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Schwarzenegger Replaces Most of State Nursing Board

Liz O. Baylen/Los Angeles Times and John Moore/Getty Images

Correction (July 14, 2009): This story incorrectly referred to former Board of Registered Nursing vice president Elizabeth O. Dietz as a professor of nursing at San Jose State. Although the board’s web site lists that as her current affiliation, the university said she retired in July 2008.

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."

California Board of Registered Nursing executive officer Ruth Ann Terry (Liz O. Baylen/Los Angeles Times)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.

Is anyone surprised by the actions of those in the nursing “profession”... it is after all a closed union, much like the teachers union, the police union, the fire department union… all are designed to protect the incompetent/dishonest and to exclude those who wish to disturbe the seniority system… so goes America.  the result is what happened to the auto industry except in these above cases the local government has control and not the will to kick the bumbs out.  Good to see the Governor of California take the first punt.  Let’s see who else in government can do the same now that we have a new motive… i.e. a budget crisis of biblical proportions.

Nelson Robison

July 14, 2009, 8:22 a.m.

Having worked as an adjunct to the medical profession, (phlebotomist, drug counselor) I have seen the egregious and sometimes life-threatening conduct of the ‘all-powerful, all-knowing NURSE.’
Most times the nurses were doing their jobs to the best of their abilities and doing that job well, but then there are the cases where the nurse in charge, the duty nurse or the LPN, had such a Napoleonic power complex that even if you tried to do something you were overridden by that nurse.
In some cases there was egregious misconduct and even life threatening incidents with medication mistakes happening because the nurse in charge was over-worked and had not enough staffing to complete the overall care team.
We say America has the best overall health care system in the world, I disagree. With stories like this, it is hard to imagine an overworked and underpaid person even joining the nursing profession. Some of the nurses I have met could not read a doctors orders, could not explain medications and their effects on a patient and could not and should not have been allowed in the profession of nursing.
Given the state of our health care system and the problems with paying for health care, it seems time for sweeping change and change for the better in all areas surrounding the health care system. Single payer health care is the only option left to this administration, yet
they will not even admit anyone who claims to represent the people. We are lost in the quagmire of ‘insurance’ debacles and cannot afford the premiums to continue our coverage and health care even if we wanted to.

Speaking as a health care worker that has seen his share of bad nurses, I guess its good to see that people who do things wrong or engage in illegal activity can now be punished more effectively, but I wonder when anyone will take that same action in regards to the real scandel of the medical profession. I am speaking of the fact that in most states it takes an act of god for an MD to lose or even have his credentials threatened by state action. The saddest part is that in most cases where the Dr does leave the practice it is not by state action,rather it is by lawsuits and the Dr himself releasing his license to prevent further lawsuits. The dangerous part of that deal is that he is then free to move to another state and present his degree and get a new license without any problem or questions. So good job on taking care of the nurses who are illegal and bad and good luck avoiding the Dr’s that are drunk and illegal.

Curtis L. Walker

July 14, 2009, 11:51 a.m.

As a California tax payer with severe medical problems, the question that needs to be asked: Why was Governor Arnold S. asleep at the wheel while his own appointees apparently did nothing to address the problem or keep him advised? These appointees do not require Senate Conformation, so the BUCK or fault rests squarely at the feet of the Governor, not the Unions.

Perhaps the Governor was too busy trashing his own workforce, State Employees, and then California Agriculture community (over needed legislation that, for example, requires HONEY to be honey—as currently it can be honey and sugar but there is no requirement to label as FAKE HONEY and such, to pay attention to the mess that took media to uncover.

Asleep at the wheel! Wonder what the press will uncover next?

hey, Onepack:

This is not a union-related issue. If you go back and read the articles, you will realize that the issue is with a licensing board, which is very different from a union.

Furthermore, some CA nurses are unionized, some are not, and the argument you make is about the most tangential one you could have come up with.

Please go grind your axe somewhere else.

Curtis L. Walker

July 14, 2009, 5 p.m.

COBRA PUPIL: WELL SAID!

THE REALLY SCARY PART IS THESE FOLKS WHO ARE RESPONSIBLE TO THE GOVERNOR FOR THE SAFETY OF SO MANY CALIFORNIA FOLKS ARE PAID $100.OO PER MEETING; THEYT ARE NOT EVEN EMPLOYED BY THE STATE. NOW IF THAT IS NOT SCARY, NOTHING IS.

SEEMS TO ME THAT FOLKS WHO ARE RESPONSIBLE TO THE GOVERNOR AND CALIFORNIA PUBLIC SHOULD NOT BE NON-PAID APPOINTMENTS BY THE GOVERNOR BUT FOLKS WHO CAN BE HELD ACCOUNTABLE BY THE LEGISLATURE AND THE GOVERNOR (MEANING REAL OVERSIGHT) BUT WHO KNOWS IF THAT WILL EVER HAPPEN???

ANYWAYS, THANKS FOR POINTING OUT THE UNION TRASHING (AND I AM NOT A UNION MEMBER BECAUSE I CANNOT BE).

Eileen Sullivan

July 15, 2009, 11:21 a.m.

ProPublica is to be congratulated for bringing these heartbreaking stories to the public. How in heaven’s name could the nurses sitting on that board not have been moved enough to visit with those families and wronged patients to hear and actually see with their own eyes the damage inflicted on these human beings? To deny them the simply courtesy of a response is unconscionable. They should be made to sit down and view the stories and explain, if they can, their lack of affording these people a remedy for their suffering. As a registered nurse in Massachusetts, I extend to those injured my heartfelt apologies for those members of my profession who have violated the trust of patients who have every right to expect competence and accountability from their health care professionals. They should be ashamed of themselves.
I am glad that the Governor has replaced board members but also dismayed that the board is, once more, populated by registerd nurses. There should be a mix of health care professionals and, dare I say it, those not in the profession. I hope some action will be taken against the board members..where are the minutes of their meetings at which charges were discussed? More heads need to roll in this travesty before other incompetent health care givers either shape up or get out of the profession.

ROBERTO ALEJANDRO GLAUBACH

July 17, 2009, 3:06 p.m.

From ROBERTO ALEJANDRO GLAUBACH July 17, 2009 3:14 pm EDT

Mr Charles Ornstein:first of all thank you from the bottom of our souls.Thank you for having pay attention to Veronica´s case and let us collaborate in your investigation. You deserve each one and all the recognitions and important prizes you´ve got.The meticulosity with which you managed your work in Veronica´s case ,asking for every single documentation as witnesses reports,letters submitted to and received from the boards officers and investigators,med records,etc etc,are talking -without any single doubt -about a remarkable professionality .Bravo Charlie. you made big waves that will get arise big changes indeed. The “silent-hurted- majotity” I´m sure is applauding you effort to lift that awful and heavy black curtain which is (or was ?) veiling the true facts that conducted health care in California to the existing mess. It seems that the river sound announces water and,new refreshing air,because,paraphrasing Shakespeare,..something smells nasty in californian boards.Could be widely interesting and a good culmination of your “periodistic work of art” if you take an investigative look over the Medical Board of California. Perhaps you will get surprising findings. Let´s see how does the authorities of said Board accomplish its duties emerging from the 2005 Final Report of the Enforcement Program Monitor Project,suscribed by Julianne Felmeth and Tomas Papageorge.I am aware that perhaps,we are facing simply cosmetical changes. Perhaps now,as a direct consequence of your report,Veronica´s case and many other cases could be revised by the new authorities in order to establish the due responsibilities of involved wrongdoers. Thank you again.

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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