- Joined
- Jul 1, 2009
- Messages
- 2,987
- Reaction score
- 6
so......maybe we should file a missing persons report? 
LA Times report on nursing board
- Thread starter Taurus
- Start date
- Joined
- Apr 1, 2004
- Messages
- 2,180
- Reaction score
- 16
What??? I thought this was commonplace...like every other post.
D
deleted6669
you know in at least 1 lap through his day bill murray kills the groundhog when he drives over a cliff in a truck with it.(movie trivia- that was a real groundhog in that scene and it bit bill).
anyone see zombieland? bill gets the short end of the stick then too.....
- Joined
- Oct 7, 2006
- Messages
- 22,382
- Reaction score
- 4,329
(off topic: I have been meaning to see zombieland...it looks great!)
- Joined
- Jun 30, 2002
- Messages
- 2,394
- Reaction score
- 532
There's really no need for this thread as it's primarily a one-member diatribe against a profession he disrespects. I'd wager that if the tables were turned I would have my account put on hold/be banned.
I'm not criticizing you, I'm just saying that I think the thread is no longer serving a useful purpose, other than fomenting discord.
- Joined
- Apr 1, 2004
- Messages
- 2,180
- Reaction score
- 16
I think it's therapeutic for the un-named person as it might change habitual patterns of behavior.
- Joined
- Jun 30, 2002
- Messages
- 2,394
- Reaction score
- 532
I think it's therapeutic for the un-named person as it might change habitual patterns of behavior.
I think a wrench will always be a wrench. If you get my meaning.
- Joined
- Nov 15, 2007
- Messages
- 69
- Reaction score
- 0
Just an update for anyone wondering exactly HOW the California nursing board is looking to revamp their system to keep a better eye on errant drug and/or alcohol addicted nurses----well, there's good news for us ALL.
CA legislators decided that every board that licenses folks will need to come up w/a more stringent way to run their disciplinary and rehabilitation programs and so now there will be one set of rules that apply to all---RN, MD/DO, PA, etc...(basically all health licensees)
IMHO, theyve gone a tad overboard and are now throwing the baby out w/the bathwater. Among the more punitive changes that will now be in effect:
Once 'suspected' of misuse/abuse, license is immediately suspended for minimum of one month--during which time you will take 3-5 drug tests a week(at your expense) and undergo psych evaluation.
--My problem w/this is the wide open criteria they've left for 'suspician'--anonymous reports vs. reasonable evidence--no guidance there at all and I think at least the nurses here might conceive of the danger in that. Also, keep in mind that any DUI/Drunk in public or any other legal involvement will automatically place you under this heading as well. So, no work, no $$(except that which you'll be shelling out), no exceptions.
If you should find yourself having a problem w/substances and do wish to seek help, regardless of whether you've actually done anything first (divert, DUI, anything) if you self refer yourself for help your name will be placed on the board's website for the duration of any agreement, which could be years. This is a new requirement for all boards.
--My issue here is the potential that many who realize they might be heading down a slippery slope will not come forward anymore because there will now be both a public stigma attached and a heavy $$$ consequence. Remember, this applies to ALL boards and while 3-5 drug tests a week for 1+ year(this is for those who do need it after the first mandatory month that everyone is subject to) may be affordable to some, there are certain professions who at some point are going to be 'cost out' of attempting to do the right thing. Better to wait 'till something happens?
--Specific exclusion of using an MRO when in program--meaning ANY positive test is automatic revocation of license or restart your time clock. If you had a DUI and later hurt your back and are prescribed opiates--doesn't matter--you fail. Prescriptions now entirely irrelevant(and this can be, for some, for up to 3-5 years). Ridiculous...
I don't personally have addiction issues but sure know many who do. I also never discount that it could also one day apply to me. These new standards--and they are written to specifically allow no wiggle room for varying circumstances--just don't sit right with me.
They're all up at the CA Board of Consumer Affairs if you care to check it out.
Btw, I watched a couple of the meetings and the guy from the Chiropractic Board was truly just the biggest douche ever....
CA legislators decided that every board that licenses folks will need to come up w/a more stringent way to run their disciplinary and rehabilitation programs and so now there will be one set of rules that apply to all---RN, MD/DO, PA, etc...(basically all health licensees)
IMHO, theyve gone a tad overboard and are now throwing the baby out w/the bathwater. Among the more punitive changes that will now be in effect:
Once 'suspected' of misuse/abuse, license is immediately suspended for minimum of one month--during which time you will take 3-5 drug tests a week(at your expense) and undergo psych evaluation.
--My problem w/this is the wide open criteria they've left for 'suspician'--anonymous reports vs. reasonable evidence--no guidance there at all and I think at least the nurses here might conceive of the danger in that. Also, keep in mind that any DUI/Drunk in public or any other legal involvement will automatically place you under this heading as well. So, no work, no $$(except that which you'll be shelling out), no exceptions.
If you should find yourself having a problem w/substances and do wish to seek help, regardless of whether you've actually done anything first (divert, DUI, anything) if you self refer yourself for help your name will be placed on the board's website for the duration of any agreement, which could be years. This is a new requirement for all boards.
--My issue here is the potential that many who realize they might be heading down a slippery slope will not come forward anymore because there will now be both a public stigma attached and a heavy $$$ consequence. Remember, this applies to ALL boards and while 3-5 drug tests a week for 1+ year(this is for those who do need it after the first mandatory month that everyone is subject to) may be affordable to some, there are certain professions who at some point are going to be 'cost out' of attempting to do the right thing. Better to wait 'till something happens?
--Specific exclusion of using an MRO when in program--meaning ANY positive test is automatic revocation of license or restart your time clock. If you had a DUI and later hurt your back and are prescribed opiates--doesn't matter--you fail. Prescriptions now entirely irrelevant(and this can be, for some, for up to 3-5 years). Ridiculous...
I don't personally have addiction issues but sure know many who do. I also never discount that it could also one day apply to me. These new standards--and they are written to specifically allow no wiggle room for varying circumstances--just don't sit right with me.
They're all up at the CA Board of Consumer Affairs if you care to check it out.
Btw, I watched a couple of the meetings and the guy from the Chiropractic Board was truly just the biggest douche ever....
- Joined
- Jun 30, 2002
- Messages
- 2,394
- Reaction score
- 532
I'm not sure why you're worried, Miss Mab. It's not like nursing is filled with bitter, vindictive people just waiting for an opportunity to get back at someone who looked at them the wrong way during shift report.
- Joined
- Jun 30, 2002
- Messages
- 2,394
- Reaction score
- 532
Well, you know what they say in The Life of Brian
"Always look on the bright side of life..."
"Always look on the bright side of life..."
- Joined
- Apr 19, 2003
- Messages
- 366
- Reaction score
- 35
ha ha ha...this thread is so funny! I thought I was the only licensed troll in town but someone beats me to it. Thanks friend for running with the baton.
- Joined
- Jul 27, 2004
- Messages
- 3,218
- Reaction score
- 663
I give those journalists credit for being aggressive and not letting a good story die. I hope they eventually do a story about the deception that the nurses are trying to pull on the public regarding the DNP.
Temp firms a magnet for unfit nurses
With scant regulation and some agencies' poor screening, workers can hopscotch from job to job.
By Tracy Weber and Charles Ornstein
December 6, 2009
Firms that supply temporary nurses to the nation's hospitals are taking perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers.
Emboldened by a chronic nursing shortage and scant regulation, the firms vie for their share of a free-wheeling, $4-billion industry. Some have become havens for nurses who hopscotch from place to place to avoid the consequences of their misconduct.
An investigation by the nonprofit newsroom ProPublica and the Los Angeles Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.
As a result, fill-in nurses with documented histories of poor care have fallen asleep on the job, failed to perform critical tests or stolen drugs intended to ease patients' pain or anxiety.
