Welcome To My Blog

A Disciplinary Action or Agreed Order Is Forever

March 1st, 2010 by Taralynn Mackay | Posted in Nurses | No Comments »
Tagged as: , , , , , , , , , , , ,

Disciplinary actions or Agreed Orders remain on a nurse’s license forever.  When stipulations/restrictions are placed on the license, the nurse’s license is encumbered and those restrictions show up on the license when the license is verified (for example, the verification page will show “Warning with Stipulations” or “Remedial Education”).  Once the stipulations/restrictions are completed and the Board sends a letter of completion to the nurse, the verification page will show clear; however, the disciplinary history remains.  If asked if the nurse has ever been sanctioned or disciplined*, the nurse will have to answer “yes.”

Recently, I have received several inquiries regarding “setting aside board orders.”  This cannot be done and this is misinformation.  While criminal incidents can sometimes be expunged or sealed, administrative actions currently cannot be removed from one’s license.  Once a disciplinary action occurs, the history remains even once the “probation” is complete.

*  The Texas BON currently asks, “Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license, certificate or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?” to obtain information about past disciplinary actions.

Trial of Winkler County Nurse Who Reported Doctor-Finale?

February 11th, 2010 by Taralynn Mackay | Posted in Doctors, Nurses | Comments Off
Tagged as: , , ,

Anne Mitchell was found not guilty. Yea!!!

Trial of Winkler County Nurse Who Reported Doctor to TMB-Part II

February 11th, 2010 by Taralynn Mackay | Posted in Doctors, Nurses | Comments Off
Tagged as: , , , , ,

The Texas Nurse Association has been tracking this case closely and is in attendance at the trial. TNA has also set up a legal defense fund and provided letters in support of the nurses’ actions. Here is their account of the daily ongoings , quoted from texasnurse.org,

Update: Wednesday, February 10

Andrews Courthouse – On the stand this morning, the nurse’s defense attorney Cook continued the cross-examination of Sheriff Robert Roberts of Winkler County. Defense wanted to know: what was confidential about the nurses’ complaint? That’s still unclear.

And, it seems, there was yet a second complaint filed against the physician. The sheriff admitted that he didn’t check with the Texas Medical Board, said he didn’t know which complaint was the first and which was the second. The second complaint was filed by a nurse who was never indicted. Sheriff said he didn’t do any investigation of whether complaints the nurses made were true.
When the defense attorney asked if the sheriff had ever arrested someone simply because the person gave him information about a possible crime, the sheriff answered, “yes.” The defense attorney rephrased the question and asked it again. Still the sheriff answered, “yes.” The courtroom laughed. The judge then admonished that their laughter was inappropriate behavior and he will have them removed if the laughter continues.
Court is now recessed for lunch. When trial continues this afternoon, the next witness is the nurse who replaced Vicki Galle in the performance improvement position at Winkler County Memorial Hospital.

Update: 3:10 p.m., Wednesday

Andrews, TX Courthouse – State prosecutors rested their case against Anne Mitchell. The court is in a recess. When it reconvenes, defense attorney Cook is to file a motion for a directed verdict that the state failed to prove every element of its case beyond a reasonable doubt. More updates to follow.

Update: 5:45 p.m., Wednesday

Court has recessed after what was day 3 of the Winkler RN trial. Judge Rex denied an earlier defense attorney’s motion for a directed verdict. The defense started presenting its case this afternoon and called a number of character witnesses for Anne Mitchell. Trial resumes tomorrow morning. Closing arguments might be heard at day’s end.

Thursday, February 11

The State and the Defense have put on their cases and rested. This morning, Anne’s attorney has finished her defense.

The State had to prove five elements to prove Anne misused official information: 1) Anne was a public servant (all public employees are), 2) she had access to information because of her employment, 3) that information not public, 4) Anne used the information with the intent to harm another, 5) the information was used for a nongovernmental purpose. The State’s evidence focused on the last two elements because the prosecutor told the jury that those were the two most in dispute. The State’s main evidence consisted of several witnesses who testified about two to three occasions on which they heard Anne make statements such as “Dr. Arafiles will be gone in a year” “he is not a doctor” “he is a witch doctor.” There was also testimony of an ongoing conflict between Anne and Dr. Arafiles. She had refused to sign off on his original credentialing because hospital bylaws required physicians to have unrestricted license. The State also focused on the need to follow the chain of command. In cross examination, Anne’s attorney was able to get in good information about substandard care by Dr. Arafiles on cases Anne reported to Texas Medical Board (TMB). The Defense showed that most of the witnesses who testified about Anne’s motives had only been contacted within the past couple of weeks and not before Anne was indicted.

