Welcome to the Medical Legal Podcast, where healthcare meets the law. I'm Shawna Butler, nurse attorney. In each episode, we explore gripping real life stories at the intersections of medicine, ethics, and justice.
From headline-making cases to the behind-the-scenes legal dilemmas that healthcare workers face every day. In big communities and smaller, lesser well-known ones. Whether you wish scrubs or a soup, these stories are compelling.
thought-provoking and deeply human. Let's begin.
Have you ever thought about what it would be like to care for a patient who committed reprehensible ox?
Somebody who's an assassin, let's say, for example, you might say, what type of reprehensible acts are we thinking about?
And it's an interesting question, isn't it? This is what we're going to talk about. We'll cover that on this episode.
In the meantime, you can find my criminalization of malpractice course on my website at nurseattorneyeducator, alloneword, dot com. You can also connect with me on LinkedIn. The links are below, and additional resources mentioned are included in the show notes.
The Boston Globe reported. that Beth Israel Deaconess Medical Center nurses were faced with the ultimate test of Florence Nightingale's founding ideals.
If you're not familiar with Florence Nightingale, she's considered the founder of nursing in some aspect, in some degrees.
And you can find more about her online. There's tons of information about her.
And what we're talking about here, what's completely challenging in this case.
And, you know, I invite you to think about your strengths and weaknesses and how you would handle this case, but we're talking about Johar Sarnev, the 19-year-old suspect in the Boston Marathon bombings.
As I said, he was a patient at Beth Israel Deaconess Medical Center.
The nurses that were asked to participate in his care did agree to do so.
The supervisor sat them all down and said, you don't have to do this.
That's a strong supervisor, right? You might say you have to do this. This is your job. You care for patients. We don't judge, we don't discriminate. But when we think about being ethical and not judging our patients, we don't think of it on such a grand terrorist scale.
We might find out things about their past, and we might say that has no aspect and no bearing on the care. But this is probably the most egregious example of that, right? And here it is happening in our city, it turned our city, I live in Boston, it turned our city upside down for an extended period of time.
After that day, they were on the run and him and his brother who did die.
during being captured, were on the streets causing more havoc for several days, and then the 19-year-old brother survived.
And the people who had to care for them were members of the community, and they… this is one of the hardest parts, they cared for the patients that were injured in the bombing.
Seven of the nurses agreed to be interviewed by the Boston Globe.
And they didn't discuss specifics of his treatment, right? Because that's barred by HIPAA.
And it's beautiful that they weren't required to, but they all agreed to. They felt like, this is my job, I'm a nurse, I don't get to choose my patients.
Some of the families of the bombing victims expressed unease that he would be treated on the same floor as his alleged victims.
The family of Paul Norden, who lost his right leg, initially was upset and asked to have Paul move to a different floor, and I thought, why does he have to come here where so many of the people who hurt… who he hurt are here?
And that makes sense. You're grieving. You have a medical emergency on your hands.
One of Paul's physicians did discuss the Hippocratic Oath.
With his mother. And she did acknowledge that passing the guarded ICU where the 19-year-old Saranib was being treated to visit her son was quite unsettling. She did say that the hospital staff members were very considerate, and she had no concerns about the medical care that her son had received.
So, to enter the guarded ICU, remember it was highly guarded, right? The FBI agents and the like. The nine nurses involved in his care were required to show identification and were searched by FBI agents at four different checkpoints.
The patient's room was guarded by FBI agents while Boston and Massachusetts State Police guarded the area.
And despite being surrounded by guards at all times, a few nurses said they sometimes forgot that they were preting a bombing suspect. And to those of you who maybe don't care for patients, that might seem strange, but the truth is, we all get caught up.
in the minutiae of the day. We're very busy, you're caring for other patients, you have other obligations, maybe you have to do a continuing education class and learn about a new bed and a new IV pump, and help your… a fellow nurse across the hall.
be easy to sometimes forget things like that. Some of the nurses, and this is according to the Boston Globe, said that the time between shifts was difficult. When you're in the room, it's just a patient, you're here to make sure they feel okay, keep an eye on their symptoms, those kind of things.