"A lot of them are really bad nurses," said Sandra Thompson, a nursing supervisor at Northridge Hospital Medical Center and Sherman Oaks Hospital, both in the San Fernando Valley. "Sometimes I see them here [at Northridge] and think, 'I wonder how long before I see them over' " at Sherman Oaks?
Some agencies are diligent about checking nurses' records, said Joey Ridenour, executive director of the Arizona State Board of Nursing.
Others are not. As a result, if wayward nurses want to work, "I think it's easier to hide in the registries," Ridenour said. "Some just sign them up."
Among reporters' findings, based on disciplinary records, personnel files, court documents and interviews:
* Firms hired nurses who had criminal records or left states where their licenses had been restricted or revoked. At least three firms employed a nurse in California whose license had been suspended in Minnesota for stealing drugs at a string of temp jobs. One used him after he'd been convicted of doing the same thing at a Santa Rosa nursing home.
* Temp agencies shuffled errant nurses from one hospital to another, even as complaints mounted. A Culver City agency continued sending one nurse to hospitals despite more than a dozen warnings that she was ignoring her patients and sleeping on the job. Before she was hired, the nurse had been convicted of 12 crimes, including prostitution, carrying a concealed weapon and possessing cocaine.
* Nurses who got in trouble at one agency had no problem landing a job at another. An Oklahoma nurse cycled through at least four Southern California agencies in a year, accused of pilfering drugs while at each. Before her final stop, she was arrested in her home state for calling in prescriptions while posing as a doctor's office employee.
Failings in the temp industry are magnified in states like California, where nurses are in particularly short supply. Almost every facility, from rural medical outposts to prestigious hospitals, must rely on temporary help.
Nearly 6% of registered nurses licensed in California -- or about 19,300 people -- are temps, based on a 2008 survey commissioned by the state. About half of these nurses live in other states.
Here, oversight of nurses in general has been weak. A Times/ProPublica investigation in July found years-long delays in disciplining nurses accused of serious misconduct. Regulators say they are working to fix the problems. Still, California's registered nursing board is among a minority that does not require hospitals, agencies or anyone else to report even serious lapses by nurses, including temps.
When staff nurses err, hospitals typically retrain or monitor them afterward. Temp nurses often are just exchanged for replacements, never receiving further guidance.
Industry executives and healthcare administrators say the firms are invaluable to hospitals and nursing homes, filling in for nurses who are sick or on strike and helping in swamped emergency rooms.
Nurses find the jobs attractive because they can see the country and control their schedules -- all while collecting premium wages, bonuses and sometimes travel and living expenses. Some work locally while others are employed by "travel" firmsthat send them all over the country. (They must have licenses in states where they work.)
"There are very good people who work registries who do not want to be tied to anything regular," said Katherine Eaves, chief nursing officer at Riverside County Regional Medical Center. "There's another group of people who are working registries because, guess what? They can't work anywhere else."
Many agencies leave it to applicants to reveal previous problems. Using multi-page checklists, they are asked to rate themselves on how well they manage critical care patients, use complex equipment and administer drugs.
Some nurses admit lying on applications or withholding information from their employers.
Raphael Obiora was hired by an agency despite allegations of drug thefts that were fully detailed on the California nursing board's website. Once on staff, he admits, he did not tell the agency when the board placed him on probation.
He said it was up to his agency to verify his credentials.
"I don't have to tell you nothing," he said. "You have to check."
A trail of complaints
In trouble in her home state of North Carolina, nurse Beverley Cathey saw an opportunity out West.
The day after Cathey applied at EZ Staffing in Glendale, she was on the job.
She said on her application in July 2007 that she was qualified to work in critical care units, tending to a hospital's sickest patients.
It didn't take long before hospitals disagreed.
Cathey "sat at the nurse's station most of the time not doing anything," a supervisor at Northridge Hospital Medical Center complained in August 2007, according to EZ Staffing records reviewed by reporters. "Not up to our standards for ER," wrote a nurse from Huntington Memorial Hospital in Pasadena the following week.
The then-57-year-old nurse gave inaccurate patient information to colleagues and failed to perform an electrocardiogram as ordered for a patient with an abnormally fast heart rate, the records show.
In August and September 2007 alone, four hospitals filed six complaints against her, according to the firm's records, including three by Huntington.
The next month EZ Staffing contacted North Carolina's Board of Nursing to check on her license: Cathey, it turned out, was on probation. One condition was that she not work at a staffing agency.
While a temp nurse at a North Carolina hospital, she'd failed to account for drugs she'd signed out, falsified records and provided negligent care, according to the North Carolina board's allegations. These records had been posted on the board's public website since December 2006.
Asked for comment, Cathey said in an e-mail that the accusations against her were "not valid or creditable."
Abraham Abirafeh, who started EZ Staffing in 1991, did not respond to questions about the case and accused a reporter in e-mails of trying to harm EZ's reputation.
In November 2007, the North Carolina board indefinitely suspended Cathey's license. Twenty-one months later, California regulators initiated formal proceedings against her license.
While her case winds its way through the disciplinary process, Cathey remains free to accept temp jobs in California.
Easy profits touted
Dee Patrick recalls sitting in a box at the Kentucky Derby some years ago exchanging pleasantries with a couple next to her. She told them about her Phoenix temp business -- how, as a veteran nurse, she'd built it from scratch in the mid-1980s when virtually no one was doing it.
Six months later, Patrick said, she was shocked when the woman called to say, "Hey, we opened up one of those businesses."
"They have no background in nursing," said Patrick. "They don't have to know anything."
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
Dozens of Internet sites tout the easy profits and hawk how-to guides for as low as $69.95.
"Be One among the Millionaires, Start Your Own Nursing Agency," trumpets one site. "You will be up and running in a week," promises another. "You don't have to be a nurse to start your own Nurse Agency," assures a third.
Agencies range from those run on dining room tables to publicly traded companies. They open and close, merge, swap staffs and change locations. Standards for screening vary widely.
Recruiters sometimes poach on one another's rosters. One Los Angeles agency alleged in court papers last year that a rival firm's employee had joined its staff, stolen its list of employees and salaries, and then returned to her old firm.
Many agencies allow applicants to take competency tests online. Testifying in a malpractice lawsuit earlier this year, an official at Fastaff, a large traveling-nurse firm based in Colorado, said applicants have been hired without even a phone interview. References weren't contacted "unless it was out of the ordinary," she said.
Some healthcare institutions say they interview and check the credentials of every temp nurse. Others say they don't, particularly in a crunch. "Clearly we have no time -- we have to count on them," said Fred Benson, administrator of Santa Rosa Convalescent Hospital in Northern California.
It hasn't always worked out. He recalled that two temp nurses at his facility took the keys to a drug cabinet.
Unlike hospitals and nursing homes, which are inspected regularly, temp firms aren't accountable to anyone but their clients. Mark Stagen, president of the National Assn. of Travel Healthcare Organizations, acknowledged the need for improvement.
Companies' standards can be "loose or nonexistent," allowing poor-performing nurses to easily "game the system," said Stagen, head of a Marina del Rey travel firm.
Reporters asked 12 public entities that run hospitals in California whether they had audited firms that supplied them with nurses. Only five had done so in the last three years.
Last year Los Angeles County health staffers went through the files of 29 agencies seeking to provide nurses to its public hospitals. Most of the firms lacked key documents, including evidence of tuberculosis screenings or proof that nurses had current licenses. One agency had 90 missing or invalid records, another 63.
The lapses were "surprising," said Vivian C. Branchick, director of nursing affairs for the county Department of Health Services. "They know -- and they've known it all along" -- what the standard is.
All of these firms were allowed to correct their shortcomings and won county business.
In late 2006, the county audited Reliable Health Care Services in Culver City, which had received $8.9 million for temp services during the previous fiscal year.
