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Finalist for Pulitzer Prize for Public Service: When Caregivers Harm

Finalist for Pulitzer Prize for Public Service: When Caregivers Harm

Once in a great while, a piece of journalism is so rigorously documented, is so persuasively presented and exposes such a basic government failing that officials are inspired to act immediately.

On July 12, 2009, a story with that rare combination of urgency and moral force landed on the doorsteps of Californians, published in the Los Angeles Times and jointly produced by the paper and the nonprofit newsroom ProPublica.

The story, headlined “Problem Nurses Remain on Job as Patients Suffer,” revealed that the board overseeing California’s 350,000 registered nurses had taken years to act on complaints of egregious misconduct, allowing nurses who had beaten patients, stolen drugs and fallen aslepp on the job to continue practicing. The result was easily avoidable pain, disability and even death.

The board’s abdication of responsibility surprised even some of the nurses who had neglected or abused their patients. “The nursing board is there to protect the public from me,” said one, astonished that he was able to keep his license after a string of assaults on patients.

Equally striking was the indifference of board officials to the reporters’ devastating findings. Confronted with an analysis drawn from their own data that shoes California was moving against troubled nurses much more slowly that other states, they insisted that little change was necessary or possible.

They were mistaken. On the Sunday the story appeared, one member of the six-person board resigned. On Monday, Gov. Arnold Schwarzenegger fired three more. The next day, the board’s executive director stepped down. In the ensuing weeks, state officials took an array of steps to stiffen oversight of nurses and other health professionals.

Schwarzenegger was clear about what prompted him to act: “It was from the L.A. Times,” he said, “that we got this.”

Like many other examples of great investigative reporting, this work has its roots in an earlier story. As reporters at The Times, Charles Ornstein and Tracy Weber had written about nurses at a public hospital in Los Angeles who turned down patients’ cardiac monitors, gave the wrong medications, ignored patients in distress and falsified records.

Almost five years later, they were surprised to find that many of those nurses were still licensed to practice. Was the Board of Registered Nursing protecting patients or protecting nurses? To find out, the reporters put the agency under the microscope.

Ornstein and Weber moved to ProPublica in 2008, but stayed on the story. Their new employer and their old one agreed to make the project a joint effort. Editors at ProPublica and The Times directed the reporting together. Staff members at the two organizations collaborated on photographs, informational graphics and online components. Times researcher Maloy Moore, a database specialist, made key contributions.

Analyzing nursing board statistics, Ornstein and Weber discovered that the board was taking more than three years on average to investigate complaints and take against errant nurses.

Did the delays endanger the public? The only way to find out was to look closely at individual cases. Not a handful. Not a year’s worth. But each of the more than 2,000 cases the board investigated from 2002 through 2008.

Among the key findings: Nurses with documented histories of incompetence, violence and drug thefts were able to practice without restrictions. The board had taken no action against more than 120 such nurses even after they were fired or suspended by employers, sanctioned by other states or disciplined by other California licensing boards.

The board also had lost track of hundreds of nurses it had placed on probation, and it did nothing when many of them committed fresh outrages. One nurse, who racked up complaints at three hospitals while keeping his license, told the reporters: “I was high some of the times that I was working. Yes, I was.”

Two weeks after that article first appeared, Onstein and Weber exposed the board failure to supervise nurses enrolled in a confidential rehabilitation program for substance abusers. For years, the reporters found, nurses in the program treated patients while intoxicated, stole pain medication and falsified records to cover their tracks.

Broadening their focus, Ornstein and Weber showed how temporary staffing agencies have become havens for unfit nurses, and how nurses sanctioned for serious misdeeds in one state are able to practice freely in others.

Complementing the stories were rich and varied online presentations at www.propublica.org and www.latimes.com. Four multimedia elements are part of this entry, including interactive graphics that show how rogue nurses hopscotched from hospital, and a searchable database of disciplinary action against California nurses.

Schwarzenegger was not the only one to take notice of the coverage. Newspapers across California published the July 12 article, some on their front pages, and several ran editorials demanding urgent action by the state. The continuing coverage had become required reading for nursing regulators nationwide.

The failure of professional boards to discipline bad doctors has been a hardy perennial of investigative reporting. But nurses also play a vital role in medical care, and a deep look at government oversight of their profession was long overdue.

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Photo by flickr user sparkieblues http://www.flickr.com/photos/sparkieblues/3971258497/

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