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State Board Seeks Swifter Action Against Errant Nurses

Managers of the California Board of Registered Nursing are seeking permission to more than triple the size of their enforcement staff and immediately boost licensing fees to speed discipline against errant nurses who may pose a danger to patients.

These and other actions were recommended to state officials Monday in response to an investigation this month by The Times and the nonprofit news organization ProPublica, which found that it takes the nursing board more than three years, on average, to act on complaints of sometimes egregious misconduct.

The recommendations came in an 11-page report submitted at a hearing called by the state Department of Consumer Affairs, which oversees the board. In the report, nursing board managers called the enforcement process "unacceptably long."

On July 13, a day after the first Times/ProPublica article was published, Gov. Arnold Schwarzenegger replaced the majority of board members. The following day, the board's longtime executive officer resigned.

A story on Saturday described how the board failed to take immediate action against nurses who relapsed or even flunked out of its substance abuse recovery program, called diversion. Some of those expelled were deemed to be "public safety threats" or "public risks" by the board but continued to work for months or years without constraints.

Monday's report by nursing board managers confirmed many of the reporters' findings. It also shed new light on bottlenecks in the disciplinary process.

Each of the board's enforcement analysts is responsible for 400 to 600 cases at any given time, shepherding complaints through the disciplinary process. Board managers want to add 60 positions in part to reduce that caseload to 150 per analyst. New staffers also would be assigned to better track nurses on probation and in diversion, among other tasks.

At a special meeting before the public hearing, the new nursing board named Louise Bailey as its interim executive officer. Bailey was a supervising consultant on nursing education under Ruth Ann Terry, the executive officer who stepped down.

The new board will ultimately decide which reform proposals to pursue, and has scheduled another meeting for August to take up the staff recommendations.

Among the other proposals:

* Seek authority to automatically suspend any nurse who fails out of diversion. Based on a review of about 80 such cases since 2002, The Times and ProPublica reported that it took a median 15 months for the board to file an accusation against noncompliant nurses internally labeled "public safety threats" or "public risks." It took an additional 10 months to impose discipline.

* Seek authority to investigate complaints against nurses while they are in the diversion program instead of waiting for someone to fail before a review starts.

* Hire some investigators within Consumer Affairs to work only with the nursing board. Currently the board shares a pool of fewer than 40 Consumer Affairs field investigators with up to 25 other licensing boards and bureaus.

* Better coordinate with the attorney general's office, which is responsible for drafting administrative charges against nurses. Board managers want the attorney general's office to provide monthly progress reports that can be discussed publicly at board meetings.

* Request administrative hearings sooner for nurses accused of wrongdoing. Currently, to save money, state lawyers often don't ask for a hearing until settlement negotiations break down, said Alfredo Terrazas, a senior assistant attorney general. That can add months to the process.

* Launch efforts to exchange information about possibly wayward nurses with other states, as well as other California departments such as Health Services.

* Seek permission from the Legislature to more easily obtain medical and personnel records during an investigation.

* Examine disciplinary processes used by other states and agencies to see if they work better.

Several of the new members on the nine-seat board said they did not want to comment on the report's recommendations until they could review them.

At the hearing, state officials bemoaned state budget cuts and their effect on enforcement. Even though the board and Consumer Affairs investigators rely on licensing fees for funding, they are not exempt from hiring freezes, furloughs and other cutbacks in the economic crisis.

Daryl Walker, acting chief of the Consumer Affairs' investigation division, said 20% of field investigator positions had been cut since 2000. Some investigators handle up to 100 cases at a time, The Times and ProPublica found.

"When you have a reduction in staff, and you have an increase in workload, there's going to be a problem," Walker said.

Read the nursing board report

.

See our complete coverage on California nurses.

ROBERTO ALEJANDRO GLAUBACH

July 31, 2009, 5:41 p.m.

