Capitol Alert

Delayed investigations against California nurses could pose risk to patients, audit finds

A registered Nurse at the San Diego Public Health Center gives a whooping cough injection in December 2014.
A registered Nurse at the San Diego Public Health Center gives a whooping cough injection in December 2014. AP

The California board charged with resolving complaints against registered nurses has such a huge backlog that some active caregivers may pose a risk to patient safety, according to a new audit.

The review of the Board of Registered Nursing’s enforcement program found that of the 40 complaints resolved between Jan. 1, 2013, and June 30, 2016, the board failed to complete 31 within its 18-month goal – and 15 of the complaints took longer than three years. Of those 15 complaints, the board took longer than four years to resolve seven, “six of which included allegations of patient harm resulting from a nurse’s actions.”

“These delays primarily occurred because of (the board’s) ineffective oversight of the complaint resolution process and its failure to move the complaints through the various stages of the process in a timely manner,” State Auditor Elaine Howle wrote in an accompanying letter.

Such delays contributed to a backlog of complaints, Howle said.

As of the end of July 2016, auditors identified a backlog of more than 180 complaints the board had not yet assigned to one of its investigators.

Nearly 140 were pending assignment for more than 10 days and, of these, roughly 70 involved “urgent- or high-priority allegations, such as patient death, harm or criminal activity, and had been waiting to be assigned for an average of nearly 80 days,” Howle said.

The board oversees some 420,000 licensed nurses and investigates about 7,500 complaints each year.

Nursing school graduates, schools and hospitals for years have been complaining that the Department of Consumer Affairs’ BreEZe computer system, over budget by tens of millions of dollars, had significantly slowed the process for licensing nursing school graduates.

Bonnie Castillo, associate executive director of the California Nurses Association, said the group was still reviewing the audit and planned to attend a briefing on the results later this week. But she keyed in on several of CNA’s concerns, including the glitches occurring with BreEZe that resulted in massive cost overruns.

She also pointed to “significant” understaffing, pegging the board’s ratio at 1 member to every 3,000 nurses, versus the 1-to-900 ratio of the Medical Board.

“We know staffing is everything, for efficiency and to ensure the public is adequately protected. And that is really way too few staff,” Castillo said. “When the public health is at stake, you have to staff up.”

She noted that the review took place under a former executive officer, and said the CNA has not been made aware of the details of the six cases where allegations of patient harm resulted from a nurse’s actions.

Auditors for their latest report found that the absence of a formal training program for enforcement officials contributed to delays in processing the complaints. If the board doesn’t develop an action plan by March, auditors said the Legislature should consider transferring its enforcement responsibilities to the Department of Consumer Affairs.

Michael Deangelo Jackson, president of the Board of Registered Nursing, did not dispute the thrust of the audit in a letter to Howle, and said officials are working to make various changes.

“We aspire to ensure that all allegations against licensees and applicants that could endanger the public are investigated promptly, diligently, and in a manner that expeditiously protects the public,” Jackson said.

Christopher Cadelago: 916-326-5538, @ccadelago