The audit found that Reliable had "forged" results of tuberculosis skin tests, physical exams and CPR training cards, which "jeopardized the safety of county patients." Reliable also made "false and misleading statements," the audit said, citing a general "lack of trustworthiness and integrity."
After the county terminated the Reliable contract, the firm filed a claim alleging libel, breach of contract and fraud. As part of a settlement, the county agreed not to formally bar the agency from county work, and Reliable agreed not to seek any for 10 years.
A lawyer for the firm called the county's allegations baseless.
Seal of approval
Some in the industry say staffing firms already have an able watchdog.
Since 2004, the Joint Commission, better known for accrediting hospitals, has been reviewing healthcare staffing firms. The national organization bestows its seal of approval on those that meet standards for screening applicants, following up on complaints and ensuring competency.
This seal is displayed prominently on firms' websites. Some hospitals will use only agencies that have it.
But the program is voluntary and used by a minority of temp agencies -- 337 firms -- in part because they must pay the commission thousands of dollars to be reviewed. Most of the largest firms are certified.
The commission doesn't release detailed findings on the firms, even to hospitals. It has withdrawn its seal of approval from temporary staffing agencies seven times this year -- all but once for nonpayment of fees.
At the same time, firms that display the seal have been cited in audits, nursing board records and court files for bad judgment or behavior.
Joseph Baiden, owner of JFB Staffing in Diamond Bar, was arrested in August on charges of defrauding the state workers' compensation fund of $1.4 million by misrepresenting the number of nurses on his payroll.
Some hospitals cut ties with JFB, and authorities froze Baiden's bank accounts and seized his property.
Although Baiden has pleaded not guilty, his attorney Tracy Green said that she is working toward a resolution with the district attorney's office and that Baiden plans to repay whatever he owes.
In the meantime, on the Joint Commission's website, there is a gold seal of approval by the JFB name.
Problems no barrier
Paystaff Pacific not only hired nurse Raphael Obiora in 2007 despite his troubled past, it also kept sending him out when it learned he wasn't a skilled nurse, documents show.
In a little more than a year, seven hospitals rejected Obiora, telling Paystaff he'd made a medication error, failed to follow a doctor's order and been "inappropriate" with a patient's relative.
Hospital managers use such rejection notices, known as "Do Not Sends," to alert agencies to the shortcomings of temp nurses. But the agencies are under no obligation to act on the information.
In April 2008, the Monterey Park firm dispatched Obiora to Garfield Medical Center. There, he failed to adequately monitor the vital signs of two critically ill patients. His conduct was "unsafe," wrote Simon Marcus, the hospital's critical care director, on a form he sent to Paystaff.
Unknown to the hospital, Paystaff had already evaluated Obiora and found his competence to be below average. Shortly before he was sent to Garfield, the firm had determined that he should be fired immediately, according to agency records that became part of a regulatory proceeding.
Only after Marcus raised an alarm did Paystaff fire Obiora.
Hugh Wu, a Paystaff official, said in an e-mail that the company acted responsibly. Other complaints about Obiora were not as serious as Garfield's, he said, and Obiora had hidden state nursing board discipline against his license.
Obiora, an evangelist who preaches at a Celestial Church of Christ in Gardena, ultimately lost his California license.
Marcus said his experience with Obiora "makes you wonder" about temp nurses. "Have they made errors elsewhere? Who is monitoring them?"
Some temp firms indicated that they don't use a nurse again if they feel at all uneasy. "We just don't want to take the risk," said Jim Essey, who runs a New York-based temp agency and is a former chairman of the American Staffing Assn., an industry trade group.
Other agencies say most rejections stem from picayune problems, such as tardiness and personality clashes.
But data provided by public hospitals show this isn't necessarily so.
According to Riverside County Regional Medical Center, for example, more than 60% of the 339 temp nurses rejected since 2003 failed to demonstrate basic nursing skills on the job. Arrowhead Regional Medical Center, San Bernardino County's public hospital, reported that it had rejected 61 temp nurses since 2005 -- more than half for performance problems.
Hospitals sometimes lose track of which nurses they have already booted. A nurse can be red-flagged by one unit and later sent to another.
At Lakewood Regional Medical Center in March 2008, temp nurse Kelvin Brown was found in a deep sleep at the nurses' station on a ward of patients hooked up to monitors.
He was roused but later fell asleep in a patient's room. Awakened again, he dozed off in the break room. Asked to leave the hospital, he made it as far as the intensive care waiting room before slipping into sleep once more. He left after security called police, according to the nursing board's December 2008 accusation against him.
A supervisor later discovered that Brown had had problems at the hospital before. He had fallen "heavily asleep on every shift and exhibited behavior -- such as talking to and answering himself aloud -- that made staff uncomfortable," the accusation said.
In fact, Brown had been placed on the hospital's "Do Not Return" list while working for another agency for such reasons, the document states.
A spokesman for Tenet Healthcare Corp., Lakewood's parent, confirmed that Brown had worked at the hospital before but disputed the state's account that he'd been previously barred from working there.
Brown could not be located for comment.
In another case, St. Jude Medical Center in Fullerton informed MedStaff Healthcare Solutions in March 2007 that it suspected nurse Donald Paradise of stealing drugs and asked that he never return, a hospital spokesman said. Six months later, Paradise was accused of stealing drugs at a sister hospital, where he also had been sent by MedStaff.
"It's absolutely not acceptable," said Kevin Andrus, a spokesman for St. Joseph Health System, which includes St. Jude.
MedStaff's contract, he said, prohibited it from sending a rejected nurse back to any hospital in the chain, but Andrus conceded that the chain doesn't keep a master list, as some entities do.
A spokesman for MedStaff said that Paradise had passed a drug screening after the St. Jude incident and that the hospital had indicated it was satisfied with that. Andrus says that was not so.
Paradise, who faces a nursing board accusation, could not be reached for comment.
In interviews, several temp nurses who had been in trouble said their employers focused more on keeping slots filled than on who filled them.
That was a lifeline for Obiora.
The agencies "just send and send and send and send," he said.
[email protected]
charles.ornstein @propublica.org
Lisa Schwartz, director of research at ProPublica, contributed to this report.
Copyright © 2009, The Los Angeles Times
With scant regulation and some agencies' poor screening, workers can hopscotch from job to job.
By Tracy Weber and Charles Ornstein
December 6, 2009
Firms that supply temporary nurses to the nation's hospitals are taking perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers.
Emboldened by a chronic nursing shortage and scant regulation, the firms vie for their share of a free-wheeling, $4-billion industry. Some have become havens for nurses who hopscotch from place to place to avoid the consequences of their misconduct.
An investigation by the nonprofit newsroom ProPublica and the Los Angeles Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.
As a result, fill-in nurses with documented histories of poor care have fallen asleep on the job, failed to perform critical tests or stolen drugs intended to ease patients' pain or anxiety.
"A lot of them are really bad nurses," said Sandra Thompson, a nursing supervisor at Northridge Hospital Medical Center and Sherman Oaks Hospital, both in the San Fernando Valley. "Sometimes I see them here [at Northridge] and think, 'I wonder how long before I see them over' " at Sherman Oaks?
Some agencies are diligent about checking nurses' records, said Joey Ridenour, executive director of the Arizona State Board of Nursing.
Others are not. As a result, if wayward nurses want to work, "I think it's easier to hide in the registries," Ridenour said. "Some just sign them up."
Among reporters' findings, based on disciplinary records, personnel files, court documents and interviews:
* Firms hired nurses who had criminal records or left states where their licenses had been restricted or revoked. At least three firms employed a nurse in California whose license had been suspended in Minnesota for stealing drugs at a string of temp jobs. One used him after he'd been convicted of doing the same thing at a Santa Rosa nursing home.
