BOARD OF REGISTERED NURSING Intervention/Discipline Committee

Agenda Item Summary

AGENDA ITEM: 9.1

DATE: September 7, 2017

ACTION REQUESTED: Information Only: Complaint Intake and Investigations Update REQUESTED BY: Barbara Yaroslavsky, Chairperson BACKGROUND: COMPLAINT INTAKE: Staff The Complaint Intake Unit currently has a Staff Services Analyst vacancy at our Expert Practice Coordinator desk. We have an open recruit to fill this vacancy. Program BRN has successfully recruited 25 new Experts into the Enforcement program since March, and we’ve experienced a sustained increase in EPC applications since beginning our new recruitment efforts in February. Our capacity to handle the EPC workload is enhanced and we are receiving an increased volume of completed Expert Reports as we work through a backlog. Expert timeframe improvement has improved slightly, and we anticipate more significant improvement in the coming months.

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Days

Cases

Sep‐16

Oct‐16

Nov‐16

Dec‐16

Jan‐17

Feb‐17

Mar‐17

Apr‐17

May‐17

Jun‐17

Volume 55 33 41 36 29 28 41 41 52 62

Age 69 69 64 59 61 57 71 46 59 50

Expert Report Volume and Timeframes

Fiscal Year 2017 Statistics

Complaints Received 4,004Arrest & Conviction Criminal Offender Reports 5,182Total Complaints Received (FY 16/17) 9,186

Current Complaint Intake Workload

Complaint Intake Desk Investigations Pending (All open complaints, not-including field investigations)

1,213

Desk Investigations Pending > 1 year 51Cases Pending Expert Review 68

Sources of Complaints The IDC Committee has asked for statistics and data regarding the source of complaints against nurses. All CORI cases are received from a law enforcement source of fingerprints. All other complaints come from a variety of sources. Board Staff have reviewed the total complaints for the last two full fiscal years. The volume of cases is as follows:

FY

2015/16 FY

2016/17 Two-Year

Totals Complaints 3,212 4,004 7,216Convictions/Arrests 4,330 5,182 9,512Total 7,542 9,186 16,728

Breeze data captures the sources of incoming complaints. The graph below shows the following source data for all non-CORI complaints for the last two fiscal years:

INVESTIGATIONS: Staff The BRN Investigation Unit is fully staffed, and there are no vacancies. The support staff position previously on loan to the probation unit has returned. I would like to introduce Special Investigator Danielle Farwell, the newest member of the BRN Investigation Unit. Program The pace of incoming investigation referrals remains very high. Despite our strict adherence to the DCA Guidelines for investigation referrals, and increasing each investigator’s pending workload, the BRN Investigation Unit again has some unassigned cases.

Investigative timeframes continue to be a focus. I am working closely with DOI management staff and the BRN Supervising Special Investigators to identify efficiencies and address the causes of investigative delays. Data in the charts below show both DOI and BRN average investigative timeframes are showing continued improvement from historical averages. As of August 22, 2017, there were approximately 51 BRN investigative cases and 53 DOI cases that have been within their respective units for more than one year. Statistics Cumulative Investigation Referrals - Fiscal Year 2017 No. of Cases Percent of all

Referrals Referred to DOI 621 48% Referred to BRN Investigation Unit 675 52%

Historical Production Numbers BRN Investigations Feb

2017Mar 2017

Apr 2017

May 2017

Jun 2017

Jul 2017

Total cases pending 475 492 474 499 489 511Cases closed 86 52 61 52 67 60Average days to case completion 279 262 269 261 253 248Average cost per case $3,054 $2,272 $2,633 $2,701 $2,549 $2,253Division of Investigations Feb

2017Mar 2017

Apr 2017

May 2017

Jun 2017

Jul 2017

Total cases pending 325 352 353 376 416 424Cases closed 24 35 28 32 25 24Average days to case completion 302 292 315 224 250 284Average cost per case $4,346 $6,721 $8,133 $6,893 $7,529 $9,689

NEXT STEP: Continue management monitoring of complaint

resolution milestone data; make adjustments to obtain the best timeframes possible.