Letter to governor Arnold Schwartzenegger
Part III

??  To the Public Health Service,official voice, that is pointing out upon said nurses´s failures coincidently with our experts, or to the Reg Nursing Board´s shameless final conclusion ??. To whom must I give my credit?? to the Medical Board´s unique expert´s misleading and liar conclusions, declaring that the unique failure of Dr Geronimo Rodriguez MD ,was not having ordered an urine analysis, (just a “single departure” from standards) avoiding the horridness that he never knew what was occuring to my daughter? . And if the failure to order a simple urine analysis got as a result,the death of the patient, where is the single departure ¿?. Killing a patient due to medical ignorance can be qualified as a single departure ¿?? If that failure was not the death´s cause….which was the cause ¿?. Can you see the (not that single) gross incongruence ¿ Veronica,was suffering of a mild preclampsia when she was admitted in hospital The preclampsia clear existing symptoms were never recognized by nurses or doctors despite several warnings posted on the prenatal records . That´s why Rodríguez ordered just Tylenol and Mylanta !!. Nobody took even a minnimum look over prenatal records ¡!. So,Rodríguez considered an upper abdominal (unbeareable)  pain as a post partum pain.  That was an outrageous conclusion. Maybe a lower abdominal pain can be considered as a post Jartum pain,but not that upper pain .But additionally : brix reflexes,nausea,vomiting,spot lights,swelling hands and face,high blood pressure,previous to partum,during partum and post partum, were so evident of what was happening that there´s no other conclusión than :MEDICAL IGNORANCE indeed. .Nothing accurately (under standards ) done ,meanwhile she was going straight to eclampsia and finnaly to HELLP and death,bleeding even through eyes and brain death. Do I have to avoid the fact that said physician (Rodríguez)  omitted on the final summary and on the death certificate,the true cause of death ¿?. That was just to avoid any explanation about the absence of any diagnosis and as a consquence of said diagnosis the correspondent treatment So he willfult omitted the true and lied (another finding of the Public Health Service´s investigation) .Do I have to blind my eyes unseeing that the other irresponsible Joseph Li MD (being my daughter very close to a deadly seizure)  , prescripted just a “liquid diet” ??  meanwhile ordering with any hurried attitude some lab tests (at that point she was almost with no platelets at all). Lab tests showed horrendous numbers.Do I have to blind my eyes unseeing that not any accurate management nor a single “blood trasfussion” - as even a medicine practicioner student knows -has been given to Veronica even after lab tests showed a terrific (low) level of platelets??  May I ignore that when asked about the absence of said blood trasfussion,Michael Gurevitch MD stammered and respònded with a big and incredible stupidity (in front of many witness)....because your daughter´s blood was a rare type..??? Unbelievable !! (she was AB Rh+) ¿?  We felt astonished after that stupid answer,..My answer to Gurevitch: You are underestimating us We are a cultured people and the worse is that you are talking on behalf of a hi-tec hospital. Do we have to concluye that is a hi-tec hospital .without a blood bank ??. Yes or not ¿? That´s all.  At that very moment I suspected that something was wrong.
Mr Governor,although I imagine that you are terribly busy,  I beg your attention in this case and I beg you to order to whom may correspond a truthful revision -and redoing if needed -over this case. It could be a good ” leading and examplarian case ”  to warn bad doctors, bad nurses and specially actual and future board´s officials . At last useful to improve health care quality which I discount is your final objective. The “silent majority”  will aplaud you ,believe me.

ROBERTO ALEJANDRO GLAUBACH

July 31, 2009, 5:45 p.m.

Letter to governor Arnold Schwartzenneger
Part IV(final)

By the way I omitted to state some badmanners showed by nurses, bad manners witnessed by Veronica´s mother and Veronica´s couple. Said badmanners existed indeed although I´m not describing them on this setter.All these years I´d been going yearly to USA ,trying to accomplish my personal endeavour in order to get some justice and to give at the same time some sense to Veronica´s death as well as a useful orientation to prevent other potential victims. I even searched the former President of the Medical Board of California Mr Ron Wender onto her office at Cedar´s Sinai Hospital requesting a truthful revision of our complaint because I was aware about the missconduct of board´s complaint analysts.They protect herselfs and every people in California is acknowledged about that.  I´ve submitted letters asking for a review and redoing of everything to the Deputy Attorney General Robert Mc Kim Bell .I went to his office asking for an appointment but he didn´t attended me answering that he was not prepared to attend drop in visitors.Previously I called from Buenos Aires to be booked.No results. I remember that Mr Ron Wender addressed me to Dave Thornton, Executive director of MBC and we had a meeting at the Ronald Reagan Bd,in LA, during which he confessed to me that the Board was floaded and things were just like that. There are much more details impossible to be described on this e-mail. I remain to your absolute disposition and if needed I can go with any delay to any place you ask to ,to complete my exposition including the whole documentation which support my statement. An I repeat: with no hesitation I can confront publicly in a hearing with board´s experts,alone .I repeat alone. So clear and unavoidables are proofs.  Although I´m not an american citizen,my grandaughter Indiana Agote Glaubach is an american citizen and the half part of my father´s family is fourth generation of american citizens,so USA is my second friendly home. However this is a human rights´s issue and nothing else.

