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California Nursing Board Executive Officer Ruth Ann Terry Resigns

(Photos by Liz O. Baylen/Los Angeles Times and John Moore/Getty Images)
The longtime executive officer of the embattled California Board of Registered Nursing resigned Tuesday, ensuring almost entirely new leadership for the agency as it strives to revamp its oversight of hundreds of thousands of caregivers.

But the sweeping reforms promised by Gov. Arnold Schwarzenegger this week face significant obstacles – not the least of which are the governor's own budgetary gambits and his failure to fill key vacancies in his administration.

One day after Schwarzenegger replaced more than half of the panel, citing "absolutely unacceptable" delays in the discipline of wayward nurses, the board's top executive of nearly 16 years sent a one paragraph e-mail to her staff.

"It is with much sadness that I am resigning my position as executive officer of the Board of Registered Nursing," Ruth Ann Terry wrote. "All of you are the greatest staff and I know that you will continue carrying out the mission of the board."

Terry, who earned $114,000 a year, hung up on a reporter seeking comment Tuesday. In an interview last week, she agreed that the disciplinary process needed streamlining, but blamed delays on other branches of the state bureaucracy.

The near-gutting of the nine-member board occurred after the Los Angeles Times and ProPublica published an investigation Sunday showing that it takes the board an average of three years and five months to investigate and close complaints against nurses – leaving many to practice with clean records in the interim.

Reporters found nurses who worked unrestricted for years despite documented histories of incompetence, violence, criminal convictions and drug thefts or abuse. Employers were often unaware of their histories, and some patients were injured or died as a result of poor care.

California Board of Registered Nursing executive officer Ruth Ann Terry resigned a day after most of the nursing board was ousted. She had been in the position for nearly 16 years (Liz O. Baylen/Los Angeles Times). "The governor was not aware of the full extent of the problems until he read it in the paper," said Rachel Cameron, a Schwarzenegger spokeswoman. "Once he confirmed the findings, he took immediate action."

On Monday, the governor abruptly replaced four board members and filled two vacancies, saying in a statement that his new panel would move "quickly and decisively" (there is still one vacancy on the board). He will swear in the new members today.

"It's fair to say the governor would accept nothing short of perfect performance from the new board," said Victoria Bradshaw, his Cabinet secretary, on Tuesday. "Incremental improvement on a broken system is not what the governor is looking for."

But the new panel will face steep challenges.

For example, Schwarzenegger has not exempted the board (or other licensing agencies) from mandated staff furloughs and contract cutbacks – even though the nursing board is entirely supported by the fees it charges for licenses and is not dependent on the state's strapped general fund.

State Sen. Gloria Negrete McLeod (D-Chino), chairwoman of the Senate Business and Professions Committee, called Tuesday for the governor to rescind his executive order requiring furloughs for employees of self-supporting boards that "oversee the health and safety of the public."

Shutting down the boards three Fridays a month "inhibits the consumer protection activities of the boards and further slows the enforcement process down, and is completely unnecessary to resolving any of the state's budget problems," she said in a news release.

But Cameron said the governor has no plans to change course on furloughs or other cost-saving measures, regardless of how boards are funded. "The state has a cash crisis," she said. "We have to do more with less."

Other actions – or inaction – by the Schwarzenegger administration could also hamper the board. The governor has not filled openings in the top two posts at the Department of Consumer Affairs, which oversees roughly 40 boards and bureaus regulating acupuncturists, veterinarians and other licensed professionals.

And Schwarzenegger has not announced steps to decrease the backlogs in agencies that the nursing board and other regulators rely on for investigative and legal help. At present, more than 20% of the investigator positions in the Consumer Affairs Department, which looks into most complaints filed with the nursing board, are vacant.

The cuts put in place by the governor "are simply strangling those agencies in terms of being able to promptly do their job," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego, which monitors the state's boards and bureaus.

Bonnie Castillo, director of government relations for the California Nurses Assn., a union that has long feuded with the governor, said she worried that replacing the board was a superficial move that would detract from more meaningful reforms. "We need this problem fixed," she said. "We don't need a witch hunt or scapegoats."

