Three Days in the ICU

Last week I was not in my office. I flew to the west coast to be with a relative who had been taken to the hospital.  When I arrived, I found the relative had been taken to the ICU at their local small community hospital. For the next three days and nights, I stayed with the relative in the hospital.  What I found was really quite amazing.

I was raised in a family of medical professionals and I have spent the better part of twenty years representing medical professionals before their professional licensure boards. I have been to the hospital before, for simple trips to the ER for stitches or a simple fracture. I also spent two nights in the hospital after the births of my children. Nothing in my past prepared me for the time I spent with my relative in the ICU.

I was thoroughly amazed at the level of care that was provided to my relative. I had always known that nurses provided the bulk of the care to patients, but to see it first hand was awe-inspiring. While it was a small hospital, all records were maintained electronically and all medications dispensed were logged into the record. However, since my relative did not have a local physician, they were cared for by the in-house “hospitalists”. Specialists were called in throughout our time at the hospital to evaluate various aspects of the patient’s care, however, it was the nursing staff who provided the constant care to the patient, advocated for the patient, and updated the physicians of the patient’s current medical condition.

Given the fact that the patient did not have an internist who coordinated care, they saw a different hospitalist at each shift. Over the three days that the patient was in the ICU and the other days that they were on a med/surgical floor, they never once saw the same hospitalist. However, the nursing staff provided the continuous care and continuity of treatment to the patient by updating each hospitalist who examined the patient and each specialist as to the patient’s medical history, demeanor and current medical condition. It was a great relief that I did not have to continue to update each physician as to the patient’s condition since they had been prepped daily by the nursing staff.

As a nurse, never under-estimate the superior service and value that you provide to patients and to their families.  To the nursing community at large, this blog post is a huge “thank you” to your service to the community.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please call me at (614) 486-3909, email me at beth@collislaw.com or check out my website for more information at http://www.collislaw.com.

If you received a Notice for Opportunity for Hearing .. request a hearing

On Friday, July 27, the Ohio Board of Nursing held its bi-monthly meeting. At that meeting, the Board voted to take disciplinary action against dozens of nurses in the state of Ohio. Nurses who face discipline by the Board will be mailed a Notice of Opportunity for Hearing, Notice of Summary Suspension or Notice of Automatic Suspension of their nursing license by certified mail.  This is not a final decision by the Board.  These Notices outline the charges that the Board has alleged against you.

If you receive notification from the post office that you have a certified letter from the Nursing Board, immediately go to the post office and collect the letter as there are important time sensitive deadlines which, if not met, can have a permanent effect on your license.

If you want the Board to hear “your side of the story” you must request a hearing in writing to request a hearing by the deadline in the Notice. This can be done by following the instructions in the Notice. A request for a hearing is a simple letter sent to the Board stating that you would like a hearing. You do not need to list your defenses or reasons why you want a hearing. You simply need to state in the letter that you would like a hearing.

You only have thirty (30) days from the date the Notice was MAILED to you to request a hearing.  The 30 day time frame starts on the date that the letter was mailed to you and not on the date that you received the letter. Failure to request a hearing will prevent you from providing any evidence on your behalf to the Board.

I am often asked “why should I even request a hearing … the Board has already made a determination.” This is not correct.  These Notices only list allegations raised against you.  While the Board has conducted an investigation prior to issuing the Notice, in most cases they have only considered one side of the evidence. By requesting a hearing you will be able to present your side of the story.

Even in cases where the nurse has violated the Ohio Nurse Practice Act, by presenting your side of the story and explaining what challenges you faced or what you were thinking when the error occurred, you increase the chances of getting a lighter sanction from the Board than if you simply do not even request a hearing.

You worked hard for your nursing license. There are always two sides to any story. If you receive a Notice of Opportunity for Hearing, a Notice of Summary Suspension, or a Notice of Immediate Suspension, request a hearing within the deadline and make sure the Board hears your side of the story before they make a final determination.