* Temp agencies shuffled errant nurses from one hospital to another, even as complaints mounted. A Culver City agency continued sending one nurse to hospitals despite more than a dozen warnings that she was ignoring her patients and sleeping on the job. Before she was hired, the nurse had been convicted of 12 crimes, including prostitution, carrying a concealed weapon and possessing cocaine.
* Nurses who got in trouble at one agency had no problem landing a job at another. An Oklahoma nurse cycled through at least four Southern California agencies in a year, accused of pilfering drugs while at each. Before her final stop, she was arrested in her home state for calling in prescriptions while posing as a doctor's office employee.
Failings in the temp industry are magnified in states like California, where nurses are in particularly short supply. Almost every facility, from rural medical outposts to prestigious hospitals, must rely on temporary help.
Nearly 6% of registered nurses licensed in California -- or about 19,300 people -- are temps, based on a 2008 survey commissioned by the state. About half of these nurses live in other states.
Here, oversight of nurses in general has been weak. A Times/ProPublica investigation in July found years-long delays in disciplining nurses accused of serious misconduct. Regulators say they are working to fix the problems. Still, California's registered nursing board is among a minority that does not require hospitals, agencies or anyone else to report even serious lapses by nurses, including temps.
When staff nurses err, hospitals typically retrain or monitor them afterward. Temp nurses often are just exchanged for replacements, never receiving further guidance.
Industry executives and healthcare administrators say the firms are invaluable to hospitals and nursing homes, filling in for nurses who are sick or on strike and helping in swamped emergency rooms.
Nurses find the jobs attractive because they can see the country and control their schedules -- all while collecting premium wages, bonuses and sometimes travel and living expenses. Some work locally while others are employed by "travel" firmsthat send them all over the country. (They must have licenses in states where they work.)
"There are very good people who work registries who do not want to be tied to anything regular," said Katherine Eaves, chief nursing officer at Riverside County Regional Medical Center. "There's another group of people who are working registries because, guess what? They can't work anywhere else."
Many agencies leave it to applicants to reveal previous problems. Using multi-page checklists, they are asked to rate themselves on how well they manage critical care patients, use complex equipment and administer drugs.
Some nurses admit lying on applications or withholding information from their employers.
Raphael Obiora was hired by an agency despite allegations of drug thefts that were fully detailed on the California nursing board's website. Once on staff, he admits, he did not tell the agency when the board placed him on probation.
He said it was up to his agency to verify his credentials.
"I don't have to tell you nothing," he said. "You have to check."
A trail of complaints
In trouble in her home state of North Carolina, nurse Beverley Cathey saw an opportunity out West.
The day after Cathey applied at EZ Staffing in Glendale, she was on the job.
She said on her application in July 2007 that she was qualified to work in critical care units, tending to a hospital's sickest patients.
It didn't take long before hospitals disagreed.
Cathey "sat at the nurse's station most of the time not doing anything," a supervisor at Northridge Hospital Medical Center complained in August 2007, according to EZ Staffing records reviewed by reporters. "Not up to our standards for ER," wrote a nurse from Huntington Memorial Hospital in Pasadena the following week.
The then-57-year-old nurse gave inaccurate patient information to colleagues and failed to perform an electrocardiogram as ordered for a patient with an abnormally fast heart rate, the records show.
In August and September 2007 alone, four hospitals filed six complaints against her, according to the firm's records, including three by Huntington.
The next month EZ Staffing contacted North Carolina's Board of Nursing to check on her license: Cathey, it turned out, was on probation. One condition was that she not work at a staffing agency.
While a temp nurse at a North Carolina hospital, she'd failed to account for drugs she'd signed out, falsified records and provided negligent care, according to the North Carolina board's allegations. These records had been posted on the board's public website since December 2006.
Asked for comment, Cathey said in an e-mail that the accusations against her were "not valid or creditable."
Abraham Abirafeh, who started EZ Staffing in 1991, did not respond to questions about the case and accused a reporter in e-mails of trying to harm EZ's reputation.
In November 2007, the North Carolina board indefinitely suspended Cathey's license. Twenty-one months later, California regulators initiated formal proceedings against her license.
While her case winds its way through the disciplinary process, Cathey remains free to accept temp jobs in California.
Easy profits touted
Dee Patrick recalls sitting in a box at the Kentucky Derby some years ago exchanging pleasantries with a couple next to her. She told them about her Phoenix temp business -- how, as a veteran nurse, she'd built it from scratch in the mid-1980s when virtually no one was doing it.
Six months later, Patrick said, she was shocked when the woman called to say, "Hey, we opened up one of those businesses."
"They have no background in nursing," said Patrick. "They don't have to know anything."
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
Dozens of Internet sites tout the easy profits and hawk how-to guides for as low as $69.95.
"Be One among the Millionaires, Start Your Own Nursing Agency," trumpets one site. "You will be up and running in a week," promises another. "You don't have to be a nurse to start your own Nurse Agency," assures a third.
Agencies range from those run on dining room tables to publicly traded companies. They open and close, merge, swap staffs and change locations. Standards for screening vary widely.
Recruiters sometimes poach on one another's rosters. One Los Angeles agency alleged in court papers last year that a rival firm's employee had joined its staff, stolen its list of employees and salaries, and then returned to her old firm.
Many agencies allow applicants to take competency tests online. Testifying in a malpractice lawsuit earlier this year, an official at Fastaff, a large traveling-nurse firm based in Colorado, said applicants have been hired without even a phone interview. References weren't contacted "unless it was out of the ordinary," she said.
Some healthcare institutions say they interview and check the credentials of every temp nurse. Others say they don't, particularly in a crunch. "Clearly we have no time -- we have to count on them," said Fred Benson, administrator of Santa Rosa Convalescent Hospital in Northern California.
It hasn't always worked out. He recalled that two temp nurses at his facility took the keys to a drug cabinet.
Unlike hospitals and nursing homes, which are inspected regularly, temp firms aren't accountable to anyone but their clients. Mark Stagen, president of the National Assn. of Travel Healthcare Organizations, acknowledged the need for improvement.
Companies' standards can be "loose or nonexistent," allowing poor-performing nurses to easily "game the system," said Stagen, head of a Marina del Rey travel firm.
Reporters asked 12 public entities that run hospitals in California whether they had audited firms that supplied them with nurses. Only five had done so in the last three years.
Last year Los Angeles County health staffers went through the files of 29 agencies seeking to provide nurses to its public hospitals. Most of the firms lacked key documents, including evidence of tuberculosis screenings or proof that nurses had current licenses. One agency had 90 missing or invalid records, another 63.
The lapses were "surprising," said Vivian C. Branchick, director of nursing affairs for the county Department of Health Services. "They know -- and they've known it all along" -- what the standard is.
All of these firms were allowed to correct their shortcomings and won county business.
In late 2006, the county audited Reliable Health Care Services in Culver City, which had received $8.9 million for temp services during the previous fiscal year.
The audit found that Reliable had "forged" results of tuberculosis skin tests, physical exams and CPR training cards, which "jeopardized the safety of county patients." Reliable also made "false and misleading statements," the audit said, citing a general "lack of trustworthiness and integrity."
After the county terminated the Reliable contract, the firm filed a claim alleging libel, breach of contract and fraud. As part of a settlement, the county agreed not to formally bar the agency from county work, and Reliable agreed not to seek any for 10 years.
A lawyer for the firm called the county's allegations baseless.
Seal of approval
Some in the industry say staffing firms already have an able watchdog.
Since 2004, the Joint Commission, better known for accrediting hospitals, has been reviewing healthcare staffing firms. The national organization bestows its seal of approval on those that meet standards for screening applicants, following up on complaints and ensuring competency.
This seal is displayed prominently on firms' websites. Some hospitals will use only agencies that have it.
But the program is voluntary and used by a minority of temp agencies -- 337 firms -- in part because they must pay the commission thousands of dollars to be reviewed. Most of the largest firms are certified.