Susanne Phillips, fired by the governor as board president Monday, echoed that concern. She said Schwarzenegger simply found "scapegoats for a system that is flawed."

Replacing board members, she said, will not make the delays in discipline go away.

"We didn't sit on our butts and ignore that people are suffering," she said. "That's a ridiculous notion."

Up until a few days ago, the administration communicated little concern or sense of urgency about the nursing board.

Just last week, Fred Aguiar, the governor's secretary of state and consumer services, declined to talk to reporters about their investigative findings. His agency oversees both the Department of Consumer Affairs and the nursing board.

Instead, the state made available the acting chief deputy director of the Consumer Affairs Department, who said that she felt the board "did a good job" and that she had a "partnership" with Terry.

On Monday, Aguiar offered an entirely different message, saying that the disciplinary process needed an overhaul and that the new board would need to quickly come up with a plan to accomplish that goal. The board will hold its first meeting later this month, his spokeswoman said Tuesday.

Ann Boynton, one of the six new members appointed to the board Monday, said she had not yet received a detailed briefing on the board and couldn't predict the magnitude of needed changes.

"Clearly the governor found the circumstances within the board were not adequate to protect public safety and to ensure that vulnerable Californians are cared for at the time they most need it," said Boynton, a consultant who was undersecretary for the state Health and Human Services Agency from 2006 to 2008.

"He believes serious change is necessary," she said. "We will investigate what those changes need to be."

In this video recently posted to the board's website (before our investigation was published), Terry talks about the board's role in overseeing nurses:

Previously: Schwarzenegger Replaces Most of Nursing Board and Problem Nurses Stay on the Job as Patients Suffer. The homepage for our ongoing investigation is here.

ROBERTO ALEJANDRO GLAUBACH

July 15, 2009, 7:59 p.m.

