Nurses under investigation for working while high on drugs — but free to work, with clean records, for months on end. Nurses accused of taking drugs for themselves from patient supplies, but out on the job market under no public warning — sometimes for over a year.
How to address that crisis, or whether it is a crisis at all, has sparked a bitter struggle at the state Capitol as the legislative session climaxes this week. The State Board of Nursing, charged with licensing and regulating the state’s nurses, wants to control its own investigators like the boards for doctors and pharmacists do. The Secretary of State’s Office, which currently controls the Nursing Board’s staff along with those of dozens of other boards, is fighting the move. Lawmakers will decide.
“Think about it. We know a nurse has a license to practice in this state that may be working impaired, and yet we are powerless to do anything, waiting for over a year for the case to be investigated,” said Janice Izlar, the board’s chairwoman. “Everything within our control, we see that it is done as quickly and as effectively as possible. … This is not about any individual, it is about a broken system.”
Georgia Secretary of State Brian Kemp oversees the Nursing Board’s staff, along with those for the State Elections Board and dozens of Georgia professional regulators, such as architects, funeral directors and barbers. The Nursing Board is his biggest, and he responded forcefully to its bid for independence.
“This proposal stands in contrast to my principles as a conservative Republican,” Kemp, who is also a GOP candidate for governor, wrote in a letter to a lawmaker, “since it will needlessly grow government, waste taxpayer resources, and ultimately increase the cost of professional licensure in Georgia.”
The cost
There is no dispute that the money nurses pay in license fees, amounting to $6.7 million last year, would more than cover the cost of moving the board with millions to spare.
Those fees, like all license fees, go directly into the state’s general fund before being redistributed by the Legislature.
The legislation the nurses support — Senate Bill 334, now also inserted into House Bill 301 — would free the nursing board to direct its staff and investigators, and attach it to the Department of Community Health as an administrative pass-through. That's how the state's boards for doctors, dentists and pharmacists are set up.
Nursing Board members say preventing their investigators from being diverted to Elections Board cases or other cases is key. Kemp staffers say the swapping goes both ways and has been more help to nursing cases.
State Rep. Lee Hawkins, a Republican and a dentist from Gainesville, in 2013 sponsored a bill, House Bill 132, that moved the state boards of dentistry and pharmacy out from under the Secretary of State’s Office.
“What I heard from the board and my dental association was that they had so much backlog of cases that they could not get to those cases,” Hawkins said. It works better, now, he said. “People have more of a focus just on that board.”
Senate Health and Human Services Chairwoman Renee Unterman, R-Buford, sponsored SB 334 and bridles at the disparity. “I don’t see why a female-dominated profession shouldn’t have the right to control their own destiny,” she said. She and House Health and Human Services Chairwoman Sharon Cooper, R-Marietta, are often at odds, and they are on this bill. Cooper stresses the cost.
The Governor’s Office of Planning and Budget estimated that moving the Board of Nursing would cost an additional $780,000, though it noted that figure was subject to change. On an ongoing basis, it estimated that a stand-alone staff would end up costing the board and the DCH $1 million additionally per year to run, for a total of $2.9 million a year.
Unterman said that estimate is overblown and based on biased numbers supplied by Kemp’s office. She did not supply an estimate of her own.
Cooper suggested the real problem is the nurses’ relationship with Kemp. “We are going to have a new secretary of state,” she said. “There’s a chance for a new beginning.”
The mission
The nurses say the core problem isn’t Kemp, but people who aren’t experienced in health care managing the high-stakes job of protecting patients.
One move, they say, spoke volumes: Without warning, Kemp two years ago switched its respected staff director with the director for the Board of Cosmetology, who served the state's barbers, nail technicians and other beauty workers. After rough publicity, the move was not finalized. Kemp's office said the reason for the proposed move was cross-training.
The issues the board members raise are many, but the time it takes for investigations has long been the central one. Factor out the cases of just serving legal papers, and the average time to complete a high-priority investigation is 283 days.
Candice Broce, a spokeswoman for Kemp, defended the office’s record. She said investigation times have improved.
Indeed, a 2013 investigation by The Atlanta Journal-Constitution found that the board had a backlog of at least 3,000 open cases, and a review of 100 public orders found the average time to clear them was 15 months.
Kemp and opponents of Unterman’s bill lay much of the blame for investigative lags on a law that went into effect in 2014. It mandated reporting of problem nurses that pushed up the board’s caseload. In addition, state budgets have been tight.
“A lot of the complaints that we have and that we’ve been hearing over the years are when we were in one of the worst recessions ever known,” Cooper said.
During those years, however, Kemp's office was sometimes willing to spend. In one elections investigation that began in 2010, the office set out to interview all 1,352 absentee voters in a racially charged election in Brooks County, and the office eventually cut it short at 402. An AJC investigation showed most of the cases were against subjects who helped willing voters to vote as they wished but crossed lines such as mailing the ballot for the voter or filling out the return address. None of the cases held up in court.
A Secretary of State’s Office spokesman then pointed out that the charges were brought by prosecutors, not investigators, and it was a joint investigation with the GBI. The current spokeswoman, Broce, said much has changed in the years since.
Following the mandatory reporting law the office invested in Nursing Board investigations, hiring three investigators just for the board, as well as five call center employees to field complaints.
Kemp’s staff emphasize that in many cases the investigators’ main task is to track down a person trying to avoid being served with legal papers. Factor those shorter cases in, they say, and the staff’s average case takes only 189 days — six months — to close. They hope to get it lower.
Tracy Blalock, one of the highest-ranking nurses in the state, sees the fallout firsthand with problem hires. “They will work for us for six months, they will have an issue where practice is not safe,” said Blalock, the chief nursing officer of Navicent Health in Middle Georgia. “We report it to the board, just to find out that they’ve left one or two other hospitals.”
Broce said the investigators already put “blood, sweat and tears” into their work for the Nursing Board.
And Kemp says they do it efficiently. “The state’s overarching policy goal should be providing streamlined occupational licensure at a reasonable cost, not picking winners and losers,” he said. “We are putting people to work faster, and we are holding Georgians accountable for workplace misconduct.”
AJC investigative reporting in 2013 revealed lagging regulatory oversight of the state’s nurses, posing danger for patients. State attempts to address the situation followed, and our reporters have continued to follow those moves, from remaining lag times to controversial staff changes and proposed legislation.
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