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Lucas Navarro was admitted to Nicklaus Children’s Hospital in Miami with the flu when he was four months old — but he went home with brain damage and a feeding tube in his stomach. Now, Lucas is unable to speak, to walk more than a few steps or to swallow solid foods.
His mother says a nurse who was high on methamphetamine accidentally pulled out the boy’s breathing tube while giving him a bath, leaving Lucas unable to breathe for at least seven minutes and causing his heart to stop, according to a lawsuit filed in Miami Dade Circuit Court last summer.
The nurse, Thomas Sprufera III, was shaking and sweating, with bloodshot eyes, on the day in November 2015 that he bathed Lucas, according to his mother, Linezka Torres, in an interview at her attorney’s office in February. Despite the nurse’s appearance, Torres said she believed that the doctors and nurses who worked in the intensive care unit at Nicklaus Children’s knew what they were doing.
The nurse, she said in Spanish, was “very hyper, very effusive, like very anxious. That didn’t look normal, but I thought it was part of his personality because nobody said anything. I tried to accept him, like everyone else.”
Scott Solomon, an attorney representing Nicklaus Children’s in the lawsuit, said privacy laws prevent him from commenting directly on the case. But he defended hospital administrators and Sprufera in a written statement to the Miami Herald.
“The hospital and Mr. Sprufera adamantly deny the plaintiffs’ description of events in the lawsuit,” Solomon said. “As an advocate for all children, the hospital always puts the health and safety of patients first. The hospital is committed to offering the highest quality care.”
Sprufera replied to an interview request by email. “These are completely false accusations,” he wrote.
Sprufera had previously admitted his addiction to methamphetamine and other drugs to Nicklaus Children’s administrators in 2014, the lawsuit alleges. Hospital administrators then referred Sprufera to a rehabilitation service called Intervention Program for Nurses or IPN, an alternative to discipline for nurses with substance abuse or mental health or physical conditions.
After getting help with his addiction and returning to work, Sprufera signed a five-year contract with IPN for substance use disorder and mental health monitoring in January 2015, according to an investigative report from the Florida Department of Health.
But Sprufera quit the program in January 2016, less than two months after the incident with Lucas, the report shows. So IPN reported Sprufera to the health department for breaking his contract.
After he quit the IPN rehabilitation program, Sprufera gave up his nursing license, according to the health department’s investigative report. He told investigators that he had not experienced a relapse in his addiction, and that the terms of his IPN contract were getting in the way of his earning enough money to pay the program fees, the report shows. Sprufera also told the health department that he had changed careers and taken a job as a consultant for a cruise line company.
Linda Smith, executive director for IPN, said she couldn’t discuss specific cases because of privacy laws. But she said state law allows nurses struggling with addiction or mental health to be referred to IPN by their employers without alerting the Florida Board of Nursing, which could suspend a nurse’s license or otherwise discipline them.
Smith said nurses who need help must be willing to seek treatment and work with IPN. Once a nurse is deemed safe to return to work, she said, he signs a contract requiring a daily check-in with a supervisor, random drug tests and weekly group counseling sessions.
“Folks who don’t follow through are in a lot of anger and denial and don’t think they need it,” Smith said, noting that about 78 percent of IPN clients return to work. “But the primary purpose of the program is the safety of patients. … If they [nurses] don’t follow through, we have to report them to the board.”
Smith said IPN contracts vary from one year to five years, depending on the severity of the nurse’s addiction. Nurses are often supervised upon their return to work, she said, and their recovery is measured in part through progress reports submitted by their employer every three months.
Nurses get more freedom to work independently as they progress through the program. But if a nurse in the IPN program is involved in an adverse incident where a patient is injured, Smith said, the nurse is supposed to be drug tested right away.
“The hospitals would do that immediately,” she said.
Nicklaus Children’s didn’t drug test Sprufera after he pulled out Lucas’s breathing tube, said Judd Rosen, an attorney representing Torres.
“No records were produced that he was drug tested within 48 hours of the adverse incident,” Rosen said.
It’s unclear when or if Sprufera was drug tested, before or after the incident, because his personnel record from Nicklaus Children’s was filed with the court under a confidentiality order.
But the hospital’s policies and procedures for medical professionals say Nicklaus Children’s is subject to Florida’s drug-free workplace statute, which requires an explicit policy regarding work-related drug use.
The hospital’s policy manual, which is online, states that drug use at work is “absolutely prohibited,” and that employees who “demonstrate impaired performance resulting in an incident report may be required by the hospital to undergo testing for drug or alcohol abuse.”