I´ll remain expectant and entirely at your disposition

Thank you for your given attention

Roberto Alejandro Glaubach,father of Veronica Glaubach
Killed by “medical ignorance” at the Huntington Memorial
Hospital,Pasadera, on June 30th,2002.
Wrongdoers are still without any disciplinarian actions.

ROBERTO ALEJANDRO GLAUBACH

Aug. 7, 2009, 7:12 p.m.

Related to my following petition,see Los Angeles Times,Ornstein´s investigation over the RNB “When Caregivers Harm “and go to “Joy of Birth then Tragedy”  an approach to Veronica´s story..also “The Complete Patient”  David Gumpert

My petition to California´s Governor Mr Arnold Schwartzenegger:Part I,

Buenos Aires,July 24th,2009
Dear Sir:
I am the mourning father of a beautiful 28 years old young and gifted girl,who was killed on June 30th 2002 in the “hi tech” Huntington Memorial Hospital , Pasadena,Ca .She died due to the more grievous,flagrant example of “medical ignorance” and “negligence” and even “bad faith” performed and committed by the people who attended him,doctors and nurses,indeed. For the last seven years i´d been fighting in every possible way to get said wrongdoers under discipline.Just a little bit of justice on behalf of my granddaughter Indiana Agote Glaubach, and moreover on behalf of my poor daughter I´ve donate her organs so,some other american people is still living and at least a little part of Veronica is still alive,so she deserves an act of justice : just the true and nothing else than the true to unveil the “responsibles behind the mask” protected by the boards`s brotherhood,indeed. .Notwithstanding numerous and by far clear evidence of wrongdoings committed by at least four nurses and three doctors, which and who headed our Veronica straight to a bloody death -involved nurses and doctors are still without any kind of disciplinarian action and -of course- they still remain ” operatives”. When I talk about “wrongdoings” I´m talking about “gross failures” ,incompetence,lack of knowledge,lack of diagnosis,lack of an accurate treatment(as a consequence of previous failure to diagnose), gross negligence,and,what is the worse,after realizing the mess, they´ve committed they felt in willfull omissions on medical records,with missing sheets and false entries on flowsheets ,incongruent entries,in short, more than clear manoeuvres or manipulations to hide the mess ,their brutal failures. In short a willful manipulation of the records to mislead.  But is seems that they were so hurried that they couldn´t perpetrate a perfect crime. Experts discovered said “omissions ,false entries and manipulations”. I´m telling the most absolute true of facts, which has been said to us, explained in a clear cut and undersigned on reports by at least four renowned experts(in USA and Argentina) .including two experts, linked to the Medical Board , to whom I´d been addressed -under compromise of confidenciality, (for logical reasons) -Additionnaly to said reports,the official voice has been heard,stated and signed in a a 10 sheets´s report by the County of Los Angeles Public Health Service´s experts, and investigators.Notwithstanding the aforesaid,which makes evident the fact that we are facing an obvious case of malpractice—(due to a lack of skill to exercice medicine and health care )..which conducted our daughter Veronica to her death, our two complaints submitted before the Registered Nursing Board and the Medical Board of California, has been dismissed after a delay of 2,,5 (Med Board) and 3,5 (Reg N Board) Both complaints managed in a same pattern of procedures,both :a- clear staging to show- up that, meanwhile something was being accomplished-.The unacceptable long time spent by the investigators of said boards have a simple explanation. I´d been going personally several times to each enforcement unit to submitt evidence and expert´s reports.I´ve been going to Chastworth where I interviewed the Senior investigator of the Reg Nursing Board Mr Broughton O Keefe.who told me;  ” I have findings I have evidence of nurses´s failures and I will report said findings to the Central Unit (Sacramento),.At that moment,Broughton was telling me the true ,no doubt. Same explanation was given by PHService´s investigation supervisor Mr Eric Stone when I went twice to the central unit in Commerce.

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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