FISCAL IMPACT, IF ANY:

None at this time.

PERSON TO CONTACT: Joseph Pacheco, Chief Complaint Intake & Investigations (916) 515-5268

BOARD OF REGISTERED NURSING Intervention/Discipline Committee

Agenda Item Summary

AGENDA ITEM: 9.2

DATE: September 6, 2017

ACTION REQUESTED: Information Only: Discipline and Probation Program update REQUESTED BY: Barbara Yaroslavsky, RN, Chairperson

PROBATION UNIT Staffing There is a Staff Services Analyst/Associate Governmental Program Analyst (Probation Monitor) vacancy that is in the process of being advertised. We have filled the two Limited Term Staff Services Analyst positions.

Program On July 26, 2017, Probation Program Manager, Elizabeth Elias and Probation Monitor, Lisa Hall instructed the Probation Monitoring Module of DCA’s SOLID Enforcement Academy for staff at various Board and Bureaus within DCA. The probation unit has initiated the new business process of allowing petitioners, who have met all probation conditions and other criteria, an opportunity to stipulate to early termination of probation. Through this process the probation unit has been able to remove 45 probationers from the current list of petitioners waiting to appear before the Board.

Probation Statistics FY

2014/2015 FY

2015/2016 FY

2016/2017 Current

Active In-State Probationers 1,095 1,189 1,196 1,219

# of Chemical Dependency Probationers

707 785 787 771

Tolled Out of State Probationers

290 345 380 378

Pending Cases at AGO for further discipline of licensure

128

91 130 122

Total Probationers 1,385 1,534 1,576 1,597

The average case load of active probationers per probation monitor is approximately 135. However, the average number of cases per monitor including Tolled cases is 177. There are 28 Early Termination and 16 Modification of Probation cases waiting to be heard by the Board. The Board has transmitted 45 Petitions for Early Termination to the AG’s office for the stipulation process. Once the vacancies are filled the average cases per monitor including Tolled cases will bring our average down slightly to 133 cases per monitor. This is still over the average case load of 75, which was estimated to be the appropriate level per monitor.

CITE AND FINE Staffing We are currently fully staffed. Program We have begun issuing citations for the licensees that have been non-compliant with fingerprints. We are anticipating this to be completed by end of this calendar year. Statistics FY

2015/16 FY

2016/17 FY Current

2017/18 Citations Issued 542 366 92Amount Ordered $ 299,638 $ 266,428 $85,450Amount Received $ 253,974 $ 202,614 $13,575

DISCIPLINE UNIT

Staffing We are currently fully staffed. Program We will begin our pilot project of case transfer via the cloud. We have been transmitting FastTrack and Petition cases, since July 20, 2017, to the Attorney General’s Office. We will be providing updates on case aging as well as when a full roll out can be expected. AG Statistics FY

2015/16 FY

2016/17 FY

Current 2017/18

No. of Cases Referred to the AG 1,395 1,198 75No. of Cases Pending 1,338 1,191 1,295No. of Cases Older than 1 yr. 390 349 432No. of Cases Older than 1 yr. Without Pleading

56 51 77

No. of Cases Awaiting Hearing 214 162 146

Legal Desk Statistics FY

2015/16 FY

2016/17 FY

Current 2017/18

Pleadings Served 1,277 1,059 118 Petitions to Revoke Probation 87 120 10 Stipulated Surrenders Signed by EO

255 254 27

Withdrawals of SOI 15 9 0 Decisions Adopted 1,641 1,282 119

NEXT STEP: Follow directions given by committee and/or board. FISCAL IMPACT, IF ANY: AG’s budget line item will be monitored for Discipline

and Probation. PERSON TO CONTACT: Shannon Silberling, Chief

Discipline, Probation, and Intervention (916) 515-5265

Board of Registered Nursing Discipline Program Statistical Summary

FY 2015/16

License Type* Case Outcome

Public Reproval Revoked, Stayed, Probation

Revoked, Stayed, Suspension, Probation

Surrender Revocation Voluntary Surrender

Total FY 2015/16

Registered Nurse 215 473 8 255 489 75 1,515 Public Health Nurse 14 40 1 18 26 9 108