And you thought, wow, I'm compassionate, that's what we do, but should I be doing it were her words quoted in the article. The rest of the world hates him right now, and the emotions, she says are like a big salad, all tossed around.
Another nurse wondered if people knew what she had done. Would they hate her, or would they thank her? It's quite the dichotomy, right? You're doing your job as you're expected. You don't get to choose your patients. We don't get to judge and discriminate against our patients.
As a professor, I'm constantly teaching nurses and students to.
You know, I had a student once that said that, you know, people who were unhoused took up space in emergency departments, and they're taking space away from other people who need it. And I had to slowly and gently and gradually work with them over the course of weeks of the semester.
To explain that that patient needs that support they're receiving in the ER, even if it might not be what ERs were invented for.
Right? They're not having trouble breathing. They're not having a heart attack. But they do need support. And our healthcare system is broken in this country, and we don't have enough community support for people suffering from substance use disorder, unhoused people. So yes, they will go to where they need help.
So I am constantly guiding students to come to that non-discrimination, right? Non-judgmental place. It's not our place to judge our patients, and we may not make the same decisions as them. And also, we may never have been in their shoes, and how do we know how we would act, right?
But this feels like that case, those cases like on steroids, right? We're all disheartened and appalled at the actions of the marathon bombers.
And so it's such a complicated case and the nurses did extraordinary work taking care of them.
And, you know, to address the stress and emotional toll the hospital brought in social workers to counsel all nine of those trauma nurses.
That was according to the hospital's Director of Social Work. I used to actually work at Beth Israel Deaconess years ago, so I do know the people in the social work department, and they're amazing.
And then, one extremely interesting, for lack of a better word, was the messages that they heard from law enforcement is you need to keep this person alive.
We need information. We need justice. Now, the reason I say interesting and for maybe, you know, not having a better word is.
We should be keeping all our patients alive, right? Obviously, if it's still quality of life thing and they're not in pain and they're not uncomfortable, that's a topic for another day, right? Quality of life versus quantity of life. But we should be keeping, the goal should be keeping patients alive and comfortable.
As long as, you know, they're still having a quality of life.
So, you know, that's an interesting mindset that law enforcement is not typically dictating care, healthcare, right, to us, to nurses, to physicians, to other healthcare clinicians. But this, again, is a unique case, and I can't think of another on record to compare it to.
I have had some probably pretty wild stories with patients on a medical floor that I worked on for many years.
And none can reach this level. I did work at a hospital after.
Boston Marathon bombing in the most serious patients were not coming to the unit I worked at, but they did after they got better, and then we got the backlog, and the other people being taken out of those trauma floors to care for the marathon bombers, so we all felt the impact, maybe not as severely as the people in the burn unit.
And in the trauma units, they had really intensive care of those patients needed, and it was traumatic for everybody involved. But we all felt it, much like another time when we cared for patients after a large-scale fire in Rhode Island, the station nightclub fire.
There were helicopters on the roof dropping off patients before the hospital had even been informed about them.
So it's, it's challenging and traumatic and the backflow falls on all staff, you know, whether you, everybody's role is important, right? The people in the cafeteria, the maintenance people, the IT people.
You know, the support people, administrative people, so it has a large impact.
For sure. After 6 full days at Beth Israel Deaconess, he was moved to the Federal Medical Center in Fort Devons.
And it seems like they took amazing care. At Beth Israel.
What's interesting is another article in USA Today said they kind of referred to him as a boy because he was 19 years old.
And some did say they felt no sympathy for him, but others were also more conflicted, and I think that's natural. I think it's natural to feel that way. Um, you know, one said she wouldn't be upset if he got the death penalty. More to come on that in a minute.