You should also consider hiring experienced legal counsel to defend you before the Nursing Board. When considering how to hire an attorney, check out my previous post on “How to Hire an Attorney”.  Your livelihood depends on you finding experienced legal counsel that you trust to help in your defense.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, feel free to contact me at (614) 486-3909 or email me at beth@collislaw.com.

Nursing Board Consent Agreements Are Binding Contracts and Generally Can Not Be Changed

A Consent Agreement is a written contract between a nurse and the Ohio Board of Nursing. A Consent Agreement is a voluntary agreement that outlines the discipline that will be imposed against a nurse. A Consent Agreement is similar to a plea bargain in a criminal case. The nurse agrees to certain disciplinary conditions, in lieu of proceeding to an administrative hearing before the Board. By entering into the Consent Agreement, the nurse generally admits to certain misconduct and agrees to comply with certain disciplinary terms.

It is important to keep in mind that once you enter into a Consent Agreement, you are required to complete all terms. Depending on the specific language of the Consent Agreement, you can, in certain circumstances, request modifications to a Consent Agreement after a period of time. However, if the Consent Agreement does not specifically provide that the Consent Agreement may be modified, generally you cannot “get out” of or change the terms of the Consent Agreement.

In most cases, for the probationary period to toll, the nurse needs to work in a position where a nursing license is required. Consent Agreements typically always provide that any time that the nurse is not employed in a nursing position will not reduce the probation or monitoring period.

Generally, once you enter into the Consent Agreement, the only way to “get out” of the Agreement is to comply with its terms. Often nurses have “buyer’s remorse” when they enter into a Consent Agreement and after several months, they no longer want to comply with the terms of the Consent Agreement. However, in most cases, unless the nurse has complied with all the terms of the Consent Agreement the probationary period will not be lifted or modified.

Also, at the end of the probation period, the Consent Agreement does not automatically end. The nurse needs to affirmatively request to be released from all probationary terms of the Consent Agreement.

Consent Agreements are contracts entered into between the nurse and the Board of Nursing. As you may be subject to compliance terms for many months, years, or even indefinitely, it is imperative that you understand the terms of the Consent Agreement BEFORE you sign it.

You worked hard for your professional license. As I have said in previous posts, prior to entering into any agreement with the Ohio Board of Nursing, it is important that you seek experienced legal counsel to assist and represent you.

As always, if you have any questions about this post, or about the Ohio Board of Nursing in general, feel free to contact at me (614) 486-3909 or email me at beth@collislaw.com.

What part of NO ALCOHOL don’t you understand?

Nurses who suffer from substance abuse or substance addiction and who are monitored by the Ohio Board of Nursing in either the confidential Alternative Program for Chemically Dependent Nurses Program or pursuant to a Consent Agreement or other public disciplinary action, are typically required to submit to random (often observed) toxicology drug screens. The screens will detect not only alcohol content in the body but can even detect the metabolites of alcohol (evidence that the body is processing or breaking down alcohol). The tests are very sensitive virtually any consumption or exposure to alcohol  in the 3-4 days proceeding such consumption or exposure will be detected.

Prior to initiating the screening process, nurses are advised that they may not consume any alcohol or any substances that may contain alcohol. They are clearly warned to not consume any alcohol, including: beer, wine, liquor, “non-alcoholic” beers and cooking wines. They are also warned to stay away from topical ointments that may contain alcohol and to stay away from cleaning products or aerosols that may contain alcohol. Nurses are usually surprised to learn that many cleaning products contain alcohol and they do not realize that hand sanitizers (the same kinds routinely used in hospitals, nursing homes, schools, etc.), aftershave, air fresheners (Febreze), contain some amount of alcohol.

