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Unions Take Fire at Bill to Revamp California Health Care Oversight

Labor unions representing California nurses are attacking key parts of a bill that would overhaul the state’s system for investigating and disciplining health workers accused of misconduct.

Nurses unions are raising objections to an overhaul proposed by Gov. Arnold Schwarzenegger to California's system of investigating and disciplining health workers.Labor unions representing California nurses are attacking key parts of a bill that would overhaul the state’s system for investigating and disciplining health workers accused of misconduct.

The objections by the politically powerful California Nurses Association, Service Employees International Union and groups for other health professions come days before a state Senate panel is set to vote on moving the bill forward.

Among the proposed reforms are safeguards that would bring California in line with other states, such as requiring that employers report workers who are fired or suspended for serious wrongdoing and allowing a top state official to quickly suspend workers who pose a threat to the public.

Gov. Arnold Schwarzenegger has made fixing the system a priority since ProPublica and the Los Angeles Times reported in July that dangerous and incompetent nurses were able to keep practicing for years despite accusations of misconduct, abuse or neglect.

In the days after the report, the governor replaced the majority of the Board of Registered Nursing, the agency’s executive officer resigned and officials pledged to take whatever action was needed to address the delays.

Schwarzenegger declined to answer questions about the bill this week, but a spokesperson said he remains committed to the reforms.

Should it pass, the measure’s impact would be far-reaching, largely standardizing the disciplinary process for the state’s 1 million licensed health care professionals, including dentists, psychologists, chiropractors and others. The registered nursing board oversees the largest number of licensees, more than 350,000.

In letters to the Senate committee set to consider the bill Monday, union officials say they support many elements of the bill, including efforts to speed up the disciplinary process and give the nursing board the power to hire its own investigators. They also raise no opposition to new rules that would bar convicted sex offenders from holding licenses and suspend the licenses of incarcerated practitioners.

But the letters object to some of the bill’s core reforms, saying they would erode the due process that health workers deserve before any action is taken against them.

The bill "creates problems for licensed health professionals without improving patient safety," wrote Bill Lloyd, acting executive director of SEIU’s California State Council. SEIU represents doctors, nurses, respiratory therapists, and many more workers in non-health fields.

In an interview, Bonnie Castillo, director of government relations for the California Nurses Association, criticized the bill’s author for working with the Schwarzenegger administration, a longtime foe of the nurse’s union, instead of with caregivers themselves.

"What they ended up with was a mishmash of a bill that really doesn’t get to what the stated aim of this bill was," Castillo said.

The measure’s chief sponsor, Sen. Gloria Negrete McLeod, a Democrat who chairs the Senate Committee on Business, Professions and Economic Development, said that given the pressure, she doesn’t know if she has the votes to advance it. Elements under attack by the unions are crucial to revamping the oversight system, she said.

"We just want to make sure that the consumer gets protected. That’s my issue, that’s my aim, that’s my goal," Negrete McLeod. "You can never make everybody happy. You just hope that you have the votes."

Unions have taken particular aim at the mandatory reporting requirement, which would oblige employers to notify regulators when workers have been fired or suspended for serious problems such as drug abuse, gross negligence, physically harming a patient or sexual wrongdoing.

Many states already require such reporting as a way to flag potentially dangerous caregivers for investigation. Currently, nursing boards in 36 states require notification, according to the National Council of State Boards of Nursing. The agency that oversees California’s vocational nurses already does so, and language in the new bill effectively adopts the same policy.

The nurses association, with a membership of 86,000, said it opposes mandatory reporting because it could punish whistleblowers who believe they were unfairly dismissed by their employers.

"RNs are required by law to advocate in the sole interest of the patient, which many times puts them in conflict with their employers," union lobbyist Kelly Green wrote this week (PDF).

State officials say quickly learning about terminated workers is a key component of the bill, SB 1111 (PDF), because it would greatly expand their ability to learn of problem caregivers. Such cases would still have to be investigated before any public action could be taken, said Brian Stiger, director of the state Department of Consumer Affairs, which oversees all 19 health licensing boards.

"All of our boards need to have a heads up about any licensee that may be harming consumers," Stiger said.

The unions and professional associations also object to a plan that could close state-run recovery programs for substance abusing health professionals. Currently, some addicted caregivers can avoid license sanctions by taking part in a confidential "diversion" program of drug testing, treatment and restrictions on their practice.

ProPublica and the Times detailed last summer how the program for addicted nurses was largely unsuccessful and had failed to quickly take action when nurses flunked out and were internally labeled "public safety threats."

The bill would set a sunset date by which the Legislature would have to renew the programs, or they would close.

"This change would treat providers with substance abuse problems in a manner that is so contrary to what we know, which is that rehabilitation is possible," wrote Michelle Rivas (PDF), a lobbyist for the California Dental Association.

Ann Boynton, president of the Board of Registered Nursing, said creating a deadline for improving – or closing – the diversion program makes sense. "If a determination is made with the administration and the Legislature that a program is no longer effective at protecting the public, then it needs to be eliminated."

The objections by the unions pose a quandary for lawmakers, particularly Democrats, who routinely receive contributions from organized labor. The California Nurses Association Political Action Committee, for example, doled out more than $300,000 in the first three months of this year, on top of $359,000 last year and $1.3 million in 2008, according to filings with the state.

Among their recipients so far this year are Negrete McLeod, the bill’s author, and at least three other committee members. Negrete McLeod said she gets money from many sources and it hasn’t affected her position on this issue.

Many of the provisions that unions object to would alter a system that state officials say has protected the interests of health workers more than the public. These changes include giving the director of the Consumer Affairs Department the power to temporarily suspend the licenses of professionals who pose a threat to the public. In Ohio, Louisiana, Virginia and Florida, for example, the heads of the nursing boards or other officials have such powers.

Currently in California, even if a caregiver is thought to be a serious risk to the public, state officials must go through a cumbersome legal process and get a judge’s permission to stop the person from practicing, even temporarily.

ProPublica and The Times reported last year that the Board of Registered Nursing had obtained emergency suspensions just 29 times from 2002 to 2007. By contrast, Florida's nursing regulators, who oversee 40 percent fewer nurses, take such action more than 70 times each year.

The California Nurses Association, the American Nurses Association California and several groups representing mental health professionals oppose giving more authority to the consumer affairs director, saying he is a political appointee and may not be qualified to make such determinations.

But Stiger said current practices leave gaps that have to be addressed. "We need to have the authority as the department to remove dangerous licensees from practice as quickly as we possibly can," he said.

The unions have feuded with Schwarzenegger’s administration for years. More recently they have criticized him for borrowing money from health licensing agencies and furloughing their staffs. The boards do not rely on the cash-strapped general fund but instead receive their money from licensing fees.

The nurses union’s Castillo said her organization is open to negotiation but would not back down if changes to the bill are not satisfactory. "This is a full court press for us because, obviously, our whole membership is affected by this," she said.

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