Nurses' role in death probed

NURSING CHAOS • State investigates suspected assisted suicide

By peter korn

The Portland Tribune, Jul 6, 2007, Updated Oct 30, 2009 (12 Reader comments)

For the past two years, the family of Hillsboro software engineer Wendy Melcher has believed that Melcher died from cancer.

What they didn’t know, until last week, was that four days before Melcher died in August 2005 two Portland-area nurses gave her massive amounts of drugs intended to cause her death. The drugs were administered in what the nurses would later call an assisted-suicide plan directed by Melcher.

The nurses have admitted to the Oregon State Board of Nursing that they administered doses of morphine and phenobarbital without informing Melcher’s physician. Oregon’s Death With Dignity Act — the only such law in the nation — allows assisted suicide but only with the assistance of a physician.

The nurses now are under investigation for possible criminal wrongdoing by state police and the Oregon attorney general after a former employee of the Oregon State Board of Nursing two weeks ago provided Gov. Ted Kulongoski information about the case.

Meanwhile, with the investigation in its beginning stages, members of Melcher’s family are questioning everything about Melcher’s death — including whether she really wanted to end her life.

“They think someone may have participated in ending Melcher’s life prematurely without (Melcher’s) consent,” said Mara Woloshin, a spokeswoman for the Melcher family.

“The family wants some answers,” Woloshin said. “This family is bleeding from the emotional pain. They have been broadsided.”

Among the issues authorities are expected to look into is how the state nursing board investigated the case and how it punished the nurses. The board, which oversees nurses in Oregon, was alerted to the case nearly two years ago, shortly after Melcher’s Aug. 23, 2005, death. That death occurred four days after the nurses administered the drugs.

But the board took more than a year to complete its investigation, which found the nurses did, in fact, participate in a suicide plan.

The board did not report the nurses to criminal justice authorities for further investigation. The board did allow nurses Rebecca Cain and Diana Corson to keep their licenses and to continue practicing nursing, Cain with a two-year probationary period and Corson after a 30-day license suspension.

Bill Toffler, an Oregon Health & Science University professor and critic of physician-assisted suicide, said that both the nurses and the nursing board have failed to perform their duties. After reviewing the nursing board’s documents on the case Toffler said that both nurses should have had their licenses revoked.

“It’s extraordinary that someone could be so blatant in their disregard for standards of practice and not have more of a consequence,” Toffler said. “You have an individual who has acknowledged she was trying to end a person’s life by misusing medications in secret from doctors.”

In Toffler’s view, merely revoking the nurses’ licenses would not be consequence enough. “It’s not nurse-assisted suicide in this state,” he said. “It’s physician-assisted suicide. It’s outside the law, and if being outside the law is criminal, it’s criminal.”

Toffler, national director of Physicians for Compassionate Care, a group that opposes physician-assisted suicide, also said he thought the nursing board should have reported the nurses to criminal justice authorities. “The cover-up is unconscionable,” he said.

Michele Laraia, a Portland psychiatric nurse practitioner, echoed others who have reviewed the nursing board documents when she said that even if the nurses were acting out of compassion, they deserved harsher punishment.

“They broke the law,” Laraia said. “I would have expected undoubtedly that they would have lost their licenses.”

Laraia also said she was “shocked” the board did not report the nurses to law-enforcement authorities.

The Portland Tribune has requested interviews with all members of the nursing board for this story, but none of the nine members has responded.

In response to a Tribune question as to whether the nursing board reported the nurses to law-enforcement authorities, board spokeswoman Barbara Holtry suggested that the board fulfilled its role with its disciplinary measures.

“You may want to ask the employer (Providence) if it … reported her to law enforcement for potential criminal issues,” Holtry wrote in an e-mail.

Melcher was 53 when she died. Suffering from neck and throat cancer, she was receiving in-home care through Providence St. Vincent Hospice at the time of her death.

Gary Walker, spokesman for Providence, said that because of federal patient privacy laws and because the case is under investigation, he could not comment on the hospice’s role, nor could he provide the name of the attending St. Vincent physician.

A number of different versions and interpretations of events leading up to the death of Wendy Melcher have surfaced as the case has come to light.

No doctor’s orders given

Public records produced by the nursing board make clear that both nurses said they were acting on Melcher’s desire to end her life and administered large doses of drugs without physician orders as part of a plan they say Melcher devised.

Cain, the Providence St. Vincent Hospice nurse assigned to Melcher, admitted to board investigators that on Aug. 19, 2005, she “administered excessive morphine because she believed (Melcher) to be in uncontrollable pain.”

Yet, according to board documents, Cain did not document her assessment of Melcher’s pain up until the administration of the excessive drugs, standard protocol in hospice care. Nor did Cain contact a physician to obtain orders for a change of pain medications.

Corson did not work for the hospice but participated in the suicide plan, according to her attorney, because she was a friend of Melcher’s partner, Katherine Tolbert.

Corson admitted to board investigators that she wrote Melcher’s four-point suicide plan on a “communication board” in Melcher’s home and participated in the plan Aug. 19 by inserting 10 phenobarbital suppositories “as quickly as she could, one right after the other” into Melcher.

The board documents — and information supplied by Corson’s attorney — portray an attempt to hasten the death of a woman who had weeks, possibly months, left to live and who may have been in great pain. But the documents and interviews show that regardless of intent, the drugs administered to Melcher did not immediately kill her — she lived four more days.

But members of the Melcher family — who only learned of how Wendy Melcher died after a Portland Tribune reporter informed them two weeks ago — do not believe the incident is a simple case of two nurses assisting a dying woman out of a sense of compassion and duty.

Daughter has different view

Melcher’s life was hardly simple, either. She began life as Wayne Melcher and fathered two children, Philip Melcher and Tricia Howe, before beginning to live as Wendy Melcher late in her life. It’s not clear whether she had surgery to change her gender.

Daughter Tricia Howe said through spokeswoman Woloshin that she does not believe Melcher wanted to die in the way the two nurses describe. Howe said that she visited her father as much as seven hours a day in the last weeks of Melcher’s life.

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