When Jim Cleghorn was fired as executive director of the state Board of Nursing this month, the Secretary of State’s office first said the 10-year veteran director left while an ethics investigation was underway.
It was improper, Brad Raffensperger’s office said, for Cleghorn to serve as a state employee and executive director of the Georgia board while volunteering as president of the board of the National Council of State Boards of Nursing, which paid for his travel to its meetings.
Nurses were stunned. Cleghorn was widely credited with improving the operations of the Georgia board, and he had worked with the organization for years, as others in government and the private sector commonly do with professional groups. Plus, an investigation of the “ethics” issue had not even been completed.
Now, an AJC examination points to another possible reason for Cleghorn’s removal: the Secretary of State’s desire to maintain control of the state’s nurses and the fees the Board of Nursing can generate.
Executives in Raffensperger’s office want to bring back to state government a license verification process that nurses use when they move and seek a nursing license in another state.
In recent years, Georgia has relied on a widely-used national system called NURSYS, run by the National Council, for its verifications. Georgia moved to that system because its prior verification system was vulnerable to fraud, according to meeting minutes. The NURSYS system is a secure, one-stop shop that offers access to state licensing information used by healthcare providers and nurses across the nation, including those licensed under a multi-state nurse licensing compact.
The Secretary of State’s office told the AJC it is looking into pulling out of the verification section of NURSYS so it can handle verifications itself and collect fees.
“We’re bringing that back under our umbrella, so it’s all in our control,” said La Trenda Tyler-Jones, director of the Professional Licensing Division of the Secretary of State’s office.
HANDOUT
HANDOUT
The nursing board, which is made up of licensed nurses, nurse educators and a consumer representative, does not get a say in the decision, Tyler-Jones said.
A state lawmaker said she sees another possible motive behind Cleghorn’s removal: Raffensperger is acting to try to make sure the nursing board doesn’t try to break away from supervision of the Secretary of State’s Office, something it attempted in the past when Gov. Brian Kemp was secretary of state, said Sen. Renee Unterman, R-Buford.
“That is the bottom line and that was the bottom line with Kemp,” she said.
In 2016, Kemp sparked a controversy when he announced plans to replace Cleghorn without consulting members of the board. After a backlash and a legal opinion saying the board had to approve its director, Cleghorn ended up staying in place. But the conflict between Kemp and the board continued. The nursing board in 2018 supported a bill to make it independent from the Secretary of State’s office, like the state’s medical, dental and pharmacy boards. The bill did not pass.
Unterman notes nurses were denied, while licensing boards for traditionally male-dominated medical professions operate independently. “It’s just part of that archaic system of male dominance,” said Unterman, a former nurse and longtime head of the Senate’s health committee until her ouster in early 2019.
The Secretary of State’s office said its actions involving Cleghorn weren’t related to the prior feud involving Kemp.
Cleghorn declined to be interviewed for this story.
Evolving explanations
Deputy Secretary of State Jordan Fuchs said she made the decision to end Cleghorn’s employment, with Raffensperger’s support. While she said the investigation is ongoing, she said she had enough information to remove him.
She said the state ethics policy bars employees from taking money or gifts from entities that do business or seek to do business with the Secretary of State’s office.
Bob Andres
Bob Andres
The AJC obtained a copy of the “participation agreement” the state has with the NURSYS database to share nurse licensing information. But the state neither pays nor receives money through the agreement. NURSYS offers most of its services for free, but it does charge nurses for verifications when they seek licenses in a new state.
On Wednesday, Fuchs provided another reason for the termination. She said the National Council had “lobbied the state and directly lobbied against the Secretary of State’s office, his employer.”
Having Cleghorn serve as president of that organization “was not a tenable situation to our office,” Fuchs said.
Asked how the National Council had lobbied “against” the Secretary of State, Fuchs did not provide an example.
Tyler-Jones said if the National Council favored a policy that Georgia didn’t want, “there could be a conflict with that.”
