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Schwarzenegger Wants Sweeping Reforms in Discipline System for Health Care Providers

(AP Photo/Rich Pedroncelli)

Gov. Arnold Schwarzenegger on Wednesday conceded that long-standing delays in disciplining errant health professionals were "absolutely unacceptable" and promised broad reforms to better protect patients from dentists, pharmacists, therapists and others accused of misconduct.

"The existing model protects licensees," said Brian Stiger, who was appointed by the governor Tuesday as director of the California Department of Consumer Affairs, which oversees the state's licensing agencies. "The new model makes the protection of consumers paramount."

Among the proposed changes: adding more investigative and legal staff, appointing an official to audit the boards and seeking legislation that would allow quicker suspension of uncooperative or jailed professionals' licenses. Many of the reforms could be paid for through higher licensing fees charged to health professionals.

The announcement comes a month after ProPublica and the Los Angeles Times reported that it takes more than three years, on average, to investigate and discipline registered nurses accused of wrongdoing, including patient abuse, neglect and drug thefts. One Riverside County nurse was accused of assaulting patients at three hospitals before the board took action.

Several other large states resolve complaints in less than a year.

The governor acted on the same day that the state, in response to a public records request from ProPublica, released data showing that it takes more than two years on average to resolve all types of complaints against health professionals. The delays have persisted throughout the governor's tenure.

"It is clear the current system is broken and the entire enforcement process across all of the boards must be reformed," said Schwarzenegger, who last month replaced the majority of the state Board of Registered Nursing and ordered a review of the state's other health-related boards.

At a specially called meeting Wednesday of the newly revamped nursing body, Stiger proposed redesigning the enforcement system for all boards. He said the state hopes that the entire disciplinary process, from complaint to resolution, can be completed within 12 to 18 months.

Despite the dramatic gestures, Schwarzenegger's own actions may have contributed to problems at both the nursing board and 18 other "healing arts" regulators, which oversee more than 900,000 licensed professionals.

Delays have persisted and in some cases worsened on his watch. A blizzard of budget-cutting under both him and his predecessor Gray Davis left some boards scrambling to stay afloat, according to several state officials.

"Last year all our part-time help was sent home," said the executive officer of one board, referring to layoffs. "Before that there were freezes, which we're still recovering from."

Work furloughs on three Fridays a month, ordered by the administration to cut costs, "are not helping us recover from the problem," said the executive, who was not authorized to speak on the record and would not be named.

Beyond that, Schwarzenegger has failed to fill vacancies on many of the boards overseeing health-related professionals, with two boards -- those overseeing psychologists and physical therapists -- having the minimum number of members required for a quorum. So if one member is absent, the board cannot vote. A spokesperson said Wednesday that the governor is working to appoint the best qualified members.

In stories last month, ProPublica and the Times found that a cumbersome disciplinary process followed by the nursing board and other licensing agencies can stall cases for years.

Complaints must wind their way through four different bureaucracies before being resolved. The biggest delays occur at the consumer affairs department, where the nursing board shares fewer than 40 field investigators with up to 25 boards and bureaus, and at the attorney general's office, where cases are prepared for hearings.

During the investigation, nurses often can practice with clean licenses, their alleged transgressions unknown to employers and patients.

Members of the newly configured nursing board generally welcomed the governor's proposals Wednesday but questioned why such reforms had not been proposed before.

Some also questioned whether they would be able to drastically cut the time it takes to investigate and discipline nurses.

Speakers representing nursing unions said that before the board raises fees to pay for new staff, it should stop furloughing its employees and seek repayment of money the governor borrowed from the nursing board's reserve fund to pay other state bills.

At Wednesday's meeting, board members at times struggled with the rules and constraints they were under -- and questioned whether they should or could be changed.

At one point, new member Jeannine Graves said the nursing board should be able to notify employers when a serious complaint has been made against a nurse.

"I personally have had a nurse that I discharged for substance abuse who went across the street [to another health facility] and got a job that afternoon," said Graves, a practicing nurse in Sacramento.

A lawyer advising the board replied that complaints are not public information.

"If there is a way that we can protect the public during the interim of investigation . . . I think it's OK to dialogue with employers," Graves said.

The lawyer replied, "Actually, it's not OK. Complaints are not public information . . . "

Graves interrupted, "That's why we're all new here."

Also Wednesday, the Senate Business, Professions and Economic Development Committee issued a highly critical report detailing other problems that must be addressed.

The report found that investigators did little to prioritize complaints, had no uniform standards for reviewing cases and communicated poorly with individual boards.

In recent years, the report said, investigators appear to have given priority to cases involving professionals working without licenses in the "underground economy," over those involving consumer harm.

Since 2000, the report noted, 80 percent of the investigative staff has left and about 500 unassigned cases await review.

On Monday, the panel will hold a hearing on the issues.

The harsh critique comes three years after lawmakers stopped their routine reviews of the boards.

"I think there needs to be more oversight on our part," said Sen. Gloria Negrete McLeod, D-Chino, the committee's chairwoman.

Clearly, the time has come for such reforms.  We applaud Governor Schwarzenegger for his efforts in improving the oversight for healthcare workers and, presumably, government employees. There have been far too many incidents where background checks and related reviews have failed to discover that employment candidates were either convicted felons or sex offenders.  Sometimes there have been no background checks conducted.  On other occasions, depending on the agency, the background checks were conducted but no one bothered to review the results in a timely fashion.

This is not a problem we can attribute solely to California.  A fair number of states are plagued with these inefficiencies, and as we drill down through municipal services throughout the country, even more egregious failures have occurred. 

The first and foremost responsibility for any government, national, state, or local, is to protect its citizens from predators.  When such predators are government employees or healthcare personnel with easy access to their victims, this is truly an untenable situation.

That is such a great news. I hope the action will be very soon.

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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