The commission doesn't release detailed findings on the firms, even to hospitals. It has withdrawn its seal of approval from temporary staffing agencies seven times this year -- all but once for nonpayment of fees.
At the same time, firms that display the seal have been cited in audits, nursing board records and court files for bad judgment or behavior.
Joseph Baiden, owner of JFB Staffing in Diamond Bar, was arrested in August on charges of defrauding the state workers' compensation fund of $1.4 million by misrepresenting the number of nurses on his payroll.
Some hospitals cut ties with JFB, and authorities froze Baiden's bank accounts and seized his property.
Although Baiden has pleaded not guilty, his attorney Tracy Green said that she is working toward a resolution with the district attorney's office and that Baiden plans to repay whatever he owes.
In the meantime, on the Joint Commission's website, there is a gold seal of approval by the JFB name.
Problems no barrier
Paystaff Pacific not only hired nurse Raphael Obiora in 2007 despite his troubled past, it also kept sending him out when it learned he wasn't a skilled nurse, documents show.
In a little more than a year, seven hospitals rejected Obiora, telling Paystaff he'd made a medication error, failed to follow a doctor's order and been "inappropriate" with a patient's relative.
Hospital managers use such rejection notices, known as "Do Not Sends," to alert agencies to the shortcomings of temp nurses. But the agencies are under no obligation to act on the information.
In April 2008, the Monterey Park firm dispatched Obiora to Garfield Medical Center. There, he failed to adequately monitor the vital signs of two critically ill patients. His conduct was "unsafe," wrote Simon Marcus, the hospital's critical care director, on a form he sent to Paystaff.
Unknown to the hospital, Paystaff had already evaluated Obiora and found his competence to be below average. Shortly before he was sent to Garfield, the firm had determined that he should be fired immediately, according to agency records that became part of a regulatory proceeding.
Only after Marcus raised an alarm did Paystaff fire Obiora.
Hugh Wu, a Paystaff official, said in an e-mail that the company acted responsibly. Other complaints about Obiora were not as serious as Garfield's, he said, and Obiora had hidden state nursing board discipline against his license.
Obiora, an evangelist who preaches at a Celestial Church of Christ in Gardena, ultimately lost his California license.
Marcus said his experience with Obiora "makes you wonder" about temp nurses. "Have they made errors elsewhere? Who is monitoring them?"
Some temp firms indicated that they don't use a nurse again if they feel at all uneasy. "We just don't want to take the risk," said Jim Essey, who runs a New York-based temp agency and is a former chairman of the American Staffing Assn., an industry trade group.
Other agencies say most rejections stem from picayune problems, such as tardiness and personality clashes.
But data provided by public hospitals show this isn't necessarily so.
According to Riverside County Regional Medical Center, for example, more than 60% of the 339 temp nurses rejected since 2003 failed to demonstrate basic nursing skills on the job. Arrowhead Regional Medical Center, San Bernardino County's public hospital, reported that it had rejected 61 temp nurses since 2005 -- more than half for performance problems.
Hospitals sometimes lose track of which nurses they have already booted. A nurse can be red-flagged by one unit and later sent to another.
At Lakewood Regional Medical Center in March 2008, temp nurse Kelvin Brown was found in a deep sleep at the nurses' station on a ward of patients hooked up to monitors.
He was roused but later fell asleep in a patient's room. Awakened again, he dozed off in the break room. Asked to leave the hospital, he made it as far as the intensive care waiting room before slipping into sleep once more. He left after security called police, according to the nursing board's December 2008 accusation against him.
A supervisor later discovered that Brown had had problems at the hospital before. He had fallen "heavily asleep on every shift and exhibited behavior -- such as talking to and answering himself aloud -- that made staff uncomfortable," the accusation said.
In fact, Brown had been placed on the hospital's "Do Not Return" list while working for another agency for such reasons, the document states.
A spokesman for Tenet Healthcare Corp., Lakewood's parent, confirmed that Brown had worked at the hospital before but disputed the state's account that he'd been previously barred from working there.
Brown could not be located for comment.
In another case, St. Jude Medical Center in Fullerton informed MedStaff Healthcare Solutions in March 2007 that it suspected nurse Donald Paradise of stealing drugs and asked that he never return, a hospital spokesman said. Six months later, Paradise was accused of stealing drugs at a sister hospital, where he also had been sent by MedStaff.
"It's absolutely not acceptable," said Kevin Andrus, a spokesman for St. Joseph Health System, which includes St. Jude.
MedStaff's contract, he said, prohibited it from sending a rejected nurse back to any hospital in the chain, but Andrus conceded that the chain doesn't keep a master list, as some entities do.
A spokesman for MedStaff said that Paradise had passed a drug screening after the St. Jude incident and that the hospital had indicated it was satisfied with that. Andrus says that was not so.
Paradise, who faces a nursing board accusation, could not be reached for comment.
In interviews, several temp nurses who had been in trouble said their employers focused more on keeping slots filled than on who filled them.
That was a lifeline for Obiora.
The agencies "just send and send and send and send," he said.
[email protected]
charles.ornstein @propublica.org
Lisa Schwartz, director of research at ProPublica, contributed to this report.
Copyright © 2009, The Los Angeles Times
- Joined
- Apr 1, 2004
- Messages
- 2,180
- Reaction score
- 16
- Joined
- Dec 10, 2009
- Messages
- 540
- Reaction score
- 2
Is safety a huge concern in the healthcare industry? Good lord yes. The Joint Comission Patient Safety mandates will be as thick as a phone book before I leave healthcare.
However, it's the same old story of good intentions without proper resources to follow through.
In the case of the CA BRN, it helps to understand the relationship between our governator and the nursing profession. His allegiance is to his piggybank rather than public safety, unfortunately. He delayed the implementation of safe ratio legislation, he has undermined the BRN and cut funding to support it. No wonder it is such a mess.
Taurus or whatever has pounded that point to oblivion. Unfortunately, the motivation is his axe to grind against advanced practice RNs.
While clearly, the take home message should be that any regulating body, be it nursing or medicine, etc. needs to be healthy and functioning properly.
Now Taurus, if you are interested in rational discourse about your concerns of professional role boundaries, proceed.
All y'all need to get it straight that respectful collaboration among all disciplines is an absolute necessity for patient outcomes. That has been researched and published.
However, it's the same old story of good intentions without proper resources to follow through.
In the case of the CA BRN, it helps to understand the relationship between our governator and the nursing profession. His allegiance is to his piggybank rather than public safety, unfortunately. He delayed the implementation of safe ratio legislation, he has undermined the BRN and cut funding to support it. No wonder it is such a mess.
Taurus or whatever has pounded that point to oblivion. Unfortunately, the motivation is his axe to grind against advanced practice RNs.
While clearly, the take home message should be that any regulating body, be it nursing or medicine, etc. needs to be healthy and functioning properly.
Now Taurus, if you are interested in rational discourse about your concerns of professional role boundaries, proceed.
All y'all need to get it straight that respectful collaboration among all disciplines is an absolute necessity for patient outcomes. That has been researched and published.
- Joined
- Dec 15, 2009
- Messages
- 4
- Reaction score
- 0
- Joined
- Jun 11, 2009
- Messages
- 606
- Reaction score
- 0
Regardless of Taurus' motives, I think a valid point exists. If a BON cannot ensure safe nursing practice, then I think we could safely assume the same would apply for advanced practice nursing. Clearly, this standard applies to medical boards as well; however, since we are talking about nurses here, I do agree with the underlying concerns. This is especially true of travelers who are able to bounce from place to place.