But the real conflict may be more whether Georgia’s nurses want something that the Secretary of State doesn’t, not whether the National Council conflicts with Georgia officials.
The National Council said it helps with lobbying only when a state Board of Nursing requests the assistance and said it did help the Georgia board when it sought the bill that would have allowed it to operate independently.
The National Council said it was not contacted by the Secretary of State’s office for information for its investigation before Cleghorn lost his job.
Fuchs also told the AJC that nobody else at the Secretary of State’s Office was serving in a role like Cleghorn’s.
“That is the bottom line and that was the bottom line with Kemp."
However, an employee who is director of another professional license board also serves on the national board of the professional organization for state boards that license physical therapists, according to the group’s website.
Also, Fuchs is on the board of the non-profit Electronic Registration Information Center (ERIC). The organization has member states that share information to help keep voter rolls up to date. She said the cases were apples and oranges.
“It’s definitely not the same thing,” Fuchs said. " ERIC doesn’t give me a credit card. ERIC doesn’t pay for my trips."
She said Georgia’s membership in ERIC was authorized through legislation and having a representative on the board was part of joining ERIC.
The National Council said it reimburses all of its volunteers, including its board of directors for expenses incurred because of council-related business, including travel expenses. The nonprofit’s major focus is developing the nurse licensure exams that all boards use as part of their licensure process.
Concerns about change
Nursing board directors in other states were perplexed by Raffensperger’s view that Cleghorn’s role could present a conflict. They viewed the leadership role as a benefit for the state and said the mission of their boards aligned with the mission of the National Council.
Officials in other states also expressed surprise that Georgia would stop using NURSYS for the license verification services. While Georgia could get a fee that NURSYS charges, the state would incur costs for customer service that NURSYS currently handles.
Fuchs said a final decision about the change has not been made, but the National Council said Georgia had notified it that it planned to make the change.
Katherine A. Thomas, executive director of the Texas Board of Nursing, said her board viewed the service as a benefit to the state of Texas when she served as president. “The Council is unquestionably a recognized leader in supporting nursing regulation,” she told the AJC. “The most obvious benefit is that the president is immediately a part of the learning, development and implementation of the best practices in nursing regulation and public protection.”
Thomas said Cleghorn is widely respected and known for making significant improvements to the functioning of the Georgia board. “His very election to NCSBN president is a testament as to his value to nursing regulation since he was the very first non-nurse president ever elected to this position. That speaks volumes about the respect he has from state BONs [Boards of Nursing],” she said.
Five years ago, at a public meeting, the Georgia nursing board and the secretary of state’s office also proudly remarked on the “resources and benefits” that came with having Cleghorn in a leadership role on the national council.
Raffensperger met with nurse leaders last week to discuss the future of the board and his oversight of nurse licensing. “We appreciated him hearing our concerns, and he agreed to continue a dialogue with us about filling the position and ways to protect the public during this transition,” said Lisa Eichelberger, dean of the College of Health at Clayton State University.
Blair Train, who served as the nursing board’s consumer member from 2015 until she was replaced in 2019, said she was concerned about the changes at a board that she said was functioning well with Cleghorn as its executive director.
“The Secretary of State and the state of Georgia should have been so proud to have an employee as dedicated to his job and his duties as Jim Cleghorn,” Train said. She said she worried the instability could undermine the board’s ability to fulfill its mission to oversee nurse licensing and protect the public.
“I’m very disappointed, and I’m very disheartened,” she said.
Our reporting
After the Georgia Secretary of State’s Office announced earlier this month that its popular nursing board director was out, The Atlanta Journal-Constitution obtained documents through the Georgia Open Records Act, reviewed years of meeting minutes and conducted interviews to examine the action. Georgia’s Board of Nursing processes thousands of licenses, oversees the state’s nurse education programs and protects the public by investigating and disciplining nurses who may be dangerous or impaired.
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