Update (July 14, 2009): Nursing Board Executive Officer Ruth Ann Terry Resigns
Gov. Arnold Schwarzenegger replaced most members of the California Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.
He fired three of six sitting board members – including President Susanne Phillips – in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.
The shake-up came a day after the Los Angeles Times and ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months to investigate and close complaints against nurses.
During that time, nurses accused of wrongdoing are free to practice – often with spotless records – and move from hospital to hospital. Potential employers are unaware of the risks, and patients have been harmed as a result.
Reporters found nurses who continued to work unrestricted for years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse. In dozens of cases, nurses maintained clean records in California even though they had been suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states.
"It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being," Schwarzenegger said in a written statement.
Board member Andrea Guillen Dutton, in a resignation letter Sunday, said she was leaving in frustration. "Certain ‘bad actors' are jeopardizing the reputation of the entire nursing profession," she wrote. "This deeply saddens me."
"I have fought to defend the integrity of patient care throughout the state by holding the negligent accountable," she wrote. "However, I have grown increasingly frustrated by the board's lack of ability to achieve its stated objectives in a timely and efficient manner."
Besides Phillips, the other fired board members were vice president Elizabeth O. Dietz, a former professor of nursing at San Jose State, and Janice Glaab, a public affairs consultant.
Schwarzenegger's action Monday fills two of three vacancies on the board and replaces four of the board's sitting members – all of whom had been appointed by him. The two remaining members are Nancy L. Beecham, appointed by the governor in 2006, and Dian Harrison, who was appointed last year by Assembly speaker Karen Bass.
Neither Beecham nor Harrison could be reached late Monday, nor could any of the departing board members.
Schwarzenegger's statement said his "administration is dedicated to protecting public health and safety, and the new board will act quickly and decisively to achieve that goal."
Fred Aguiar, secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. "This plan needs to include how many more investigators are needed, how much that will cost. … I want to know now."
The governor's decision does not directly affect the standing of Ruth Ann Terry, who has been the board's executive officer for nearly 16 years and a staff member for 25. Only the board has the power to hire and fire the executive.
Terry, reached late Monday, hung up on a reporter, saying, "We don't have anything to say."
But Aguiar suggested Monday that Terry and other staffers could be vulnerable. The governor "supports the new board in its commitment to protecting patients – and if that means cleaning house, including board staff, so be it," he said. "The days of excuses and status quo are over. It's broken and we're going to fix it."
The Times and ProPublica found that the board relied heavily on Terry and her staff. At five public meetings attended by reporters since November 2007, Terry never focused on the delays in disciplining errant nurses. Neither did board members, even though they must vet all disciplinary actions.
In an interview last week, Terry acknowledged that the system needed to be "streamlined" but blamed other parts of the state's bureaucracy for delays.
Early Monday, Terry and her assistant executive officer, Heidi Goodman, sent an e-mail to all board staff members encouraging them not to lose heart.
"Ruth and I are aware of the grim picture painted by this article," they wrote, "however, the board members, managers and supervisors know that you work very hard to carry out the mission of the board to protect the healthcare consumers in California and we appreciate all that you do."
Presented with the investigation's findings Thursday, board President Phillips, a family nurse practitioner and associate clinical professor at UC Irvine, said she supported Terry "absolutely – without question."
"The issue of patient safety is of the utmost importance to this board," she said. "It's not that we are ignoring a situation where there are delays. We absolutely are not."
Questions about the board's leadership were first raised last fall when The Times and ProPublica reported that nurses with serious or multiple criminal convictions kept their licenses for years before the board acted against them. As a result, the board now requires every nurse to submit fingerprints, which can be matched against arrest records. Renewing nurses must also disclose any convictions or discipline by other states.
In addition to the governor's action, the state Senate Business and Professions Committee, which has jurisdiction over the board, plans to hold a hearing next month to address the issues raised in The Times' article.
The committee will look at introducing legislation that would appoint an "enforcement monitor" to evaluate the board's discipline process and make recommendations, said Bill Gage, the committee's chief consultant. Such a monitor was appointed at one time to work with the Medical Board of California, which regulates the state's doctors.
Consumer advocate Ken McEldowney said the board members need to do more than just fill seats.
"The leadership is key," said McEldowney, executive director of Consumer Action, a San Francisco-based national consumer advocacy and education membership organization. "It just appears to me that they don't care."
The six new board members are: Ann Boynton, 47, of Sacramento, a former undersecretary for the Health and Human Services Agency; Judy Corless, 58, of Corona, a clinical nursing director at the Corona Outpatient Surgical Center since April 2009; Jeannine Graves, 49, of Sacramento, a staff nurse for the Capitol Surgical Associates and the Mercy San Juan Medical Center; Richard Rice, 60, of Imperial Beach, a former chairman of the Unemployment Insurance Appeals Board; Catherine Todero, 57, of La Mesa, director of the school of nursing at San Diego State University and a professor there; and Kathrine Ware, 50, of Davis, a nurse practitioner for the Vascular Center Clinic at the University of California Davis.
These positions do not require Senate confirmation, and the compensation is $100 per working day.