Presentation on theme: "The Investigatory Process 2013 NCSBN IRE Conference"— Presentation transcript:
1 The Investigatory Process 2013 NCSBN IRE Conference Rene Cronquist, J.D., RNMinnesota Board of NursingDirector of Practice and Policy
2 Tools in the Regulation tool box Regulation uses a variety of mechanisms – tools, if you will, to carry out is mission of public protection
3 What’s in your tool box?Statutes, Rules, Regulations, Case Law, Policies, Advisory OpinionsProgram approval/AccreditationCredentialingLicensureRegistrationCertificationInformation/DataOther mechanisms, components?
4 What’s in your tool box?Big tools: Enforcement, compliance, discipline, investigation, remediation
5 The right tool for the job Knowing which tool to use depends on what you are trying to do.In the context of investigation, are you:Deciding if the complaint/report is within the authority of your agency?Gathering factual information to determine whether the complaint has merit?Gathering information for another group or agency to make decisions?Determining what action is most appropriate based on the available information?Knowing which tool to use depends on what you are trying to do.Have any of you ever used a wrench, or other handy, heavy tool for a hammer? Or tried to use a regular screwdriver when you really need a Phillips head? How did it turn out? Ever try to open a bottle with a crimped top without a bottle opener? Yeah, you can do it but it can be frustrating and the results may not be what you intended.
6 Reporting and Enforcement Complaint processIntakeInvestigationBoard ProceedingsBoard ActionsReporting and Enforcement
7 Complaint process – another view IntakeInvestigationBoard ProceedingsBoard ActionsReporting and Enforcement
9 Complaint receipt Initial review Intake Complaint receipt – paper (mail), fax, , on-line formOther state agencies, law enforcementInternal complaints – Application forms, identified in course of investigating another complaints, Nursys reports, newspaper articlesAre there mandated complaints?Are there statutory requirements for complaints such as time deadlines or format requirements?
10 Intake tools Sources of complaints Methods of submitting complaints Mandatory and permissive reportBoard as a source of complaints; self reports; NursysMethods of submitting complaintsScreen for jurisdictionThresholds, triage, prioritizing, codingTracking mechanismsIntake – complaint receipt and initial reviewPurpose: determine whether complaint is jurisdictional to the board and where the complaint fits in scheme of priorities and processes.
12 Investigation tools An effort to learn the who, what, where, why, when and how of the allegationsMethods:Record gatheringEmploymentMedical records of nurse or patientPharmacy and Prescription drug monitoring program recordsControlled substance inventory logsCourt records and police reportsSchool recordsReports from other agenciesBank recordsSubpoenasHIPPA and other privacy and data practices limitationsFederal protection of CD records
13 Investigation tools Forensics Interviews/Written statements Evaluation of licensee (CD, mental health, neuropsych)Drug testingComputers (home & work PCs, cell phone, EHR access)Drugs (assay of syringe contents, analysis of automated dispensing machine history)Interviews/Written statementsLicenseePatient/victimWitnessesSupervisor and coworkersCollateral contactsScreen castCaptures the look, the words, the images, the interactivity and inter-relationships from one page and link to the nextCaptures webcam narration by witness – which can be compelling to judge and juryFree, open-source tool: screencast-o-matic.comOther products like Camtasia
14 Investigation tools Written statements/affidavits Recordings Surveillance videosAudio recordings as evidenceAudio recordings of interviewsSite visitsOther recordsEmployer policies and proceduresDatabanks (Nursys, HIPDB/NPDB)
15 Investigation results ReportsFormats, templatesKnow your intended audience and all possible readersRecommendations; Determining next steps
16 Challenges Coordinating investigation with other agencies Peer review protection of recordsOut-of-state recordsDestroyed recordsUncooperative witnessesUnreliable or incompetent witnessesUncooperative or unlocatable licenseesCoordinating with law enforcementCoordinating with other state boards and agencies or other Boards of Nursing
18 Results of Investigation Board proceeding & action
19 Board proceedings & actions Informal processesStipulated agreementsFormal processContested case hearings; administrative hearingsStandard of proof must be met (clear and convincing vs. preponderance); Board typically has burden of proofAppeals of Board decisionsEmergency/temporary proceedingsAuthority -- usually limited – to take action against a license before a hearing on the meritsMiscellaneousInformalStaff may be authorized to propose stipulated agreementsMay be based on pre-determined range of actionsMay or may not need board ratificationMisc.Stips to cease; cease and desistAdministrative suspensions for tax delinquency
20 Board proceedings & actions Conclude the complaint without action (dismissal)Referral to a non-disciplinary monitoring programNon-disciplinary action (letters of concern, admonishment, reprimand, Agreements for Corrective Action)Disciplinary Action
21 Board proceeding & action Reporting and Enforcement (Compliance monitoring)
22 To Report or Not to Report Is the action public?Is the action reportable?NursysHIPDB/NPDBOIG
23 Compliance monitoring Terms and ConditionsProbationary termsReports from the nurseReports from the nurse’s supervisorAudits – documentation, med administrationAdditional educationMaintain sobriety, attend support groupsDrug screensRestrictions/LimitationsSupervision requiredRestricted access to controlled substancesLimitation on work hours or locations
24 Compliance monitoring Non-complianceFailure to comply, violations of the order; new allegationsProcess used to address non-compliance depends on terms and conditions of the order and individual state lawsMore toolsChecklistsTracking mechanismsReport formsAuditsRandomizing drug screens
25 Challenges and policy questions How much information is enough?How to manage sometimes competing priorities? Efficiency, cost containment, timely resolution of cases, appropriate resolution of cases.How do we measure quality and effectiveness?