From ROBERTO ALEJANDRO GLAUBACH July 14, 2009 8:28 pm EDT

FIRST OF ALL,BEFORE ANYTHING,HERE GOES MY DEEPEST AND WARMEST CONGRATULATIONS TO THE AUTHORS OF “WHEN CAREGIVERS HARM..” CHARLES ORNSTEIN,TRACY WEBER AND MALOY MOORE. THEY PERFORMED A VERY GOOD AND METICULOUS WORK OF INVESTIGATION. IT IS ABSOLUTELLY USEFUL TO KEEP POLITICIANS AND LEGISLATORS “IN MOVEMENT” TO gather and to DISCUSS AND ENACT NEW RULES TO GET A BETTER AND CLOSER CONTROL OVER THIS KIND OF “BOARDS” (INCLUDING THE MEDICAL BOARD OF CALIFORNIA INDEED). AS A DIRECT CONSEQUENCE,NEW LEGISLATION SUPPORTING TRANSPARENCY AND TRUTHFULNESS TO MANAGE HARMED PEOPLE´S COMPLAINTS, WILL HELP TO IMPROVE THE QUALITY OF HEALTH CARE .THEREFORE PATIENTS ,COMMON PEOPLE, THE “SILENT MAJORITY” FOR SURE,WILL GIVE A HUGE APPROVAL TO THE INCOMING CHANGES AND ,MOREOVER WILL BE MUCH MORE CONFIDENT WITH ITS HEALTH CAREGIVERS.I KNOW -UNFORTUNATELY -OF WHAT I´M TALKING ABOUT.THE CASE OF MY BELOVED DAUGHTER VERONICA,MENTIONNED IN THE ARTICLE IS A CLEAR EXAMPLE OF THE EXISTING SITUATION EMERGING FROM THE PATTERN OF “LAISSEZ FAIRE ” WITH WHICH MOSTLY ALL COMPLAINTS ARE MANAGED BY THESE “ENFORCEMENT AGENCIES”.FOR ALMOST FOUR YEARS I HAD TO ARGUE WITH THE MANAGEMENT ANALYSTS AND INVESTIGATORS OF THE CALIFORNIA NURSING BOARD.DESPITE CLEAR EVIDENCE SHOWING THE UNSKILLFULNESS AND GROSS NEGLIGENCE OF MORE THAN FOUR INVOLVED NURSES,(AND THREE PHYSICIANS AGAINST WHO I SUBMITTED A COMPLAINT BEFORE THE OTHER BOARD,I MEAN THE WELKNOWN MEDICAL BOARD OF CALIFORNIA), DESPITE A TEN SHEETS REPORT SIGNED BY ANALYSTS AND INVESTIGATORS AND SUBMITTED BY THE COUNTY PUBLIC HEALTH SERVICE POINTING NURSES´S AND DOCTORS´S GROSS FAILURES,AS MAIN CAUSES WHICH HEADED MY BEAUTIFUL VERONICA STRAIGHT TO HER BLOODY DEATH,( AN ACCURATE MANAGING OF HER MILD PRECLAMPSIA COULD SAVE HER,BUT THE CAREGIVERS NEVER KNEW WHAT WAS OCCURING FROM THE VERY BEGINING AND THEY LET HER DIE WITHOUT ANY KIND OF ACCURATE TREATMENT,JUST TYLENOL AND MYLANTA…FOR HOURS !!) DESPITE MORE THAN FOUR RENOWNED WITNESS EXPERTS´S REPORTS, DESPITE CLEAR EVIDENCE OF WILLFUL OMISSION OF ENTRIES AND OTHER IRREGULARITIES (PUBLIC HEALTH SERVICE´S REPORT IS QUITE CLEAR ABOUT THAT), IRREGULARITIES THAT ARE BORDERING THE LIMITS OF A WILLFUL FALSIFICATION OF THE RECORDS LIKE THE EXISTING “MISSING SHEETS”,FALSE ENTRIES, INTELEGIBLES ,UNSIGNED ENTRIES,DESPITE SEVERAL PERSONAL VISITS TO CHASTWORTH FIELD OFFICE TO PROVIDE DOCUMENTATION WITH EVIDENCE WHICH I GAVE IN HAND TO THE SENIOR INVESTIGATOR BROUGHTON O´KEEFE ...WHO ACKNOWLEDGED ME ABOUT SEVERAL “FINDINGS”...AFTER THOSE WASTED AND UNBEAREABLE YEARS,THE BOARD FINNALY ALLEGED A..