Our guest: Maggie Ortiz, RN, MSN CEO Advocates for Nurses
Ever feel like the nursing license you worked so hard for hangs by a thread? You’re not alone. Board of Nursing investigations and disciplinary actions can feel overwhelming, with due process sometimes seeming like a distant hope. In this episode, we sit down with Maggie Ortiz, the fearless leader of Advocates for Nurses, to unpack the realities of navigating Board of Nursing complaints. You’ll hear firsthand how:
– Misunderstandings and procedural errors can jeopardize your career.
– Lack of awareness of your rights can put you at a disadvantage.
– Seeking professional help too late can limit your options and defense.
We’ll break down the essential steps to take when facing a complaint, including:
– Understanding your legal rights as a licensed healthcare professional.
– Building a strong support network with experienced advocates and advisors.
– Navigating the investigation process with confidence and clarity. This episode is your essential guide to protecting your license and livelihood.
Tune in for practical advice, empowering stories, and crucial insights on safeguarding your career from the uncertainties of Board of Nursing actions. Bonus: Learn about Advocates for Nurses, a resource dedicated to empowering nurses and securing fair treatment within the healthcare system.
Transcript:
Terri
Welcome back, everybody, to diversion insights. We are going to take a little different topic today, but I think it’s going to be interesting nonetheless and certainly apply to any nurses or any discipline that finds themselves potentially in trouble with suspected diversion. My guest today is Maggie Ortiz. Welcome back, Maggie. Maggie and I have filmed a previous podcast, and if you haven’t watched the first one, I really want you to consider checking it out. Maggie is a nurse and CEO of advocates for nursing. In our previous podcast, Maggie told us all about advocates for nursing and what they do, and we also discussed things that nurses are not typically trained on. And I think that also probably goes for pharmacists as well. Different, different aspects of it, but certainly the same idea from the legal perspective and things that were just not taught in school.
Terri
And then we also talked about how a pharmacist perspective is different from a nurse’s perspective, and yet they’re both important and can be very important when it comes to legal things, too. Maggie has some experience with the board of nursing. I believe she used to work for the board of nursing. Correct, Maggie?
Maggie
Yes, ma’am.
Terri
And from that experience, she found that the board of nursing does not always provide the due process that they should or we would like them to do. And so that’s what we’re going to talk about today, because anytime anyone goes before their licensing board with a complaint, we are now to some extent, at the mercy of that board. Right. So it might get a little controversial, especially for those listening that are with the board of nursing or another board, but that’s what we’re going to talk about today. So let’s start, Maggie, with, let’s start somewhere, maybe tell us about a specific example where you saw that due process was not followed and how that could have been different turned out for the nurse. Or let’s just start with one thing that I’m sure that will be able to flow from there.
Maggie
So let’s just start with, like, one of the things that we talked about on kind of our cross paths where I was asking you about some of your workflow as it pertains to nurses. And when a nurse, quote unquote, alerts, I’m working 60 hours, I work on a detox unit, and now I’m on also the ortho floor where there’s hips, knees. I’m recovering surgical patients. I’m also working 60 hours a week. You get my name because I’ve alerted. On what? What have I alerted? And now there’s something that’s done, and we’re told as the nursing staff that there’s an algorithm, and now I’m being questioned. And then what looks like on paper, and I’ve seen this more often than not, and I’ve seen nurses stand in front of a board of nursing even recently, thankfully, it got dropped before Christmas, thankfully for her.
Maggie
But where she’s standing in front of the board of nursing in the report or even in her case, and I’m not talking about all pharmacists not wanting to work with a nurse to look at. Take the lens out on. Let’s just say, okay, let’s look at the unit you’re working on. Let’s look at, you know, what your hours were and what that looks like in relationship to what you’re doing, what I’m doing, and to the border of nursing. So let’s just start there. About that case. I, you get my name on a list because I’ve alerted in you.
Terri
If you’re working 60 hours a week, I’m going to go with an assumption that you alerted for more dispensers than some of your peers. Okay?