- Joined
- Dec 31, 2009
- Messages
- 93
- Reaction score
- 0
Excuse me? I'm from Tennessee and that's not funny, now in West Virginia, Kentucky or Arkansas that might be true
(to all that live in those places j/k)
- Joined
- Dec 31, 2009
- Messages
- 93
- Reaction score
- 0
Being a nurse for 34 years I've seen my fair share of dangerous nurses, I swear I don't know how they ever made it through nursing school much less passed the NCLEX. Nurses kill thousands of patients. Likewise I've seen some dangerous doctors and have been known to report an occasional doctor and my side won when taken to administration.
The truly dangerous in the medical profession IMHO are MA's who think they are nurses and the doctors who hire them because they are cheap and also refer to them as nurses, gives me the willy's. I refused to get an injection once from "the nurse" I said do you not have a licensed person in this office? He said I'll give you the injection
- Joined
- Jun 11, 2009
- Messages
- 606
- Reaction score
- 0
Being a nurse for 34 years I've seen my fair share of dangerous nurses, I swear I don't know how they ever made it through nursing school much less passed the NCLEX. Nurses kill thousands of patients. Likewise I've seen some dangerous doctors and have been known to report an occasional doctor and my side won when taken to administration.
I agree, some real knuckleheads manage to make it through school and even pass the boards.
The truly dangerous in the medical profession IMHO are MA's who think they are nurses and the doctors who hire them because they are cheap and also refer to them as nurses, gives me the willy's. I refused to get an injection once from "the nurse" I said do you not have a licensed person in this office? He said I'll give you the injection
There is a little self preservation gnome that screams this very thought in my mind every time the discussion of MA's come up. Clearly, the nurse in me. However, the more rational side of me wants to look at this situation a bit more objectively.
Non licensed providers give injections all day long and nurses do no cry about it. Of course, not many nurses are keen on working 24 hours shifts and getting paid 10 bucks an hour along the way. Clearly, I am talking about EMS where basic and intermediate providers are performing invasive procedures.
Therefore, I have to ask a question. Is there any evidence that suggests letting non-licensed providers give injections is inherently more dangerous? I am honestly not sure as I have not aggressively looked through the evidence relating to this topic.
I do agree that MA's should not refer to themselves as nurses.
I think the most pressing issues of nursing revolve around working conditions and nursing education.
- Joined
- Jul 27, 2004
- Messages
- 3,218
- Reaction score
- 663
I'm still hoping and waiting for them to write about the DNP degree.
Inept nurses free to work in new locales
Lax regulators allow harmful workers to lose licenses in one state, keep them in others.
By Charles Ornstein, Tracy Weber and Maloy Moore
The frantic knocking of home health nurse Orphia Wilson startled the boy's parents awake just after dawn.
Their 3-year-old son, who suffered from chronic respiratory failure and muscular dystrophy, had stopped breathing.
The boy's mother raced to his side and began performing CPR as Wilson stood by. It was too late. Jexier Otero-Cardona died at a Hartford, Conn., hospital the next day.
In the months that followed Jexier's May 2005 death, Connecticut health officials discovered that Wilson had fallen asleep, then ignored -- or possibly turned off -- ventilator alarms that signaled the boy was not getting enough oxygen, state records show.
And Jexier, they learned, was not the first child to die under Wilson's care. Seven months earlier, she had lost her registered nursing license in Florida for similar lapses in the death of another boy in 2002. In that case, 21-month-old Thierry LaMarque Jr. had stopped breathing while Wilson was caring for him at her Orlando home. Instead of calling 911, she tried CPR, then drove the boy's limp body three miles to his parents' house.
"She said she panicked," recalled the boy's mother, Glenda Brown, who was summoned home and found her dead son still strapped into his car seat. "Why would you bring him to my house if he passed at your house?"
Wilson's case highlights a dangerous gap in the way states regulate nurses: They fail to effectively tell each other what they know. As a result, caregivers with troubled records can cross state lines and work without restriction, an investigation by the nonprofit news organization ProPublica and The Times found.
Using public databases and state disciplinary reports, reporters found hundreds of cases in which registered nurses held clear licenses in some states after they'd been sanctioned in others, often for serious misdeeds. In California alone, a months-long review of its 350,000 active nurses found at least 177 whose licenses had been revoked, surrendered, suspended or denied elsewhere.
Such breakdowns are readily fixable. Yet state regulators aren't using their powers to seek out this information, or act on what they find, the investigation found.
Florida officials, for instance, didn't notify Connecticut authorities when they sanctioned Wilson -- even though she'd told them that she also held a Connecticut license. And Connecticut's nursing board renewed Wilson's license three times after Thierry's death, relying on her pledge that she hadn't been disciplined or investigated elsewhere.
By simply typing a nurse's name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don't check regularly or at all.
The failure to act quickly in such cases has grave implications: Hospitals and other healthcare employers depend on state nursing boards to vouch for nurses' fitness to practice.
"It only takes one outlier to end up killing a bunch of patients," said Robert E. Oshel, who retired last year as an associate director at the federal agency that runs discipline databases on health providers. "The fact that the vast majority of nurses don't cause problems and are fine professionals . . . doesn't mean you shouldn't be very vigilant against the few who aren't."
State practices vary
Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.
In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly -- or harshly -- they act on this information, according to interviews with regulators in 14 states.
Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses' licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.
Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can't be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri's nursing board.
Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida's action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.
Even when states share borders, they sometimes fail to heed each other's disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.
Nurse Karen Rheuame's Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for "the ride home."
But she's free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame's case and others to see if action is warranted, but they haven't received any complaints about the nurses in Massachusetts.
Rheuame said she'd made mistakes but has completed rehabilitation for addiction. "I'm not going to minimize what I did," she said. "I've really turned my life around since then."
There is ample information available for states to identify nurses disciplined by other jurisdictions. Two separate databases attempt to track disciplinary actions from every state. States are required to report to one, run by the federal government, within 30 days of taking an action. Reporting to the other, operated by the National Council of State Boards of Nursing, is voluntary.
Each database can be programmed to alert a state whenever a nurse it has licensed runs into trouble in another state.
When checking a nurse's record, nursing officials say they almost uniformly use the council's database; it's free and the government's is not. In fact, federal statistics show that nursing boards accessed the government database fewer than 300 times total in 2007 and 2008.
In addition, ProPublica and The Times found that the federal database is incomplete, despite the requirement that all states report discipline to it. Many actions appeared to be missing when reporters tried to match known cases by date of discipline to a version of the database in which confidential information had been removed.
Some regulators are vigilant, while others are not.
Louisiana, for example, checks the council database every day for discipline involving its nurses, its board director said. Rhode Island does it once a month, an official said.
New York, by contrast, uses it primarily to look into the backgrounds of people applying for nursing licenses. It typically does not check it for problems involving the 266,000 registered nurses already licensed to practice in New York.
Barbara Zittel, head of the New York board, said she relies on other states to notify her if one of her nurses has been disciplined and she counts on the nurses themselves to honestly disclose their problems. It works, she says, "unless someone is lying to us."
Officials at the National Council of State Boards of Nursing said they don't tell nursing boards how often to consult their database. But tools are there to help them. State boards imposing discipline, for instance, can send out warnings known as "speed memos" to flag other states.
But the council's database continues to have significant weaknesses. Nearly all states report their disciplinary information to the council, according to its website. Yet only 37 states and the District of Columbia supply it with the names of all their licensees.
As a result, it's difficult for regulators to know who is licensed in the 13 other states, including California, and when to alert them about discipline. Those states account for more than 40% of the nation's approximately 3.5 million registered nursing licenses.
The council cannot force states to submit names, and states have a financial incentive not to: They make money by charging nurses to verify their licenses, test scores and training to authorities in other states. For example, a nurse licensed in California who wants credentials to practice in Arizona must pay California $60 to confirm her background. Those sorts of checks netted California nearly $1 million in fiscal 2009. New York, which charges $20 a check, earns more than $250,000 a year.
