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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.

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