To the Editor:

I was one of the attendees at the annual course of the Society of Gastroenterology Nurses and Associates (SGNA) in Minneapolis. The annual course was very informative. Your presentation on "Writing for Publication" and your encouragement to start writing is what gave me the inspiration to write this letter.

The next presentation that was of real help to me and my practice was "Medical Malpractice in Endoscopy: What Every Nurse Needs to Know." Recently we have had many questions related to our legal obligation to patients regarding their transportation home after they receive moderate sedation. This talk helped to answer some of those questions.

I am employed at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) in Houston, Texas. We serve a large area, with many patients traveling 100 miles or more for endoscopic procedures. The MEDVAMC has three outlying primary care clinics in towns from 50 to more than 100 miles from the facility in Houston. We serve patients who come from great distances, and many take advantage of van transportation from these areas. In brief, our hospital policy states patients undergoing endoscopy must have a driver upon discharge and gives other options the patient can employ, such as:

* Spending the night in our Courtesy Quarters (on-site "no cost" hotel).

* Using a taxi at their cost.

* Organizing a driver from the van drop-off point to transport them to their home.

* Having the procedure without sedation.

One patient just 2 weeks ago asked me, "How do you know I got in the taxi?"

We call the taxi for them and then send them by escort to meet the driver. We were concerned, however, about not knowing for sure if they really used taxi transportation. We have had other cases of the patients deciding to drive after leaving the unit with a designated driver.

The Arkansas case Deborah Krohn cited in her lecture was one we had discussed in our journal club. We had begun to feel uneasy after reading the details of this case and noting that the judge had allowed the family to sue the facility and the nurse. Our question was "Where does our obligation end?"

Deborah's presentation was very complete. I was ecstatic to learn the case was decided in favor of the facility and the nurse and that the facility's legal obligation is to inform the patient before the procedure. I feel we are well covered in this respect because the need for a driver for patients who receive moderate sedation is addressed in all of our written correspondence, video presentation, education booklets and pamphlets, preparatory instruction sheet, and on admission to the unit the day of the procedure. Furthermore, the name of the designated driver is documented in the medical record. We prefer to see the driver but will verify the designated driver by telephone if the driver is not able to talk with a staff member in person.

We make every effort to ensure the safety of our patients, but they also have a responsibility in their care. I have learned my duty is to inform and advise, not to control.

Sandra Jones Bordelon, BSN, RN

Greater Houston Regional Society