“COMPETENT CARE FROM NURSES” ..WITHIN THE STANDARDS OF CARE UNDER CALIFORNIA LAW (JUST A UNBELIEVABLE AND UNTRUTHFUL STEP PHRASE)
MRS RUTH ANN TERRY,AS RESPONSIBLE OF THE REGISTERED NURSING BOARD,IS RESPONSIBLE OF THAT “UNTRUTHFULL WORK OF ART” PERFORMED TO PROTECT (PEERS) WRONGDOERS. SHOULD I HAVE TO CONSIDER THE THOROUGH INVESTIGATION OF THE PUBLIC HEALTH SERVICE (AN OFFICIAL VOICE) AND THE SERIOUS REPORTS OF 4 RENOWNED EXPERTS AS FALSE,UNTRUTHFUL OR USELESS?? ...SHOULD I HAVE TO CONSIDER THE EXISTING TRUE FACTS OF REALITY AS INEXISTENT BECAUSE MRS TERRY ORDERED TO IGNORE SAID EVIDENCE TO HIDE AND PROTECT DANGEROUS NURSES ? ALLOW ME TO RESPOND:  OF COURSE NOT !.IF THE DATABASE OF SAID BOARD DOESN´T REFLECT REAL BACKGROUNDS,THE BOARD COMMITS ,IN MY HUMBLE OPINION,A GROSS FAILURE (WHY NOT A FELONY?) MISLEADING CITIZENS “THE SILENT MAJORITY” SAID BEHAVIOUR DESERVES AND MUST HAVE A STRONG DISCIPLINARIAN ACTION (TAKE NOTE MRS LEGISLATORS AND POLITICIANS )AGAINST THE RESPONSIBLES.I READ THAT YOU RESIGNED MRS TERRY. WITH THE ALL DUE RESPECT,I´M SURE YOU DID THE CORRECT PATH. SO CONGRATULATIONS…,
BY THE WAY ,HERE GOES MY PETITION TO MR GOVERNOR ARNOLD SCHWARZENNEGER,PLEASE SIR,I´M SURE YOU ARE TERRIBLY BUSY BUT,PLEASE FORGIVE ME FOR MY DARING : MAY YOU HAVE THE KINDNESS TO ORDER TO WHOM IT MAY CORRESPOND A FULL AND TRUTHFUL REDOING- IN THE SHORTEST TIME AS POSSIBLE -OF THE WHOLE INVESTIGATION CONCERNING VERONICA´S KILLING ? PLEASE,SIR .MY DAUGHTER DESERVES AND HAS BEEN WAITING FOR VERY LONG WHILE ,ASKING FOR ANYTHING ELSE THAN A LITTLE BEAT OF JUSTICE,AND AT THE SAME TIME A DISCIPLINARIAN ACTION 8UNAVOIDABLE ON THIS CASE)SHOULD BE USEFUL TO WARN AND PREVENT POTENTIAL WRONGDOERS AND A STRONG EXEMPLARY ACTION WELCOME FOR THOUSANDS OF HURTED PEOPLE,YOUR PEOPLE.MY GRANDDAUGHTER INDIANA IS ONE AMONG THEM AND SHE LIVES IN LA.A BEAUTIFUL AMERICAN GIRL WHO ENJOYED HER MOTHER FOR ONLY TWO HOURS.INDIANA WAS ONLY TWELVE HOURS OLD. .I REMAIN EXPECTANT AND AT YOUR ENTIRE DISPOSITION IF NEEDED.
MY FAMILY AND I , APPRECIATED.
ROBERTO ALEJANDRO GLAUBACH,A FATHER