And that there was no way to reconcile the 2 different feelings. You feel sorry for him, he's injured, maybe he's in pain, you don't know what led up to this, was… did he have mental health issues? Not that that's an excuse, and it doesn't mean mental health. People who experience mental health issues are violent people.
But was he not getting support that he needed in some way that could have prevented this grand massive attack?
So, the articles talked about the conflicting feelings and how do you manage that.
You know, his specific treatment is shielded by the privacy laws, right? Hipaa laws and confidentiality laws. But nurses just did typical, I shouldn't say just, but you know what I mean? They did typical ICU care, they checked wounds, asked about pain, monitored vital signs.
All with those FBI stations, FBI agents stationed right out the room.
They did attend those special counseling sessions that I noted. And, you know, they felt compassionate, but they felt conflicted. Should they feel compassion?
Is that the right way to feel? What do we do when someone has committed abhorrent acts?
Again, it's not our place to judge, it's our job to take care of the patients, but I think Beth Israel Deacon has handled it very well. They didn't force any nurses to care for him, yet all of them felt like it was their obligation and their duty and that they were able to separate the two and still care appropriately, excuse me.
For the patient. Now, this episode is probably a little bit unlike others that you may have listened to.
I, what's the main takeaway, like I said, as a professor, I constantly teach, we don't discriminate, we don't judge, check your biases at the door, be aware of your biases. All human beings have biases, so we have to check and say, am I gatekeeping? Is this a bias that I have? Am I evaluating and analyzing this situation appropriately?
And this is just a unique, nuanced situation. So what I would think about is, you know, how could you handle this situation? How would you take in the cops saying, keep this person alive at all costs? It's interesting. That's a unique situation. There may be times when police come in and actually interfere with care.
If you had a chance to listen to the Alexandra Wubbles case, where the nurse refused to give medical records and draw labs and give them to police because she was protecting the patient and they didn't have a warrant or a summons, subpoena, things like that.
that's a little different, right? That's not appropriate, because they haven't organized that with hospital administration or hospital police. Now, if you're at a hospital, if you're lucky enough and privileged enough to work at a hospital that has its own police force, that's a huge privilege, that's a huge thing. They can help you and support you, because they're an internal person.
So you could ask your local police right at the hospital, what do I do here? How do I handle this? How do I let the FBI, like, know what they need to know, but not what they don't need to know? And that's helpful.
If you don't have that and you're at a smaller place, and you have to reach out to, like, corporate to figure out this grand scale, I recognize how challenging and much harder that can be. Beth Israel Deaconess does have a police force, so I'm sure that they were instrumental in helping that.
Um, but if not, reach out. Don't worry alone. This is not your problem unilaterally to solve. Reach out to the resources available to you, corporate, find out, go to your leader, go to your administrators on call.
your directors? Is it patient safety? Is it risk management? Is it compliance? Those departments are all packaged a little bit differently in every facility. So, they are equipped, and you just find out who that is, because you, as the nurse caring for the patient on the unit.
Even if you're a leader, if you're a director or a manager, you're not expected to handle these, you know, large-scale cases on your own.
So don't worry alone. Reach out to your supports, find out what your resources are, and use those.
Nobody will hopefully ever be in such an egregious case, but we'll all have challenging cases, challenging patient situations, family situations, whatever it might be.
So don't worry alone, and remember that the best interest patient standard still applies in all cases. Thank you.
One last note on this case is. Sarnav did appeal his death sentence appeal, so he was sentenced to the death penalty in his trial and he did appeal it, but just recently, if you're listening to this in real time in July of 2025, the federal court denied his request for a new judge.
to oversee his sentence appeal. So that's the latest as of this time. Thank you!
Thank you so much for listening to the Medical Legal Podcast. If you enjoyed the show, please take a moment to leave a review on Apple Podcasts. It really helps more listeners find the show.
And if you know someone who would find these stories compelling and interesting, share the podcast with them. Until next time, stay curious, stay informed, and take care. And to all my healthcare clinician listeners, always remember to practice in the best interests of every single patient.
Thank you.
