By DARREN BARBEE - Star-Telegram staff writer - Mon, Jun. 11, 2007
Second in a four-part series examining state regulation of health professionals
One dentist was accused of botching root canals, bridges and crowns and writing 100 prescriptions after his controlled-substances permit had expired.
Another dentist was sentenced to 27 months in prison for overbilling a government program to help the poor. Still another, from Euless, was shot in the chest while breaking into his in-laws' home. He received probation after pleading guilty to criminal trespass and assault charges.
The dentists all have at least two things in common: They're currently licensed to practice in Texas, and the Texas State Board of Dental Examiners only shares details about their past if a request is made in writing -- just don't expect a quick answer.
Some say the governor-appointed board has struggled in recent years to fulfill its basic mission: protecting the public.
Board member Tammy Allen, a Hurst dental hygienist, said the board does the best it can with the resources it has. But she is troubled by a sharp decline -- 58 percent over three years -- in the number of dental professionals disciplined. She's also concerned penalties are handed out too subjectively.
"Two dentists can have the same violation and one will get a warning and the other a $1,000 fine," Allen said. "That's not right, it's not fair, and as a board member, that bothers me."
The state has taken the board to task for such problems as failing to enforce its disciplinary actions and not meeting deadlines.
Consumer advocates are concerned that, while the board can give bad dentists and even those who are convicted criminals a second chance, its Web site merely states if a dentist has faced discipline and the type of penalty imposed. It offers little information about the nature of their offenses.
Supporters say the board in recent years has cleared a large backlog of complaints, some stretching back more than six years. During that time, disciplinary actions exceeded state-set benchmarks, although last year they were lagging.
Fread Houston, the board's general counsel, said the agency's penalty system has been overhauled in recent years to make it more evenhanded. More consistent results would come if the small agency with 29 budgeted employees had more funding, he said.
State reports show last fiscal year the board generated $4.5 million more than it spent. But that money, largely from fees related to licensing, credentialing and examinations, went to the state's general fund. The board spent $1.8 million.
Among other needs is an updated computer system.
"It's crazy," Houston said. "Literally, I look at the screen and it's as if you're in 1980."
Houston said the board is making progress.
"Can it be made better? Yes. I think there is room for improvement."
Backlog of complaints
The board's job is big: Each year it must screen the approximately 12,000 dentists and 10,000 hygienists it licenses, on top of investigating hundreds of complaints.
It has fallen short in both areas, according to the most recent state auditor's report on the board.
Houston said he doesn't agree with some conclusions reached in the August 2005 report, including the discovery that six convicted felons weren't investigated during the licensing process.
The board uses the Texas Department of Public Safety to conduct criminal background checks but relied on a report that showed only changes in criminal records during the prior four months, rather than a full criminal history as required by law.
The board responded by saying that it would work with the DPS to ensure it obtained full histories on all new licensees.
"It wasn't that we weren't doing our job," Houston said. "It was that the information we were getting back was just not complete."
The audit also found that sanctions imposed against dentists and hygienists weren't enforced. One dentist, for instance, was required to receive peer assistance for a substance-abuse problem. The day after the board was notified the dentist hadn't done so, its staff renewed his license.
In response, the board noted that it is not authorized to use the license-renewal process as a disciplinary tool.
In a separate report by the Legislative Budget Board, the board took hits for failing to investigate complaints on time. In 2005, for instance, it averaged about a year to resolve problems, about 80 days longer than the state benchmark. Last year, the board again averaged a year response time, but the state upped the deadline to 400 days.
Earlier this spring, the board faced a backlog of about 270 complaints, including a 2001 case.
The slow response to a backlog of complaints resulted from employees leaving for other agencies or the private sector, Houston said.
From June through December 2005, for instance, the executive director, director of enforcement, five investigators, an attorney and two administrative employees left the board. As a result, new employees were constantly being trained and were unfamiliar with the system. In the legislative session that just ended, the board was granted eight new positions it requested.
Thief's license reinstated
Greed got the best of Amarillo dentist Charles T. Carr.
In the late 1990s, he began overbilling a government poverty program for the care he provided. In the end, it cost him two years in prison, but not his profession.
"You know, it was just a case of seeing a way to maybe make a little extra money," Carr said.
He was stripped of his license but in 2003 received a new one from the board. He's at a loss to explain why the board granted his application.
"I haven't got a clue," said Carr, who is barred from billing the state or federal government for patients. "I've prayed about it a lot."
The board considers the nature of the crime, the amount of time passed, recommendations from court personnel and other information when deciding whether to license a dental professional.
Cases such as Carr's aren't detailed on the board's Web site. The site notes if a dental professional has faced disciplinary action in the past. In another part of the Web site, there's a listing of the penalty a dental professional received, but it only goes back about three years.
Dr. Robert Baratz, a Massachusetts physician and dentist who helps run the watchdog Web site dentalwatch.org, said it ought to be easier for the public to know about disciplinary actions. "As the consumer, I would like to know. ... A lot of boards want you to go through hoops to try to get it," Baratz said. "I would just as soon click on it and read it."
New York state's Web site, for instance, gives the day action was taken against a dentist, a summary of the infraction -- such as "admitted to the charge of filing a false report" -- and details about penalties, such as the terms of probation and amounts fined.
Dr. Richard Black, an El Paso dentist and past president of the Texas Dental Association, said the group doesn't support adding more information to the Web site.
"I feel that's a privacy issue between the licensees and the people who are disciplined," he said.
The association supported increasing the board's budget.
Online.
Filling the coffers
Like most regulatory agencies of its kind, the Texas State Board of Dental Examiners is a moneymaker for the state, spending less than a third of its revenues.
A look at fiscal 2006 revenue and expenses:
Net revenue: $6,337,539
Net expenditures: $1,806,608
Excess: (to the state general fund): $4,530,931
Source: State of Texas 2006 Annual Cash Report
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.
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
Showing posts with label patient safety. Show all posts
Showing posts with label patient safety. Show all posts
Saturday, August 25, 2007
Nursing board sets high standards - Some state lawmakers want agency to relax its tough rules
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
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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