Psych/Mental Health - - - - - - 0

Nurse Practitioner 18 24 - 11 8 - 61

NP-Furnishing # 17 18 - 8 7 - 50

Nurse-Midwife 1 3 - 1 - 1 6

NM-Furnishing # 1 3 - 1 - 1 6

Nurse Anesthetist 2 6 - 1 3 1 13 Clinical Nurse Specialist

2 1 - - - 1 4

*Specialty certifications are a subset of the Registered Nurse license. When enforcement action is taken on an RN license, all

advanced certifications a nurse holds is also included in the action. More than one enforcement action may be taken (thus counted

here) against an RN during the time period.

FY 2016/17 License Type* Case Outcome

Public Reproval Revoked, Stayed, Probation

Revoked, Stayed, Suspension, Probation

Surrender Revocation Voluntary Surrender

Total FY 2016/17

Registered Nurse 222 391 5 254 245 63 1,180 Public Health Nurse 22 35 - 25 15 8 105

Psych/Mental Health - - - - - - 0

Nurse Practitioner 15 22 - 15 4 5 61

NP-Furnishing # 15 21 - 10 4 4 54

Nurse-Midwife 2 1 - - - - 3

NM-Furnishing # 1 - - - - - 1

Nurse Anesthetist - 7 - 2 1 1 11 Clinical Nurse Specialist

1 - - - 2 - 3

*Specialty certifications are a subset of the Registered Nurse license. When enforcement action is taken on an RN license, all

advanced certifications a nurse holds is also included in the action. More than one enforcement action may be taken (thus counted

here) against an RN during the time period.

Board of Registered Nursing Discipline Program Statistical Summary

July 1, 2017 – August 21, 2017 License Type* Case Outcome

Public Reproval

Revoked, Stayed, Probation

Revoked, Stayed, Suspension, Probation

Surrender Revocation Voluntary Surrender Total FY 17/18

Registered Nurse 19 41 - 23 33 4 119 Public Health Nurse

1 3 - - 1 1 6

Psych/Mental Health

- - - - - - 0

Nurse Practitioner 1 1 - 2 1 - 5 NP-Furnishing # 1 1 - 2 1 - 5 Nurse-Midwife - - - - - - 0 NM-Furnishing # - - - - - - 0 Nurse Anesthetist - 1 - - 1 - 2 Clinical Nurse Specialist

- - - - - - 0

*Specialty certifications are a subset of the Registered Nurse license. When enforcement action is taken on an RN license, all advanced certifications a nurse holds is also included in the action. More than one enforcement action may be taken (thus counted here) against an RN during the time period.

Probation Data Numbers % of ActiveMale 371 30%Female 848 70%Chemical Dependency 771 63.2% Required Drug-Screening 625 51.3%Practice 292 24.0%Mental Health 10 0.8%Conviction - excluding chemicaldependency/alcohol use 146 12.0%Advanced Certificates 113 9%Southern California 706 58%Northern California 510 42%Pending AG - Tolled 3 0%Pending AG 122 10%License Revoked Fiscal YTD 5License Surrendered Fiscal YTD 8Terminated Fiscal YTD 6Successfully Completed Fiscal YTD 21

Active In-State Probationers 1219

Completed/Revoked/Terminated/Surrendered YTD 40

Tolled Probationers 378

Active and Tolled Probationers 1597

Probation Program StatisticsJuly 1, 2017 - August 29, 2017

BOARD OF REGISTERED NURSING Intervention/Discipline Committee

Agenda Item Summary

AGENDA ITEM: 9.3

DATE: September 7, 2017

ACTION REQUESTED: Information Only: Intervention Program Update and Statistics REQUESTED BY: Barbara Yaroslavsky, Chairperson

Staffing The previous vacant Staff Service Analyst (SSA) position has been filled and the Intervention unit is fully staffed.

