California's Board of Registered Nursing has historically done little on its own to ferret out such problems. Until last year, the state did not even ask nurses renewing their licenses whether they had been disciplined by another state.
Moreover, the board only checked nurses' records against the council's database of disciplinary actions when they applied for a California license. Since August, California also has been checking the database when the board begins an investigation of a nurse.
Sanctions found
Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.
Among them are:
* Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. . . . I guess I deserve what is coming to me."
His California license is active, without restrictions, and does not expire until July 2010.
* Jeffrey Strong, whose license was indefinitely suspended in Virginia in September 2008 after he allegedly left his post at a hospital psychiatric ward with the medication cart unattended. He had previously been disciplined for medical errors at another hospital in the state, including failing to monitor a patient who fell and as a result required emergency surgery.
"I was not providing safe care on that unit at that time and could not now," he wrote the Virginia nursing board in December 2007 about that earlier discipline. Strong has a clear license in Florida as well as California.
* Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.
Martinez and Strong could not be reached for comment. Hopp declined to comment, saying the discipline was in the past. Reporters could not determine if or where they and others in this article were working, because this information is not collected by most states.
Asked about this article's findings, California officials said regulators will now check for out-of-state discipline for every licensee by the end of March. At its February meeting, the nursing board plans to discuss additional steps to better use the council's database.
California is also working to speed up the pace of discipline.
In the past, the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.
Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.
Experts and regulators say the patchwork nature of nursing regulation in the country underscores the importance of a complete national database. State regulators should be required not just to submit their licensees, they said, but to routinely check to see if their nurses have been disciplined elsewhere.
Currently, only information about completed sanctions is available. Some experts say formal accusations, detailing charges against nurses, should be included too. "The more information that's available as quickly as possible and shared as fully as possible . . . the better off you are," said Oshel, the former federal official.
Such efforts might have kept Orphia Wilson from moving easily from Florida to Connecticut. Within days after Florida regulators revoked her license in October 2004, they reported the action to the federal government's database. Sometime later, the information was put into the council database.
As is their practice, however, Florida officials didn't report their action to other states. Connecticut, as is its practice, did not regularly check the national databases.
The next year, Wilson once again renewed her Connecticut license, checking "no" when asked if she had been disciplined elsewhere.
Moreover, the board only checked nurses' records against the council's database of disciplinary actions when they applied for a California license. Since August, California also has been checking the database when the board begins an investigation of a nurse.
Sanctions found
Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.
Among them are:
* Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. . . . I guess I deserve what is coming to me."
His California license is active, without restrictions, and does not expire until July 2010.
* Jeffrey Strong, whose license was indefinitely suspended in Virginia in September 2008 after he allegedly left his post at a hospital psychiatric ward with the medication cart unattended. He had previously been disciplined for medical errors at another hospital in the state, including failing to monitor a patient who fell and as a result required emergency surgery.
"I was not providing safe care on that unit at that time and could not now," he wrote the Virginia nursing board in December 2007 about that earlier discipline. Strong has a clear license in Florida as well as California.
* Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.
Martinez and Strong could not be reached for comment. Hopp declined to comment, saying the discipline was in the past. Reporters could not determine if or where they and others in this article were working, because this information is not collected by most states.
Asked about this article's findings, California officials said regulators will now check for out-of-state discipline for every licensee by the end of March. At its February meeting, the nursing board plans to discuss additional steps to better use the council's database.
California is also working to speed up the pace of discipline.
In the past, the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.
Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.
Experts and regulators say the patchwork nature of nursing regulation in the country underscores the importance of a complete national database. State regulators should be required not just to submit their licensees, they said, but to routinely check to see if their nurses have been disciplined elsewhere.
Currently, only information about completed sanctions is available. Some experts say formal accusations, detailing charges against nurses, should be included too. "The more information that's available as quickly as possible and shared as fully as possible . . . the better off you are," said Oshel, the former federal official.
Such efforts might have kept Orphia Wilson from moving easily from Florida to Connecticut. Within days after Florida regulators revoked her license in October 2004, they reported the action to the federal government's database. Sometime later, the information was put into the council database.
As is their practice, however, Florida officials didn't report their action to other states. Connecticut, as is its practice, did not regularly check the national databases.
The next year, Wilson once again renewed her Connecticut license, checking "no" when asked if she had been disciplined elsewhere.
