returned to Boston and “entered into the work [of medicine] with renewed rigor” (2). She stated that with her renewed passion she began this work, primarily on hospitalized children, not out of a desire for wealth, but for the goodness of the community. In 1883 she published her book, A Book of Medical Discourses: In Two Parts, which contained personal journal entries during her time of practicing medicine. In her book Rebecca focuses on the health of mothers and infants, covering topics such as “the better mode of washing the new-born”, “nursing from the breast made easy”, “artificial nursing”, and many more topics focused towards helping new mothers and children (2).

It was Rebecca Lee Crumpler’s passion to provide medical care to women and lesser-privileged people that enabled her to jump the hurdle and become the first Black female doctor, proving that Black women are not only capable of practicing medicine, but are able to thrive and improve the welfare of their communities. However, Dr. Crumpler’s fight continues to this day. In 2020, thousands of women have overcome the hurdle to lead today’s medical professionals. However, despite it being 150 years after Rebecca began her journey, as of 2020 only three percent of physicians are Black women, less than one-third of the number needed to be representative of the US population today (4).

This country has made great strides, but it is clear that we still have a long way to go. Rebecca never lost sight of who she was fighting to care for, despite the harsh environment that she encountered and the many setbacks that she faced by simply being born a Black woman. Today, we can look back at and reflect on Rebecca’s accomplishments, and use her story to inspire us to continue this fight for the future of equality and fair representation in healthcare. 

References

1. Aspan, M. (2020, August 9). Why do black women account for less than 3% of U.S. doctors? Fortune. Retrieved 2021, from https://fortune.com/2020/08/09/health-care-racism-black-women-doctors/
2. Diaz, contributed by: S. (2007, March 12). Rebecca Davis Lee Crumpler (1831-1895) . BlackPast. Retrieved 2021, from https://www.blackpast.org/african-american-history/crumpler-rebecca-davis-lee-1831-1895/
3. Keiser Family Foundation. (2022, February 7). Professionally active physicians by gender. KFF. Retrieved 2021, from https://www.kff.org/other/state-indicator/physicians-by-gender/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D
4. National Institutes of Health. (2015, June 3). Changing the face of Medicine | Rebecca Lee Crumpler. U.S. National Library of Medicine. Retrieved 2021, from https://cfmedicine.nlm.nih.gov/physicians/biography_73.html
5. Smith, K. J. (2019, June 10). Celebrating the first of the 2% – dr. Rebecca Lee Crumpler. FemInEM. Retrieved May 6, 2022, from https://feminem.org/2019/06/10/celebrating-the-first-of-the-2-dr-rebecca-lee-crumpler/