Testimony at the Senate Business, Professions and Economic Development Committee Meeting – August 17, 2009

August 2009

Chairperson Negrete McLeod, committee members and community leaders,

My name is Kathy J. Sackman, Registered Nurse and president of the United Nurses Associations of California/Union of Health Care Professionals, also known as UNAC/UHCP. We represent over 16,000 Registered Nurses and other health care professionals throughout California and, therefore, serve as a leading representative and stakeholder with regard to changes the Board of Registered Nursing must make to address its enforcement efforts. I would like to thank each committee member and the chairperson for recognizing the need for our inclusion in these discussions, as well as for inviting me to speak today.

The purpose of the Board of Registered Nursing is to provide oversight on the quality of nurses and to ensure the safety of the patients they serve. Our concerns and recommendations to improve enforcement incorporate both of these objectives.

Let me start by stating that UNAC/UHCP supports three overarching principles that we regard as essential to strengthening oversight and enforcement:

First - All interdependent departments and offices must collaborate to correct existing communication processes and partner to implement best practices to reduce processing delays, promote necessary training of staff, share data and track open cases.

Second - Each appropriate department or office must expedite enforcement efforts by managing healthcare and non-healthcare licensing board cases separately.

And third - Data management must utilize an appropriate and real-time digital framework to promote efficient documentation and information sharing with germane departments, offices, and applicable out-of-state agencies.

As we all would agree, the old model is broken. These structural changes are fundamental to the promotion of any effective and long-lasting safeguards to patient protections and due process.
However, the pressures and demands to improve the Board of Registered Nursing's oversight must be carefully and thoughtfully weighed so that irrational and over-reactive changes are not instituted, thereby creating unintended consequences that are more harmful than beneficial. Three primary issues raise concerns for me, both as a Registered Nurse and as a representative of thousands of Registered Nurses throughout California. These issues include funding for necessary Board activities, discussions about discontinuing the Diversion program, and assuring the balance between consumer protections and due process.

As we all know, funding for the Board of Registered Nursing is not tied to the General Fund but is, in fact, self-funded through professional licensing fees. State-mandated furloughs to this special fund licensing board have negatively impacted the Board's ability to protect California consumers. The savings created by the Governor's mandated furloughs are subsequently redirected to the General Fund, thereby stripping the Board of essential resources necessary to fulfill its duties to the public. The furloughs are creating structural cracks to the Board's enforcement process, and must be stopped immediately for all healthcare licensing boards if the Department of Consumer Affairs is to protect Californians. We believe full support of SR 25 by our State representatives will effectively accomplish this necessary goal.

UNAC supports Title 16 regulatory language to increase RN licensing fees in order to bring additional resources to the Board, particularly considering that these fees have not been raised in 18 years.
However, an increase in fees MUST include a greater level of accountability. Prior to officially taking action on a fee increase, we must first determine the amount of the fee increase and specifically how the additional funds will be utilized. It makes no sense to increase fees for additional staff and have furloughs siphon away these monies for purposes unrelated to the health, safety and protections of Californians.

In regard to the Diversion program, this vital resource serves both the public interest and the Registered Nurses who suffer from the disease of addiction because it builds in a monitoring function that would not exist in the absence of the program. It is common knowledge that addiction is a disease.

And more than 30 years of empirical health research shows us that treatment for addiction does, in fact, work. Therefore, we should not throw out the baby with the bath water. Registered Nurses in the
Diversion program must understand, however, that the program is a last chance opportunity to continue their career in nursing, with the consequence of license suspension upon failure to comply.

Setting a sunset date on a program that has yet to be audited is inappropriate, ineffective, and unreasonable. UNAC/UHCP recommends that a full audit be conducted on the Diversion program immediately, with an annual audit for a minimum additional two years in order to allow Diversion program staff an opportunity to correct inefficiencies and implement best practices.

Lastly, maintaining due process in any structure of enforcement affords the accused with a basic civil right. As Registered Nurses, we believe that harm to even one patient is harm to one patient too many. However, each case that comes before the Board of Registered Nursing must be considered on its own merits, rather than regard the submission of a complaint as confirmation of wrongdoing. Additionally, any actions the Board of Registered Nursing takes on complaints should contain an element of remediation, rather than a purely punitive response.

Due process and consumer protection are not mutually exclusive. Neither should assuring due process for individual Registered Nurses and other health care professionals mean sacrificing expediency. To be both effective and efficient, any and all actions taken by the Board of Registered Nursing must simultaneously focus on protecting the consumer from errant nurses and guaranteeing fundamental legal protections for the accused. Improving enforcement should not result in a kangaroo court.

Let's all be clear here: the length of time to investigate and process complaints against nurses and other health professionals is not the result of the accused delaying the process; it's not the result of lenient penalties; it's not the result of the board's "unwillingness" to get the job done. This is almost exclusively a RESOURCE problem - in other words, too few resources dedicated to managing cases. And the past few years have demonstrated an absolute steady reduction in those resources. None of us should expect real change unless REAL resources are afforded to the Board of Registered Nursing.

I would like to point out to the Committee and to all Californians that the vast majority of the State's
350,000 Registered Nurses have never had a complaint filed against them. The number of complaints is minute in comparison to the number of Registered Nurses working in our state. California's 350,000 nurses are fully dedicated to ensuring high quality patient care and are proud to work in a distinguished and respected profession. Keep in mind - it is Registered Nurses who are the primary advocates for patients in the spectrum of available health services.

As it transitions to a more effective enforcement process, the Board of Registered Nursing must be mindful and vigilant that its actions can positively or negatively influence patient protections. It should not take actions that simply demonstrate "political responsiveness" but should take actions that genuinely protect patients and implement best practices in the fields of nursing, diversion, and enforcement. We see an opportunity to improve a critical public safety system. With prudent judgment, the Board of Registered Nursing can fulfill its responsibility to protect California consumers.

Thank you for your time and attention.

In solidarity,
Kathy J. Sackman, RN