Program Update

On June 19th, 2017, Intervention program staff and Virginia Matthews, MAXIMUS Project Manager provided training to approximately 50 nursing and pharmacy leaders at Mission Hospital, Mission Viejo. Topics of discussion where, what is the Intervention program, what is Substance Use Disorder and the signs, symptoms and progression of the disease. On August 23, 2017, Intervention program staff and Virginia Matthews, MAXIMUX Project Manager will be presenting an educational outreach presentation at Citrus Valley Hospital, San Gabriel Valley. This will be a two session presentation for the facility’s nurses and leadership. On August 17th, 2017, the Intervention program hosted the third in a series of approximately four Mental Health Ad Hoc Committee meetings. The committee members worked effectively to review all current practices and discussed different approaches and potential changes. The purpose of this committee is to develop best practice strategies to meet the unique needs of nurses with mental illness and to develop a model rehabilitation plan for use by all the Intervention Evaluation Committees. Intervention Evaluation Committees (IEC) There are currently two physician member vacancies, one in Oakland (IEC 13) and one in San Jose (IEC 7). Statistics – Intervention The Statistical Summary Report is attached. To date there have been 2,210 successful completions.

NEXT STEP: Follow directions given by Committee and/or Board. FISCAL IMPACT, IF ANY: None at this time.

PERSON TO CONTACT: Shannon Silberling, Chief Discipline, Probation and Intervention (916) 515-5265

Current Months

Year 

To Date

Program 

To Date

Complaints Referred 80 80 16,283

Current Month

Year 

To Date

Program 

To Date

Referral Type* 

Board‐Referred 4 4 3,924

Self‐Referred*  6 6 1,382

TOTAL INTAKES COMPLETED 10 10 5,306

Current Month

Year 

To Date

Program 

To Date

Substance Abuse (only) 8 8 3,336

Mental Illness (only) 1 1 175

Dual Diagnosis 1 1 1,710

Undetermined 0 0 85

Current Month Year to Date

Alcohol 3 3

Opioids 4 4

Depressants 2 2

Stimulants 0 0

Cannabis 0 0

Other (e.g. Hallucinogens, Inhalants, etc.) 0 0

None 1 1

Current Month

Year 

To Date Program to Date

Applicant: Clinically Inappropriate ‐ Pre DEC 0 0 31

Applicant: No Longer Eligible 0 0 13

Applicant: Not Accepted by DEC 0 0 61

Applicant: Public Risk 0 0 98

Applicant: Sent to Board ‐ Pre DEC 0 0 2

Applicant: Withdrawn ‐ Pre DEC 2 2 551

Applicant: Withdrawn ‐ Due to Program Cost 1 1 6

COMPLAINTS REFERRED

DRUG OF CHOICE

Pre‐IEC Closures

Board of Registered NursingIntervention ProgramStatistical Summary

July 2017

INTAKES

PRESENTING PROBLEM AT INTAKE

CLOSURES

NUMBER OF PARTICIPANTS: 374 (as of July 31, 2017)

*May change after Intake

Post‐IEC Closures

BRN Intervention Program Statistical Summary: July 2017Page 1 of 3

Prepared 8/22/2017

Completed 13 13 2,210

Clinically Inappropriate ‐ Post DEC 0 0 3

No Longer Eligible ‐ Post DEC 0 0 7

Withdrawn ‐ Failure to Sign Contract 0 0 1

Withdrawn ‐ Post DEC 0 0 342

Withdrawn ‐ Due to Program Cost Post Dec 0 0 2

Terminated ‐ Deceased 0 0 41

Terminated ‐ Failure to Receive Benefit 0 0 125

Terminated ‐ Moved 0 0 52

Terminated ‐ Non Compliant 0 0 985

Terminated ‐ Public Risk 1 1 276

TOTAL CLOSURES 17 17 4,806

Current Month

Year 

To Date Program to Date

Gender

Female 9 9 4,145

Male 1 1 1,134

Unknown 0 0 27

Age Category (at Intake)

