I accepted a relocation expense package when the telephone triage company I work for decided to close its office in Phoenix.

I transferred to their Sacramento, Calif.-area office and signed an agreement that stated that if I left the company before one year of service after the transfer, I would need to return the entire sum of relocation money. Since relocating, I have been very dissatisfied. I have been on a schedule that requires I work every weekend.

I would like to leave before my year is up. Is this an enforceable contract? Can they really require me to return that money?

E.A.

You need to take that contract to an attorney. The attorney you select may not even be able to represent you, but she or he will be able to counsel you as to the enforceability of the contract. The contract itself might specify the state whose law will govern the contract. No one can tell you if the contract is enforceable without seeing the document. Most of those contracts are drafted by lawyers who want to make sure they are enforceable. In any event, do not quit your job-which would most probably be a breach of contract-until you have had an attorney review that document.

Unlicensed nurses

I have a question that has caused some argument in my office and I would appreciate a legal opinion.

If a registered nurse is acting as charge nurse or unit manager and that unit is understaffed, or the hospital is using unlicensed staff, and someone working in that unit-unbeknownst to the RN in charge-makes an error or endangers a patient, is the RN's license in jeopardy should a lawsuit ensue?

P.S.

You brought up several issues. If you know that your hospital is using unlicensed nurses, it is your duty to notify the nursing board in your state. It may be that these people have temporary permits to practice nursing while awaiting licensure. In any event, the nursing board will follow up to determine if these people are practicing nursing illegally.

As to short staffing, if you belong to a union, you need to refer to your union contract regarding staffing amounts. If you are not part of a union, then you are left to deal with your hospital. If you have a staffing matrix and it is not being followed or if you consider your floor or unit to be short-staffed, then you need to take up this problem with the nursing administration. Is there a hospital policy that determines staffing with regard to acuity? If not, ask for one.

If you truly believe that patient lives are in danger and the nursing administration is not responding, you and a few others need to seek an appointment with the person or department above nursing administration. Remember though, that this issue belongs with the nursing department and you should do your utmost to solve the problem at this level.

Your license belongs to your state's nursing board. Only they have the power to discipline you with regard to your license. If you continue to work with and rely upon nurses you know to be unlicensed, the charge nurse might face an inquiry by your state nursing board.

A civil lawsuit is a different matter. If a civil lawsuit is brought by a patient who has been harmed by any nurse, licensed or otherwise, the charge nurse might be a defendant in the suit. It is up to the attorney filing the suit as to who is to be named as a defendant. It is also the role of that attorney to determine whether short staffing was an issue contributing to the plaintiff's injury.

72-hour holds

I have been checking the current trends of patients placed on 72-hour holds. Can they refuse to take medications?

The information I have searched so far has been in regard to patients arrested and rendered insane by the courts and who refuse to take their medications because once considered competent, they will stand trial for murder. This is not what I need.

I need information on the patient who is placed in a hospital on a 72-hour mental health or police hold and refuses care, such as medications, baths and oral hygiene.

K.H.

Your research has uncovered the medical-legal moral dilemma regarding people who are found to be incompetent by a judge and sent to a mental health facility. The dilemma is whether these people should be forced to take medication that will improve their mental status and therefore render them competent to stand trial. This is a totally different situation than the 72-hour hold.

State laws may vary as to the time limits and the process, but the purpose is the same. The state permits a hold on people who are a danger to themselves or others for a brief period, just long enough to file the paperwork and obtain a competency hearing before a judge.

All people who are of legal age are presumed to be competent until a judge says otherwise. Therefore, a person who is being held is presumed competent and has the right to refuse medications and other treatments or care.

Additionally, it is not legal to take hold of a person for the sole purpose of overriding his or her consent with regard to medical treatment.