When states turn over their lists of licensed nurses to the national council, that group earns such verification fees. "The decision to join is a revenue loss for them," said Kathy Apple, the council's chief executive officer. "That's difficult for some states."
Barbara Morvant, executive director of Louisiana's board, said the trade-off was worth it. After the board submitted the names of all its licensees last year, it saw an immediate upswing in the number of disciplinary actions it discovered.
"While it was a loss of revenue to our state, it was a benefit to the public," she said.
To estimate the scope of the problem nationwide, ProPublica and The Times searched the records of the nation's largest state, looking for examples of nurses licensed in California who had been disciplined elsewhere.
California's Board of Registered Nursing has historically done little on its own to ferret out such problems. Until last year, the state did not even ask nurses renewing their licenses whether they had been disciplined by another state.
Moreover, the board only checked nurses' records against the council's database of disciplinary actions when they applied for a California license. Since August, California also has been checking the database when the board begins an investigation of a nurse.
Sanctions found
Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.
Among them are:
* Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. . . . I guess I deserve what is coming to me."
His California license is active, without restrictions, and does not expire until July 2010.
* Jeffrey Strong, whose license was indefinitely suspended in Virginia in September 2008 after he allegedly left his post at a hospital psychiatric ward with the medication cart unattended. He had previously been disciplined for medical errors at another hospital in the state, including failing to monitor a patient who fell and as a result required emergency surgery.
"I was not providing safe care on that unit at that time and could not now," he wrote the Virginia nursing board in December 2007 about that earlier discipline. Strong has a clear license in Florida as well as California.
* Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.
Martinez and Strong could not be reached for comment. Hopp declined to comment, saying the discipline was in the past. Reporters could not determine if or where they and others in this article were working, because this information is not collected by most states.
Asked about this article's findings, California officials said regulators will now check for out-of-state discipline for every licensee by the end of March. At its February meeting, the nursing board plans to discuss additional steps to better use the council's database.
California is also working to speed up the pace of discipline.
In the past, the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.
Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.
Experts and regulators say the patchwork nature of nursing regulation in the country underscores the importance of a complete national database. State regulators should be required not just to submit their licensees, they said, but to routinely check to see if their nurses have been disciplined elsewhere.
Currently, only information about completed sanctions is available. Some experts say formal accusations, detailing charges against nurses, should be included too. "The more information that's available as quickly as possible and shared as fully as possible . . . the better off you are," said Oshel, the former federal official.
Such efforts might have kept Orphia Wilson from moving easily from Florida to Connecticut. Within days after Florida regulators revoked her license in October 2004, they reported the action to the federal government's database. Sometime later, the information was put into the council database.
As is their practice, however, Florida officials didn't report their action to other states. Connecticut, as is its practice, did not regularly check the national databases.
The next year, Wilson once again renewed her Connecticut license, checking "no" when asked if she had been disciplined elsewhere.
Wilson, who did not respond to requests for comment, wrote in a sworn statement to investigators later: "I am very sorry about the deaths of the babys I cared for. Believe me I went through my share of guilt."
The month after Jexier's May 2005 death, she was back at work, as a supervisor in a Connecticut nursing home.
Connecticut suspended Wilson's license in June 2006 and revoked it several months later. The nurse was sentenced to jail last year for reckless endangerment and hiding her Florida discipline from Connecticut.
In an e-mail response to questions, a Connecticut health department spokesman blamed Wilson for hiding her past, and said communication among states has improved.
Christopher T. Godialis, who prosecuted Wilson for the Connecticut chief state attorney's office, said a system that relies chiefly on the honesty of such nurses does so at its peril.
"The way the situation is set up now, there's no way for Connecticut to have known about what happened in Florida unless Orphia had told them," he said. "The state didn't check anything."
charles.ornstein @propublica.org
[email protected]
[email protected]
Ornstein and Weber are senior reporters at ProPublica. Moore is a Times researcher.
Lisa Schwartz, ProPublica's director of research, contributed to this report.
Lax regulators allow harmful workers to lose licenses in one state, keep them in others.
By Charles Ornstein, Tracy Weber and Maloy Moore
The frantic knocking of home health nurse Orphia Wilson startled the boy's parents awake just after dawn.
Their 3-year-old son, who suffered from chronic respiratory failure and muscular dystrophy, had stopped breathing.
The boy's mother raced to his side and began performing CPR as Wilson stood by. It was too late. Jexier Otero-Cardona died at a Hartford, Conn., hospital the next day.
In the months that followed Jexier's May 2005 death, Connecticut health officials discovered that Wilson had fallen asleep, then ignored -- or possibly turned off -- ventilator alarms that signaled the boy was not getting enough oxygen, state records show.
And Jexier, they learned, was not the first child to die under Wilson's care. Seven months earlier, she had lost her registered nursing license in Florida for similar lapses in the death of another boy in 2002. In that case, 21-month-old Thierry LaMarque Jr. had stopped breathing while Wilson was caring for him at her Orlando home. Instead of calling 911, she tried CPR, then drove the boy's limp body three miles to his parents' house.
"She said she panicked," recalled the boy's mother, Glenda Brown, who was summoned home and found her dead son still strapped into his car seat. "Why would you bring him to my house if he passed at your house?"
Wilson's case highlights a dangerous gap in the way states regulate nurses: They fail to effectively tell each other what they know. As a result, caregivers with troubled records can cross state lines and work without restriction, an investigation by the nonprofit news organization ProPublica and The Times found.
Using public databases and state disciplinary reports, reporters found hundreds of cases in which registered nurses held clear licenses in some states after they'd been sanctioned in others, often for serious misdeeds. In California alone, a months-long review of its 350,000 active nurses found at least 177 whose licenses had been revoked, surrendered, suspended or denied elsewhere.
Such breakdowns are readily fixable. Yet state regulators aren't using their powers to seek out this information, or act on what they find, the investigation found.
Florida officials, for instance, didn't notify Connecticut authorities when they sanctioned Wilson -- even though she'd told them that she also held a Connecticut license. And Connecticut's nursing board renewed Wilson's license three times after Thierry's death, relying on her pledge that she hadn't been disciplined or investigated elsewhere.
By simply typing a nurse's name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don't check regularly or at all.
The failure to act quickly in such cases has grave implications: Hospitals and other healthcare employers depend on state nursing boards to vouch for nurses' fitness to practice.
"It only takes one outlier to end up killing a bunch of patients," said Robert E. Oshel, who retired last year as an associate director at the federal agency that runs discipline databases on health providers. "The fact that the vast majority of nurses don't cause problems and are fine professionals . . . doesn't mean you shouldn't be very vigilant against the few who aren't."
State practices vary
Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.
In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly -- or harshly -- they act on this information, according to interviews with regulators in 14 states.
Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses' licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.
Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can't be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri's nursing board.
Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida's action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.
Even when states share borders, they sometimes fail to heed each other's disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.
Nurse Karen Rheuame's Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for "the ride home."
But she's free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame's case and others to see if action is warranted, but they haven't received any complaints about the nurses in Massachusetts.
Rheuame said she'd made mistakes but has completed rehabilitation for addiction. "I'm not going to minimize what I did," she said. "I've really turned my life around since then."
There is ample information available for states to identify nurses disciplined by other jurisdictions. Two separate databases attempt to track disciplinary actions from every state. States are required to report to one, run by the federal government, within 30 days of taking an action. Reporting to the other, operated by the National Council of State Boards of Nursing, is voluntary.
Each database can be programmed to alert a state whenever a nurse it has licensed runs into trouble in another state.
When checking a nurse's record, nursing officials say they almost uniformly use the council's database; it's free and the government's is not. In fact, federal statistics show that nursing boards accessed the government database fewer than 300 times total in 2007 and 2008.