On Wednesday, Anne’s attorneys began her defense and called several witnesses to testify. The first was a nurse practitioner who had worked at the Winkler County Rural Health Clinic and left because of her concerns that issues relating to the care provided by Dr. Arafiles had not been addressed. She had also filed a complaint against Dr. Arafiles with the TMB at the same time as Anne and Vicki (all worked together). The NP testified that she has subsequently filed a second complaint. She testified that Anne was motivated only by her concern for patients. The second witness was an LVN, who testified about her concerns regarding Dr. Arafiles’ work at the clinic. She also left because of those concerns and the stress they were causing her. The Defense called the Winkler County judge (not the trial judge) testified that she knew Anne and Anne had discussed her concerns about Dr. Arafiles. The judge said Anne’s motive was patient concern. Lolly Lockhart, RN, testified as an expert witness on a nurse’s duty. Dr. Pham, Chief of Staff at Winkler County Memorial Hospital, testified about concerns about Dr. Arafiles’ care. He also testified that Anne was concerned about patient care and that Anne is a good nurse.

Thursday morning, the defense called a medical expert, who testified that he had reviewed the five cases cited in the complaint to TMB and found substandard care. The Defense has rested. Next, the charge will be read to the jury, the Prosecution and Defense will give their closing arguments, and the jury will begin deliberation.

The case is no less perplexing as to why Anne was indicted. All witnesses (even the State’s) have agreed nurses have a duty to report unsafe care.

Personal take: That this case has even gotten this far is unbelievable and the only hope is that the jury is fair and unbiased. It sounds like the defense teams for both nurses have been working hard in establishing that the nurses were concerned about patient care.

Trial of Winkler County Nurse who reported Doctor to Texas Medical Board-Part 1

February 10th, 2010 by Taralynn Mackay | Posted in Doctors, Nurses | Comments Off
Tagged as: , , , , , , ,

The trial began on February 8, 2010 with jury selection.  Prior to the trial, one of the two nurses, Vicki Galle,  originally indicted was dismissed from the case.  Anne Mitchell’s trial involves felony charges for mis-using private, patient files to harass the County hospital’s doctor.  On February 9, 2010, testimony began in the trial.   The IT person testified and then Dr. Arafiles testified. The allegations of his poor care were discussed and Dr. Arafiles actually testified that he did not think there was a difference in the way diabetic patients healed compared to non-diabetics.  It was also pointed out that the Sheriff is a friend of Dr. Arafiles and a business associate as well.  For news articles see: CBS7 and the New York Times.
Personal take:  The fact that these nurses were ever charged with anything is not justice.  The actions taken by the Sheriff and the DA reek of “good ol’ boy” tactics.  This case should be thrown out and the “officials” involved investigated for misuse of official power.  The “system” only works if all involved believe in it–that it is fair and that the people in power have no personal agendas for their actions and are acting based on the best for the public.  For a Sheriff and DA to go after whistle blowers is an affront to their job of protecting the public.

Trying to find a job while under a Board Order

February 3rd, 2010 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , , , , , , , , , , , , , ,

I have heard from another nurse who is having a difficult time obtaining a job while under a Board Order.  This is an ongoing problem especially in this economy. Some employers are refusing to hire a nurse no matter what the basis for the Order. Most nurses cannot afford to fight an Order in court or the facts of the nurse’s case are such that there is a definite violation and fighting in an administrative law court may not gain the nurse much.  There are some solutions that can help:

1.  Make sure you have malpractice insurance so that you have the financial resources to go to a hearing if you do not agree with the BON’s decision in your case.

2. When looking for a job, ask everyone you know for help in finding a job.  It tends to be easier to get a job if someone is on the “inside” vouching for you and your skills.  There are also employers out there that understand that most nurses with a Board Order are not “bad” nurses; that the nurse just made a mistake, or was overworked/understaffed, or had a disease relapse etc.  These employers recognize that most nurses that have had a Board Order become extremely cautious nurses and become definite assets to the facility.

3. Make sure that you have an experienced and BON knowledgeable attorney assist you with your case before the BON so that you get the best outcome possible.

4. You must present a professional appearance (this includes your resume, your social networking site pages, and any application you complete).

5. Contact your state senators and representatives and ask them to make some changes for the next legislative session in 2011.  Some areas that need changes: expand the corrective action provisions to apply to minor practice violations, allow non-public orders for mental health issues and substance abuse (these are diseases, so why allow the publicity?), allow deferred adjudications to be just that and not be considered a conviction by the BON, and change the language in the NPA from shall to may to allow the BON leeway to make determinations based on mitigating factors.   As 2010 progresses, I will probably think of more…

I also have more info here:  http://nursinglaw.blogspot.com/2009/07/how-to-explain-past-board-orders-to.html

Additions to BON’s website

January 12th, 2010 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , ,

The Board reports online that they have some new options to help nurses obtain information needed from the Board: 1) the ability to track application status online, so that applicants can track what the Board has received and what is still required and 2)a “Live Help” function that allows individuals to chat online with BON staff during normal working hours. Hopefully, these changes will help to move the various processes more quickly and efficiently.

