By YAMIL BERARD - Star-Telegram staff writer - Fri, Aug. 17, 2007
Last in a four-part series examining state regulation of health professionals
An applicant for a state nursing license is being questioned in front of a licensing panel about a minor criminal infraction committed years ago. The discussion turns from the infraction to an unrelated topic: the applicant's extramarital affairs.
This is not a scene out of Desperate Housewives. It is a documented exchange in front of the Texas Board of Nurse Examiners.
The board is perhaps the most aggressive healthcare regulator in Texas, taking patient safety to heart.
It was the first nurse professionals oversight board in the nation to embark on a program to conduct criminal background checks on every nurse. Nursing applicants now undergo the checks and submit fingerprints to be screened against an FBI database. In the next several years, the board will also run checks on the 264,450 nurses already working in Texas.
The board has no problem, either, with listing on its Web site the names of nurses whose licenses have been suspended or revoked for violating one of the profession's rules. And in the next few months, it will beef up that portion of the site to give detailed information about specific violations.
What's more, it is the only health-practitioner board that posts on its Web site color photographs of impostors -- in this case, people impersonating nurses at doctors' offices and health clinics.
"That's so people could recognize these individuals," Executive Director Katherine Thomas said. "Some of them use aliases."
Texas lawmakers who scrutinized the nursing board last year said it is one of the state's best-run agencies. "They do take their job seriously," said Rep. Donna Howard, D-Austin, who is a nurse.
The irony is that lawmakers and others have criticized the board for being too tough, saying that the board's stance, at some level, has contributed to Texas' nursing shortage.
"We agreed that we need good nurses; we just need more of them," said Dan Sutherland, spokesman for Rep. Vicki Truitt, R-Keller, vice chairwoman of the Sunset Review Commission, which scrutinized the nursing board in September 2006.
Legislators pounced on the board for asking more questions about one applicant's extramarital affairs than about the minor criminal infraction when the applicant was 18 years old. They said the board's focus should be to ensure nurses are minimally competent to practice rather than setting standards so high that only select groups could attain them, and advised the board not to be so obsessed with image.
They also said that the criminal background checks can easily bog down the board. So they've recommended that the board only focus on serious crimes and try to ignore offenses they said were not relevant to nursing.
Some attorneys who defend nurses say the board has gone overboard. At times, the board punishes nurses for what amounts to transgressions of staff members' personal moral values, rather than nursing standards, said Elizabeth Higginbotham, an Austin attorney who used to be an assistant general counsel for the board.
Nurses often don't appeal board decisions because they can't afford to hire attorneys to defend them, said Rachel Sheeran, a Fort Worth attorney and former nurse.
But other attorneys say the organization is a tough act to follow.
"I do think they do a great job," said Joyce Stamp Lilly, a Houston medical malpractice attorney who also represents nurses under investigation by the board. "They'll investigate any call they can as far as I know. They're serious."
And many nurses think almost any questionable activity can tarnish a nurse's ability to provide care -- and that such issues are germane to nursing.
Americans rate nurses at the top of the list of trusted professionals. And there's plenty of reason why, Thomas said. Nursing requires a higher order of integrity because nurses visit homes and have access to patients' belongings.
"Patients are very vulnerable. They are sick, elderly, very young, unconscious," Thomas said. "Often, they are not able to make decisions for themselves."
After the board started the criminal checks, the number of board investigations soared. Investigations climbed to 8,623 in 2006, from 5,274 in 2003.
Last year, criminal background checks discovered that a number of new nurses and nurses renewing their licenses had a record with law enforcement. All told, 14 percent of registered nurse applicants and 17 percent of licensed vocational nurse applicants had records; of the renewing nurses, 7.5 percent of registered nurses and 18.5 percent of licensed vocational nurses had records.
Applicants who had committed what were seen as "youthful indiscretions" were most often approved, but those with more serious criminal activity in their pasts were almost always denied, regulators said.
"In any group or profession, there is always a certain group who are not good and should not be in the field," said Mark Majek, spokesman for the board. "We catch them."
Online.
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Missed part of the report?
If you missed part of the series, you can find the reports at www.star-telegram.com.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
Filling the coffers
Like most regulatory agencies of its kind, the Texas Board of Nurse Examiners is a moneymaker for the state.
A look at fiscal 2006 revenue and expenses:
Net revenue: $13,847,075
Net expenditures: $5,954,416
Excess: $7,892,659
Source: State of Texas 2006 Annual Cash Report; Texas Board of Nurse Examiners
Read more in the Fort Worth Star Telegram
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