Despite this requirement, nurses routinely test positive for alcohol or for the metabolites of alcohol in their system (positive ETG test).   Ethyl Glucuronide (ETG) is a direct metabolite of alcoholic beverages (ethanol).  Its presence in urine may be used to detect recent alcohol consumption, even after ethanol is no longer measurable.  The presence of ETG in urine is a definitive indicator that alcohol was ingested.

When questioned, many will initially deny use. Then, they will try to argue that they used a hand sanitizer or over the counter medications, which may have resulted in a positive alcohol or ETG drug screen.

However, while the tests (specifically the ETG test) are very sensitive and can detect consumed alcohol, the cut off for the screening is above the level that would test positive in an “accidental” exposure. Generally, merely cleaning your house with Lysol or spraying your couch pillows with Febreze should not result in a positive screen. However, consuming Nyquil for a cold will result in a positive screen.

As always, if you have any questions about the Ohio Board of Nursing or this post, please feel free to email me at beth@collislaw.com or call me at 614-496-3909.

What the Nursing Board really cares about ..addiction, lies and convictions

I had the opportunity to speak to a nursing school last week about the role of Ohio Board of Nursing. In preparing for the talk, I knew I would be asked “What is going to get me in trouble with the Nursing Board?”.  I have a pretty good idea of the types of actions that I regularly see investigated by the Board, but I also did a little research and reviewed the last few months’ list of disciplinary actions or proposed actions so I would be ready for this question.

I found, generally, the Nursing Board receives 3000 complaints each year. While the Board investigates all complaints, they only take action against approximately 600 nurses each year.

Half of the nurses disciplined or monitored by the Nursing Board involve cases of nurses who suffer from drug or alcohol abuse or dependency. (see my former post The Alternative Program for Chemically Dependent Nurses)   Many nurses voluntarily seek treatment and then are entitled to participation in the Board’s confidential monitoring program.

But, some nurses find themselves the subject of Board discipline after being found guilty of a DUI, or testing positive on a drug screen through their employer. Last month, the Nursing Board cited several nurses who tested positive at work for illegal street drugs or for medications for which they could not produce a valid prescription (ie. they had been given a prescription drug from a friend or family member)

In addition to actions against nurses who suffer from substance abuse, the Board also takes actions against nurses who have felony convictions and misdemeanors involving moral turpitude.  The Nursing Board recently cited nurses who had been charged with numerous crimes including: child endangering; Medicaid fraud; transporting or possessing a semi-automatic handgun; stealing narcotics; misdemeanor assault; illegal processing of drug documents; theft by deception, just to name a few.

The Board also takes action against nurses who have been disciplined by other state agencies (other state Nursing Boards) and they take actions against nurses for practicing outside of the scope of their license or for failing to disclose to the Board a disciplinary action or conviction from another agency or district (lies).

Most nurses are surprised to learn that the Nursing Board is genuinely concerned about conduct both at work and also outside of work. In addition to discipline related to practice, nurses can be subjected to disciplinary actions for “bad behavior” outside of the work setting. Nurses are routinely the subject of discipline by the Board for DUIs, assault, child abuse, neglect, passing a bad check and other crimes. As professionals, nurses are held to a high standard by the Board while at work and after work.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please feel free to email me at beth@collislaw.com or call me at 614-486-3909.

Hello Ohio Nurses!

Hi, in my practice as an attorney I exclusively represent professionals before their state licensing boards in Ohio.  As a former Ohio Assistant Attorney General, I am familiar with the disciplinary process of Boards such as the State Medical Board of Ohio, Ohio Board of Nursing, Ohio Board of Pharmacy, Ohio Chiropractic Board and many, many more licensing agencies.

I regularly help applicants apply for a professional license in Ohio or wade through the disciplinary process. I have started this blog to answer many of the common questions that I receive in my practice on a weekly basis from nurses throughout Ohio. Such as, “should I apply for a license in Ohio if I have a criminal conviction on my record?” “what will happen with my professional license if I get a DUI?” “what should I do if contacted by a board or criminal investigator?”. I hope over  the next few months to answer many of your questions.