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Nursing chief digs up mess

New official finds dropped complaints, many uninvestigated cases and more

Two months into her new job as executive director of the Oregon State Board of Nursing, Holly Mercer has found things aren't as bad as expected at the embattled state agency that oversees the state's 65,000 nurses and nursing assistants.

They're worse.

Last week, Mercer wrote an unusual letter to members of the Oregon House of Representatives' Health Care Committee describing 'alarming discrepancies' in agency files concerning discipline and investigations of nurses.

Mercer started her job at the nursing board the first week in January, and her second in command, the board's manager for compliance and investigations, Linda Fisher-Lewis, began work Jan. 7. In the letter to legislators, Mercer described what they found as they began to examine the agency's files.

Among their findings, according to Mercer's letter:

• Of 90 nurses currently on probation as a result of a board discipline, 56 have been found to be out of compliance with the terms of their probation but without having suffered any consequence.

• A review by Fisher-Lewis of complaint files assigned to one of the board's investigators over the last five years has revealed approximately 100 instances in which a complaint was lodged against a nurse but no investigation ever took place.

• In 2006, faced with a growing number of complaints, 'it appears,' according to the letter, that board staff closed as many as half of its backlogged cases without launching an investigation.

• A preliminary review of the 260 participants in the board's controversial nurse monitoring program - designed to allow nurses to continue on the job while they privately get help for substance abuse and psychiatric problems - has revealed that three out of four are not fulfilling the requirements of participation.

They are missing or failing drug tests, failing to check in with their monitors, or are the subjects of poor reports from their employers, according to Mercer's letter. Nevertheless, they continue to retain their nursing licenses.

Mercer's letter comes after more than two years of controversy surrounding the board and its lax oversight of problem nurses. In March 2006, the Portland Tribune published a series of stories detailing the problems. In August, the state Department of Administrative Services released its own scathing report on the board's oversight.

Joan Bouchard, the board's longtime executive director, resigned the day after the DAS report was made public. The board's second in command was fired the day after Bouchard resigned by Sue Nelson, appointed interim executive director by Gov. Ted Kulongoski.

At the time, a number of critics said that Kulongoski had not gone far enough, and that changes at the agency should include a new board of directors. But Kulongoski chose not to change board members, with staff explaining that state law said he could only do so with proper cause.

Two members of the Oregon House Health Care Committee, Mitch Greenlick, D-Portland, and Ron Maurer, R-Grants Pass, said this week that the new revelations offered further evidence that the governor should have removed board members in addition to replacing top administrators.

'I think the governor's office has way more than enough evidence to relieve members of the board for cause,' Maurer said.

Maurer also said that the length of time the nursing board was able to operate under bad management - even after the initial Tribune stories - was proof that the state needed better oversight of state agencies. He said that he supports the formation of a legislative audits office so that legislators can order their own investigations of boards and agencies.

More changes may come

Greenlick said that he is in the process of writing a bill that will limit the ability of licensing boards to operate as independently as they do. Among the key points in the bill, Greenlick said, will be a change in the makeup of the boards themselves.

Currently, the board of nursing has seven nurse members and two public members. Greenlick said his bill will propose a minimum of four public members.

But Greenlick said the Legislature does not need its own auditing function. He said he supports better funding for the Oregon secretary of state's current auditing division as a means of keeping a closer watch on state agencies.

In an interview this week, the nursing board's Mercer said some of the reported problems are traceable to one staff member, unnamed in the letter to legislators, who was in charge of probationary nurses. That staff member, who Mercer said may be subject to a personnel action, appears to have allowed probationary nurses something close to free rein.

Mercer said the same staff member also may have disposed of about 100 complaint files without having investigated them.

But the 2006 cases that were dismissed without investigations and the nurse monitoring program's apparent lax oversight did not involve that same employee, Mercer said. She said some of the employees responsible for those problems may still work at the board.

'It's a culture and a process change that's happening here,' Mercer said. 'We will learn those staff (who) will be able to move forward with the culture and those (who) aren't.'

Holdover detects an iceberg

Jim McDonald, a Portland nurse practitioner who serves as president of the nursing board, listed 'amazement' and 'anger' as his reactions upon hearing the latest revelations from Mercer.

'Basically, what we've been doing since last August is turning over every rock and every pebble and every stone and we've discovered all this,' McDonald said. 'I thought we had found the problem and were addressing it. We had found the tip of the iceberg.'

McDonald, who has served on the board since 2004, was the board member who most publicly objected to changes being made after the Tribune stories and the administrative services report. After the August 2007 change of board executives, McDonald blamed media and political pressure for 'jump-to-conclusion type of thinking.'

McDonald said at the time that he still felt that the board's nurse monitoring program was among the best in the country, and that issues over the program 'have been exaggerated and blown out of proportion.'

Anna Richter Taylor, spokeswoman for Kulongoski, said the new revelations disclosed by Mercer are proof that changes made in August are having an impact.

'The governor has asked the new leadership at the board of nursing to be transparent, and this memo is an example of this increased transparency,' Richter Taylor said.

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On Friday, March 7, the Oregon Nurses Association issued a statement supporting the 'aggressive investigation of discrepancies' by the Oregon Board of Nursing.

Here is the association's press release:

All complaints by members of the public, related to any licensed health care professional, must be taken seriously by state agencies. Oregon Nurses Association fully supports the aggressive plan of the Oregon Board of Nursing to deal quickly and decisively with recently uncovered public complaints and monitoring discrepancies.

As the state's professional association for nurses, ONA is committed to ensuring that the public receive the best health care possible, and that any complaints filed by members of the public related to the provision of nursing care be taken seriously by the state's nursing licensure agency.

ONA believes that the discovery of serious discrepancies concerning the investigation and discipline of nurses is evidence that the changes made to the Oregon Board of Nursing by Governor Kulongoski last fall were both necessary and effective. It is due to these recent management changes, and the growing involvement of the Board of Nursing's board membership, that the Board of Nursing was able to uncover these problems.

The Board of Nursing's response to these recent discoveries was timely, detailed and appropriate and has the full support of ONA. ONA looks forward to working with the State Board of Nursing, the Oregon Legislature and members of the public in our continuing efforts to protect the health of all Oregonians.