Rosen, the attorney representing Torres, said Nicklaus Children’s failed to supervise Sprufera once he returned to work, and that the hospital didn’t submit quarterly progress reports to IPN. He called that a betrayal of patient trust.
“If they’re having nurses in a drug recovery program, that’s one thing,” Rosen said. “But when they put him in ICU and leave him unsupervised, and they didn’t test him … and the fact that they’re not telling parents about this guy. You’re walking into a facility thinking you’re going to get the best possible care, and you don’t know this guy is a severe drug addict.”
Torres, Lucas’s mom, said she believes Sprufera never intended to pull out Lucas’s breathing tube. “I saw a lot of pain, a lot of embarrassment in his eyes,” she said.
Lucas had been at Nicklaus Children’s about 12 days when he was extubated during the bath, according to hospital records that Rosen provided.
Because Lucas was born with Jeune syndrome, a rare genetic disorder that can restrict the lungs’ ability to grow and expand, doctors placed a breathing tube in the boy’s throat to keep his airway open soon after he was admitted with the flu on Nov. 15, 2015.
But Lucas’s condition worsened. Doctors diagnosed him with a deadly blood infection, and he was transferred to the pediatric intensive care unit, where nurses care for kids with serious medical problems.
Torres said she had been at her son’s bedside nearly the entire time that he was at Nicklaus Children’s from November 2015 to February 2016. And Torres was there when she said Sprufera arrived to give the baby a bath.
Because Lucas was in intensive care with a breathing tube, Rosen said, nurses bathed him in the hospital bed. He said the task takes three people — one to hold the breathing tube in place, a second to bathe the baby, and a third to change the sheets on the bed during and after the bath.
Torres said Sprufera asked her to help him bathe Lucas. Though she speaks Spanish and she said Sprufera does not, Torres said she understood that the nurse wanted her to change the wet sheets beneath the boy and to replace them with dry ones.
After bathing Lucas with a wet washcloth, she said, Sprufera lifted Lucas out of the bed so she could change the sheet.
“At that moment, his hands started to shake,” she said. “He held him, and the tube he [Lucas] had in his mouth fell out. I looked at the monitor and the numbers started to drop. I didn’t understand at that moment what had happened. I watched as he tried to put the tube back in his mouth. He couldn’t, and he was so nervous that he went to another nurse and said something in her ear.”
Torres said the second nurse tried to get Lucas to breathe by using a manual resuscitator. “Then I heard ‘beep, beep, beep’,” she said. “I stepped back, and then more nurses came in and they stood around Lucas and started to work on him.”
Soon after, Torres said, a team of medical residents arrived, and one of them began CPR on Lucas, whose heart had stopped beating. A nurse placed cold towels around Lucas’s head, a common procedure to help reduce brain damage from a lack of oxygen.
“I remember that I started to pray,” Torres said.
She said that while the medical team worked to revive Lucas, Sprufera went to a corner of the room and began to cry.
Lucas’s medical record from the hospital shows that doctors issued an emergency code for respiratory failure at about 9:04 a.m., though Torres said several minutes had passed between the moment when the breathing tube was removed and the nurse began to use the manual resuscitator.
Medical records, provided by Torres’s attorney, show that Lucas was starved of oxygen for at least seven minutes and possibly as long as 13 minutes.
After doctors revived Lucas, they performed a tracheotomy to help him breathe and a gastrostomy to feed him through his stomach because had stopped swallowing.
Doctors told Torres that Lucas’s condition was critical. “They didn’t know if he was going to live through the night,” she said. “They asked me what I wanted. I said I wanted a priest.”
Torres wanted her son baptized. She asked Sprufera to stand in as Lucas’s godfather.
“I asked him if he could please help me baptize him because I didn’t have anyone,” she said. “He said yes.”
About two months after the incident, Lucas went home from the hospital. A review of Lucas’s medical records by an independent doctor, which is required by Florida law in all medical malpractice lawsuits, states that the boy suffered a “global anoxic brain injury” as a result of his heart stopping and his inability to breathe.
Torres, who lives in Miami, said she quit her job at a concession shop in Miami International Airport to help care for Lucas.
More than two years later, Torres said, Lucas cannot walk on his own and he hardly speaks. He needs around-the-clock care from a nurse, and he is still fed through a tube in his stomach.
“I have a lot of anger,” Torres said.
“Our life has changed totally,” said Jorge Navarro, Lucas’s dad. “He can’t do lots of things that would be normal. He doesn’t eat. He runs and falls. He doesn’t talk. A 2-year-old should talk. He needs a lot of therapy, and we still don’t know what the future holds.”