New Nursing Jurisprudence Course Set

January 4th, 2010 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , , , ,

I just received the Texas Board of Nursing’s brochure for their upcoming Nursing Jurisprudence course.  It looks like instead of having a course in August in Austin (which is what has happened the past few years), the Board is having the course for central Texas in San Antonio on February 25 or February 26, 2010.  So, if you were going to wait for the Austin course to complete your stipulation, you should consider taking the upcoming San Antonio course.  Likewise, the other typical dates have been changed as well, so plan accordingly.

The other posted dates for the Nursing Jurisprudence course by the Board (the formal title is “Texas Board of Nursing: Protecting Your Patients and Your Practice”, the course is only one day and is offered on two consecutive days):

  • June 23/24, 2010 – Arlington, Texas
  • August 18/19, 2010 – Houston, Texas

Temporary Suspension of License for a Postive Drug Screen

December 15th, 2009 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , , , , , , ,

Nurses that are on Board Orders for monitoring due to substance abuse or on a Board Order sending the nurse to TPAPN must be extremely careful with complying with their Board Order and with what they ingest because of the following section of the Nurse Practice Act (taken from the Board’s website at www.bon.state.tx.us).  There is no provision to allow for an explanation that you mistakenly took a medication or that you were only taking cough medicine or whatever explanation is given for the positive screen.  The Board will temporarily suspend your license and then you and your attorney will work on getting the issue resolved and your license unsuspended; so, it is much better to be careful to begin with.

Sec. 301.4551. Temporary License Suspension for Drug or Alcohol Use.

The board shall temporarily suspend the license of a nurse as provided by Section 301.455 if the nurse is under a board order prohibiting the use of alcohol or a drug or requiring the nurse to participate in a peer assistance program, and the nurse:

(1) tests positive for alcohol or a prohibited drug;

(2) refuses to comply with a board order to submit to a drug or alcohol test; or

(3) fails to participate in the peer assistance program and the program issues a letter of dismissal and referral to the board for noncompliance.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Impairment Issues before the Nursing Board

December 7th, 2009 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , , , ,

The Texas Board of Nursing’s E&D Committee is discussing the following issues today:

1. Discussion and review of the Board¿s policies and rules relating to physical and psychological evaluations for mental impairment, physical impairment, and/or chemical dependency/abuse of drugs or alcohol, including review and discussion of the Occupations Code §301.4521; 22 Tex. Admin. Code §§213.20, 213.29, and 213.30; proposed amendments to 22 Tex. Admin. Code §213.33; and the Eligibility and Disciplinary Sanctions for Nurses with Substance Abuse, Misuse, Substance Dependency, or Other Substance Use Disorder.

2. Presentation by Dr. A. David Axelrad, M.D., relating to physical and psychological evaluations, including information regarding objective testing, evaluation criteria, and qualifications of evaluators.

3. Committee recommendations regarding proposed amendments to 22 Tex. Admin. Code §213.33 and guidelines for physical and psychological evaluations for mental impairment, physical impairment, and/or chemical dependency/abuse of drugs or alcohol.

4. Continued discussion and review of SB 1415, enacted by the 81st Legislature, Regular Session, effective September 1, 2009, and Pilot Program on Deferral of Final Disciplinary Actions, including discussion of the feasibility of conducting a pilot program to determine the efficacy of deferring disciplinary actions.

5. Committee recommendations regarding the feasibility of conducting a pilot program to determine the efficacy of deferring disciplinary actions pursuant to SB 1415.

This means that we should see some new rules or guidelines or policies coming from the Board regarding psychological evaluations and something regarding how the Board plans to implement SB 1415. So, more to come….

New Prescriptive Rules for APRNs

December 3rd, 2009 by Taralynn Mackay | Posted in Nurses | Comments Off
Tagged as: , , ,

The Texas Nursing Board has posted new prescription rules for APRNs and the deadline to comment on the rules in 12.27.09 (scroll down to find the Nursing Board rule). The new rules have some “clean-up” language including changing APN to APRN; however, there are significant changes that require APRNs to review these rules. There is new language regarding practice sites and there is a requirement that the delegating physician must designate to the Texas Medical Board that the APRN is authorized to sign a prescription. There are restrictions on prescribing off label usages of medications. There some definite changes recommended and all APRNs should review these proposed rules.