What a sad and disheartening story. Clearly the CBRN has not been protecting the public.  While I commend your work and the response your story engendered, I have some concerns. I am a Nurse Practitioner and nursing instructor. I hold my profession to the highest ethical and competency standards which I intend to pass on to my students. Nursing is a difficult profession and most practicing nurses struggle to advocate, care for, and protect their patients’ well being. It makes me sad to think that our California nurses will now have to labor under the added pressure of a distrusting public. I can only imagine the number of potential nurses who will rethink their decision to join our profession. I would hope you will write another story. One that shows the work of an RN and the positive difference a good nurse makes in the lives of his or her patients.

ROBERTO ALEJANDRO GLAUBACH

July 17, 2009, 12:13 a.m.

Dear KCAPRN:
Unfortunatelly I have not another story to tell.This is my unique story and as you can imagine I certainly would preferred another more,lighter and with a happy end different than this one.Never this one. But,my family and I,we have the disgrace to bear and carry on with this heavy weight for the rest of our lives.That simple.But,..we know,of course,that there are good nurses indeed. Women and even men who are delicate human beings,skilled,responsibles,compassionate and merciful with patients as well as there is another category of: incompetent,unskilled,ignorant awful and ugly individuals.I don´t like to generalize.It is not a good way to analize any issue or any matter.Unfortunatelly,in Vero´s story ,events and things had been quite bad,wrong.She had had the bad luck of being attended by the second category I´ve described ..and additionally by two or three much more unskilled and incompetent doctors.Let´s see ,in short,some details of happenings.When she was admitted at the Huntington Memorial Hospital,in Pasadena,she was already suffering of a mild preclampsia.Prenatal records are clear about that.A lot of clear warnings concerning IUGR and PTL are posted on it.Proteinuria +2. The ecosound report of Gregory Devore was showing twinkling spots in the placenta,other symptoms as swelling,she saw spotlights,and other unavoidable( to a good nurse or doctor)  symptoms of said mild preclampsia .At this point you can agree that she was deserving a care as a “high risk patient”.Nobody take care not even took a look over the records.(Specially the admittance nurse) Admitted 12pm,delivered a girls,my grandaughter Indi at 6am,june 30,2002 via vaginal.High blood pressure during delivery and after.Five hours after delivery,started with a unbeareable upper-abdominal pain,insoportable pain.It was sunday.veronica´s mother asked,suplicated for an emergency doctor,a doctor nobody attender her shouts.Nobody did anything.veronica was crying and vomiting.Nurses on charge respoonded: we can manage this,meanwhile they tried to page Dr Rodriguez.Impossible to be reached for two 2golden hours” A badmannered nurse apparently upset or discusted for having to clean vero´s vomit.2 pm,Rodriguez ordered( by phone) Tylenol and mylanta telling to the nurses that the pain was normal,a post-partum pain (upperabdominal) Ridiculous diagnosis to any expert consulted,even a renowned Nursing Ph Dr master of nurses. He ordered Tylenol and mylanta.meanwhile Veronica was loosing her platelets.Nobody was acknowledged of what was occuring. What is the adjective to be used for this managing ??: Ignorants,no other.i´m sure you agree with me. 4pm,another physician Dr Li came and overviewed in a slightly basis Vero,and ordered lab tests and a “liquid diet”,..YES you are not dreaming,it´s not a nightmare, I repit..LIQUID DIET,meanwhile she was very close to die.Even that,still at that point a strong accurate management could save her. Experts dixit..Lab tests were terrible.Almost with no platelets. She was going straight to death and even at that point,with that awful scenario ,not even a simply blood trasfussion (fresh platelets)has been ordered.Therafter she seized and bleeded .Brain death.end of story.Every expert consulted felt perplex facing such a medical ignorance and negligence.Thereafter another etails…Dou you want??. Hospital representative Dr Gurevitch responded to my question: “Why you did not tranfussed fresh platelets to my daughter…well Sir,your daughter blood was quite rare (she was Rh+)..(¿?) Probably that intelligent man thought that was talking to an ignorant or dumb person.I´m not.So I runned to the Med.Records office.have to fight there to get a full copy.Late,very late. A lot of pages missing,false entries,not signed entries,falsified bp takes,,intelligible entries and another “candies”. It took me hours to reconstruct some big flowsheets.It takes me years to obtaina little beat of justice and I won´t give up untill the true arise and every one of said wrongdoers,nurses and doctors,be accurately disciplinated,despite all these years facing the malfeasance,misfeasance and nonfeasance of RN Board and MedBoard of Cal on this case (which I´m sure is one more amid thousands.They owe a little of justice to my poor daughter.I owe her to give some sense to her avoidable death,helping perhaps another harmed people “the silent majority” We(my family and I) are morally offended for the spurious and unacceptable
management carried on by these agencies and their officials.That killed my daughter twice.You don´t want to be on my shoes my dear.Perhaps you are a loving mother,Yes ? well honey ,you should understand (and I´m sure you do) that I am a loving father.
Yours truly
Roberto Alejandro Glaubach Veronica´s father

ROBERTO ALEJANDRO GLAUBACH

July 20, 2009, 5:55 p.m.

Mr Charles Ornstein and staff.
Your report made big waves that for sure will arise big changes indeed. The “silent-hurted- majotity”  is right now applauding you effort to lift that awful and heavy black curtain which is (or was ?) veiling the true facts that conducted health care in California to the existing mess. It seems that the river sound announces water and,new refreshing air,because,paraphrasing Shakespeare,..something smells nasty in californian boards.Could be widely interesting and a good culmination of your “periodistic work of art” if you take an investigative look over the Medical Board of California. Perhaps you will get surprising findings. Let´s see how does the authorities of said Board accomplish its duties emerging from the 2005 Final Report of the Enforcement Program Monitor Project,suscribed by Julianne Felmeth and Tomas Papageorge.I am aware that perhaps,we are facing simply cosmetical changes. Perhaps now,as a direct consequence of your report,Veronica´s case and many other cases could be revised by the new authorities in order to establish the due responsibilities of involved wrongdoers. Thank you again.

This article is part of an ongoing investigation:
When Caregivers Harm

When Caregivers Harm: America's Unwatched Nurses

California has failed to protect patients from nurses who are incompetent and dangerous.

The Story So Far

In California, nurses accused of serious wrongdoing have often been left free to practice for years while their cases were being investigated—with patients unaware of the danger.

The board that oversees the state’s registered nurses has taken more than three years, on average, to discipline nurses with histories of drug abuse, negligence, incompetence and violence.

More »

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