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Reform of California Nursing Board’s Discipline System Shows Early Progress

This story was published in the Los Angeles Times.

After moving swiftly to replace the leadership of the Board of Registered Nursing, California officials are revamping practices that had allowed errant nurses to work for years after complaints were filed against them.

For the first time, the board is prioritizing complaints, moving first to investigate nurses who pose the greatest threat to the public.

In addition, top officials will this month get subpoena power to gather documents about nurses accused of wrongdoing. Before, some cases sat for months until outside investigators issued such orders.

The moves come after The Los Angeles Times and ProPublica disclosed in July that the board took more than three years on average to investigate and discipline even its most troubled nurses. Some were able to move from hospital to hospital despite accusations of assault, criminal activity or on-the-job drug use.

Within days, Gov. Arnold Schwarzenegger replaced the majority of the board’s members and the board's longtime executive officer resigned.

Three months later, statistics show early progress on the governor's pledge to reform the system. In the first quarter of the fiscal year that started in July, the board filed formal accusations seeking disciplinary action against 159 nurses, compared with 68 during the same period a year earlier, officials said.

Also in the first quarter, the board obtained emergency orders to suspend the licenses of six nurses, compared with none in the same period last year. The Times and ProPublica had found that California used such orders to stop dangerous nurses far less often than several other states.

"One of the reasons we got ourselves into the position that we were in is that we were satisfied with the status quo," said Brian Stiger, director of the state Department of Consumer Affairs, which oversees the nursing board and other professional licensing agencies. "That has changed. We are no longer doing business the way that we used to."

State officials say they hope within two years to reduce by more than half the time it takes to discipline nurses, bringing the average to less than 17 months.

That goal would require many substantive changes to take place, changes that await action by the Legislature, permission from the governor or votes of the nursing board.

For example, the board says it needs dozens more staff members in order to clear its case backlog and speed the handling of incoming complaints, but the governor has yet to formally request those workers. The Legislature has yet to fully consider a bill that would, among other things, suspend the licenses of certain jailed health professionals, revoke those of sex offenders and authorize a new computer system to better track complaints. And the new board has yet to propose a requirement for hospitals to report nurses they have fired for misconduct.

Beyond that, the nursing board is still subject to budget cuts and state-mandated furloughs even though it is wholly funded by the fees paid by its licensees.

"The governor kind of engaged in this charade," said Bonnie Castillo, government relations director for the California Nurses Assn., the state's largest nurses' union. "You've put all of this in motion and yet you're expecting greater oversight and enforcement with less people-hours and less public accountability."

Stiger said officials need to prioritize their workloads. In part, that involves changing the practices of the board and other state agencies that help investigate and prosecute its cases.

To keep cases from stalling at the investigative stage, the consumer affairs department has given the board permission to hire several non-sworn investigators to handle less complex cases and those that won't result in criminal prosecution. Previously, the board had to rely solely on a pool of sworn consumer affairs investigators who were stretched thin serving a variety of boards.

The nursing board also is taking over some responsibilities previously handled by the attorney general's office, such as preparing default decisions when nurses don't respond to accusations against them.

The state attorney general's office said it will quickly schedule hearing dates for nurses who are contesting their discipline. In the past, state attorneys would wait until settlement talks broke down to schedule a hearing, then wait months for the first available date.

Beyond that, officials are addressing other roadblocks that were "unusual and extreme," Stiger said.

It used to take two weeks, for instance, for the consumer affairs department to photocopy a nurse's case file so it could be sent to expert witnesses or others. Proposed disciplinary actions were allowed to stack up for a month or two before being sent out to board members for a vote. And just one staffer was responsible for receiving and logging nearly all new complaints to the board -- more than 5,700 last year.

Now it takes two days to copy a case file. Proposed actions are immediately sent out to board members for a vote. And a team of eight is helping to processincoming complaints and wade through the backlog, officials said.

Ann Boynton, the nursing board's new president, said she was pleased with the progress but acknowledged, "It is not something that we're going to be able to do overnight."

Boynton said she has been "close to appalled sometimes" seeing the amount of time it has taken the board to act on problems. "It reinforces to me, every time I see that, the need to ensure that that never happens again," she said.

More has been done to speed up the pace of discipline than at any other time in more than a decade.

"It's remarkable what a little sunshine will do to stodgy agencies that are stuck in the past," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego.

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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