In addition, ProPublica and The Times found that the federal database is incomplete, despite the requirement that all states report discipline to it. Many actions appeared to be missing when reporters tried to match known cases by date of discipline to a version of the database in which confidential information had been removed.
Some regulators are vigilant, while others are not.
Louisiana, for example, checks the council database every day for discipline involving its nurses, its board director said. Rhode Island does it once a month, an official said.
New York, by contrast, uses it primarily to look into the backgrounds of people applying for nursing licenses. It typically does not check it for problems involving the 266,000 registered nurses already licensed to practice in New York.
Barbara Zittel, head of the New York board, said she relies on other states to notify her if one of her nurses has been disciplined and she counts on the nurses themselves to honestly disclose their problems. It works, she says, "unless someone is lying to us."
Officials at the National Council of State Boards of Nursing said they don't tell nursing boards how often to consult their database. But tools are there to help them. State boards imposing discipline, for instance, can send out warnings known as "speed memos" to flag other states.
But the council's database continues to have significant weaknesses. Nearly all states report their disciplinary information to the council, according to its website. Yet only 37 states and the District of Columbia supply it with the names of all their licensees.
As a result, it's difficult for regulators to know who is licensed in the 13 other states, including California, and when to alert them about discipline. Those states account for more than 40% of the nation's approximately 3.5 million registered nursing licenses.
The council cannot force states to submit names, and states have a financial incentive not to: They make money by charging nurses to verify their licenses, test scores and training to authorities in other states. For example, a nurse licensed in California who wants credentials to practice in Arizona must pay California $60 to confirm her background. Those sorts of checks netted California nearly $1 million in fiscal 2009. New York, which charges $20 a check, earns more than $250,000 a year.
When states turn over their lists of licensed nurses to the national council, that group earns such verification fees. "The decision to join is a revenue loss for them," said Kathy Apple, the council's chief executive officer. "That's difficult for some states."
Barbara Morvant, executive director of Louisiana's board, said the trade-off was worth it. After the board submitted the names of all its licensees last year, it saw an immediate upswing in the number of disciplinary actions it discovered.
"While it was a loss of revenue to our state, it was a benefit to the public," she said.
To estimate the scope of the problem nationwide, ProPublica and The Times searched the records of the nation's largest state, looking for examples of nurses licensed in California who had been disciplined elsewhere.
California's Board of Registered Nursing has historically done little on its own to ferret out such problems. Until last year, the state did not even ask nurses renewing their licenses whether they had been disciplined by another state.
Moreover, the board only checked nurses' records against the council's database of disciplinary actions when they applied for a California license. Since August, California also has been checking the database when the board begins an investigation of a nurse.
Sanctions found
Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.
Among them are:
* Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. . . . I guess I deserve what is coming to me."
His California license is active, without restrictions, and does not expire until July 2010.
* Jeffrey Strong, whose license was indefinitely suspended in Virginia in September 2008 after he allegedly left his post at a hospital psychiatric ward with the medication cart unattended. He had previously been disciplined for medical errors at another hospital in the state, including failing to monitor a patient who fell and as a result required emergency surgery.
"I was not providing safe care on that unit at that time and could not now," he wrote the Virginia nursing board in December 2007 about that earlier discipline. Strong has a clear license in Florida as well as California.
* Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.
Martinez and Strong could not be reached for comment. Hopp declined to comment, saying the discipline was in the past. Reporters could not determine if or where they and others in this article were working, because this information is not collected by most states.
Asked about this article's findings, California officials said regulators will now check for out-of-state discipline for every licensee by the end of March. At its February meeting, the nursing board plans to discuss additional steps to better use the council's database.
California is also working to speed up the pace of discipline.
In the past, the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.
Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.
Experts and regulators say the patchwork nature of nursing regulation in the country underscores the importance of a complete national database. State regulators should be required not just to submit their licensees, they said, but to routinely check to see if their nurses have been disciplined elsewhere.
Currently, only information about completed sanctions is available. Some experts say formal accusations, detailing charges against nurses, should be included too. "The more information that's available as quickly as possible and shared as fully as possible . . . the better off you are," said Oshel, the former federal official.
Such efforts might have kept Orphia Wilson from moving easily from Florida to Connecticut. Within days after Florida regulators revoked her license in October 2004, they reported the action to the federal government's database. Sometime later, the information was put into the council database.
As is their practice, however, Florida officials didn't report their action to other states. Connecticut, as is its practice, did not regularly check the national databases.
The next year, Wilson once again renewed her Connecticut license, checking "no" when asked if she had been disciplined elsewhere.
Wilson, who did not respond to requests for comment, wrote in a sworn statement to investigators later: "I am very sorry about the deaths of the babys I cared for. Believe me I went through my share of guilt."
The month after Jexier's May 2005 death, she was back at work, as a supervisor in a Connecticut nursing home.
Connecticut suspended Wilson's license in June 2006 and revoked it several months later. The nurse was sentenced to jail last year for reckless endangerment and hiding her Florida discipline from Connecticut.
In an e-mail response to questions, a Connecticut health department spokesman blamed Wilson for hiding her past, and said communication among states has improved.
Christopher T. Godialis, who prosecuted Wilson for the Connecticut chief state attorney's office, said a system that relies chiefly on the honesty of such nurses does so at its peril.
"The way the situation is set up now, there's no way for Connecticut to have known about what happened in Florida unless Orphia had told them," he said. "The state didn't check anything."
charles.ornstein @propublica.org
[email protected]
[email protected]
Ornstein and Weber are senior reporters at ProPublica. Moore is a Times researcher.
Lisa Schwartz, ProPublica's director of research, contributed to this report.
- Joined
- Jun 11, 2009
- Messages
- 606
- Reaction score
- 0
Oh yeah, take this:
http://www.latimes.com/news/local/la-me-nurses-fingerprints26-2009dec26,0,3288465.story?track=rss
My article is definitely more shocking than yours!
http://www.latimes.com/news/local/la-me-nurses-fingerprints26-2009dec26,0,3288465.story?track=rss
My article is definitely more shocking than yours!
D
deleted87716
Is this what happens when you're the "most trusted profession in the US?"
Geez, Louise.
Kinda makes me glad that doctors were #3...
Geez, Louise.
Kinda makes me glad that doctors were #3...
D
deleted87716
The truly dangerous in the medical profession IMHO are MA's who think they are nurses and the doctors who hire them because they are cheap and also refer to them as nurses, gives me the willy's. I refused to get an injection once from "the nurse" I said do you not have a licensed person in this office? He said I'll give you the injection
I employ certified medical assistants, and make an effort not to refer to them as "nurses." In addition, they wear ID badges identifying them as medical assistants.
To be fair, however, MAs are qualified to administer injections.
- Joined
- Jun 11, 2009
- Messages
- 606
- Reaction score
- 0
A perfect demotivator:
Trust:
Just because you trust me, does not mean I won't make a med error and kill you.
In all honesty, California really is a mess...
Trust:
Just because you trust me, does not mean I won't make a med error and kill you.
In all honesty, California really is a mess...
D
deleted87716
- Joined
- Dec 31, 2009
- Messages
- 93
- Reaction score
- 0
I employ certified medical assistants, and make an effort not to refer to them as "nurses." In addition, they wear ID badges identifying them as medical assistants.
To be fair, however, MAs are qualified to administer injections.
Yes, they most definately are qualified to give IM's, SQ's. My PCP employes MA's that are awesome and they do wear name tags which say MA and when someone calls them a nurse they tell them no I'm an MA. Those who truly believe they are a nurse in every way are those who are dangerous.
- Joined
- Jun 11, 2009
- Messages
- 606
- Reaction score
- 0
That is pretty funny! Blue Dog, you ever feel like you missed you're calling?
D
deleted87716
I have a strange sense of humor that's well-suited to the format. I can also find practically any kind of photo in seconds using Google. It's a good combination.