20‐24 0 0 35

25‐29 2 2 431

30‐34 1 1 889

35‐39 2 2 1,107

40‐44 0 0 1,085

45‐49 3 3 859

50‐54 1 1 544

55‐59 1 1 250

60‐64 0 0 79

65+ 0 0 13

DOB Error/Not Entered 0 0 14

Ethnicity

American Indian/Alaska Native 1 1 40

Asian/Asian Indian 1 1 129

African American 1 1 172

Hispanic 1 1 235

Native Hawaiian/Pacific Islander 0 0 31

Caucasian 6 6 4,331

Other 0 0 84

Not Reported 0 0 284

Worksite at Intake**

Case Management 0 0 5

Clinic 0 0 118

Clinical ‐ Public, non‐profit 0 0 2

Corporation 0 0 9

Doctor's Office 0 0 46

Government Agency 0 0 7

Group Practice ‐ profit 0 0 16

Health Maintenance Organization 0 0 6

INTAKE DEMOGRAPHICS

BRN Intervention Program Statistical Summary: July 2017Page 2 of 3

Prepared 8/22/2017

HMO 0 0 1

Home Health Care 0 0 19

Hospital 0 0 2,608

Not Working in Nursing 0 0 4

Nursing Home 0 0 10

Other 0 0 248

Prison/Jail 0 0 13

Private Practice 0 0 9

Registery 0 0 179

Retail 0 0 1

School of Nursing 0 0 9

Telephone Advice 0 0 2

Temporary Service 0 0 3

Undetermined 10 10 684

Unemployed 0 0 1,307

Specialty at Intake

Chemical Dependency 0 0 8

Critical Care 0 0 914

Dental Public Health 0 0 1

Doctor's Office 0 0 27

Emergency Department 0 0 592

Gerontology 0 0 28

Home Care 0 0 100

Hospital 0 0 349

Insurance 0 0 5

Medical Surgical 0 0 988

None 0 0 74

Nurse Anesthesia 0 0 54

Nurse Midwife 0 0 7

Nurse Practitioner 0 0 108

Nursing Home 0 0 16

Obstetrics/Gynecology 0 0 291

Oncology 0 0 160

Operating Room 0 0 179

Other/Other Specialty 0 0 485

Pediatrics 0 0 140

Psychiatry 0 0 148

Recovery Room 0 0 103

Undetermined 10 10 529

**NOTE: RN licenses are placed on inactive status once an RN enrolls in the Program

BRN Intervention Program Statistical Summary: July 2017Page 3 of 3

Prepared 8/22/2017

BRN Intervention Program Statistical Charts

July 2017

BRN Intervention Program Statistical Charts: July 2017 Page 1 of 2

Intake Demographics

BRN Intervention Program Statistical Charts

July 2017

BRN Intervention Program Statistical Charts: July 2017 Page 2 of 2

0 2 4 6 8 10 12 14

Applicant: Clinically Inappropriate - Pre DEC

Applicant: No Longer Eligible

Applicant: Not Accepted by DEC

Applicant: Public Risk

Applicant: Sent to Board - Pre DEC

Applicant: Withdrawn - Pre DEC

Applicant: Withdrawn - Due to Program Cost

Completed

Clinically Inappropriate - Post DEC

No Longer Eligible - Post DEC

Withdrawn - Failure to Sign Contract

Withdrawn - Post DEC

Withdrawn - Due to Program Cost Post Dec

Terminated - Deceased

Terminated - Failure to Receive Benefit

Terminated - Moved

Terminated - Non Compliant

Terminated - Public Risk

Program Closures (July 2017)