Maggie
Correct. So let’s say that again. So I don’t even think nurses often realize that. And will you talk to us about that a little bit as well? I know we’re kind of all over the place, but, you know, breaking that down, that, let’s just break that down. So a nurse alerts, why. Tell us about your workflow, what you’re doing in this algorithm that you’re doing, because that’s a very appropriate, you know, we talked about on the previous podcast, nurses don’t realize that you can get in trouble if there’s DV, if a drug is diverted or if there’s inappropriate use stuff, whatever it is. So part of your workflow is reviewing the nurses or any provider that’s pulling drugs. Will you just talk about that just a little bit? Sure. Yeah.
Terri
So what Maggie’s referring to is on our previous podcast, we had talked about how the pharmacist in charge is responsible for all of the medications as well, certainly all the controlled substances, and so they need to do their due diligence. So whether it’s through a software surveillance program that they have or whether it is through the automated dispensing machine reports and looking for people that they are outside of the standard deviation, they call it. One of the things that we look at is to see is somebody dispensing more medications. That and others. And when we see that, then we need to dig into it and see what’s going on. I think where Maggie’s going to go with this is that the example that she’s giving, where she’s working 60 hours a week, she’s doing some in rehab and she’s going to ortho.
Terri
Those are very high volume units. There’s a lot of medication. So who are we comparing? Maggie too? Are we comparing her to the other ortho nurses? Okay. Is she still higher than the other orthonurses? Okay. But is she working more hours in that area than the other ortho nurses? Now that doesn’t mean that we don’t have diversion going on, but it does mean that we need to drill down a little bit further. And it would not be appropriate at all to compare Maggie with. I mean, rehab gives probably quite a few meds as well, but ortho is really high. So if we’re comparing her to just her rehab people, but she’s doing a lot of hours in ortho, that’s gonna skew things as well.
Terri
So we wanna be very careful to never just take somebody has high dispenses and then file that complaint with the board of nursing. We, and when I say we, I mean whoever is in charge of your diversion program needs to be doing their due diligence before they even hand it off to Maggie’s manager, because it may not be a thing at all. And then, of course, you know, you keep your documentation as to why you did not hand that off because this is what you found, you know, hours and unit, you know, what have you, whatever the things are. But if you’re not sure after you’ve ruled those things out, then you take it to the next step of then having that conversation with the manager and deciding with your diversion response team what have you know what you’re going to do next.
Terri
But yes, we need to be careful and not just making assumptions off of one data point.
Maggie
And so another question bears, should it matter, and I already know the answer, should it matter if it’s a travel or a temporary person, should that person be treated any different than a full time staff member? Do I, am I not extended the same courtesies of you sitting down with me as a professional? If I’m a temporary staff, if I’m local agency, travel agency versus permanent?
Terri
Yes. I mean, the due diligence is the same. You look at the factors. Unfortunately for travel nurses, you know, I mean, there are a higher percentage of travel nurses that we do find end up in trouble with diversion because that’s often a way that they can travel around and get access to different facilities. But that being said, we should never go in with the assumption, oh, it’s travel nurse. You know, that’s it. And unfortunately, some facilities do want to spend less time and resources on their travel nurse, because there are travel nurse. We can just cancel the contract. But when you think about it from a human perspective, you know, you could be changing that person’s.
Maggie
No, you are. You are changing that person’s life. I’m here to tell you are changing that person’s life, because that person’s calling me now. They’re sleeping in the car. Because this kind of allegation, anything tied to a drug. And we talked about this. This is the DEA. This is the board of pharmacy. This is the board of nursing. And it is. It does have law, far reaching ramifications to that nurse. It absolutely does. And so I loved all the stuff that you were talking about, how even, like, your educational piece, where you will go in and talk and educate, like, even your community, and just say, hey, bump the brakes here, buddy. Or, you know, sister, you know, and just say, hey, let’s just take the lens out a minute.
Maggie
Like you said, they’re on a rehab and an ortho, and she’s working 60 hours, so we cannot put her in the same algorithm. Right. So let’s just pause here and do a little bit more due diligence. I even think you talked about as well, when we talked saying that about. Okay, so now this person is alerted. Okay, so I did. It’s maybe, you know, uncertain. I can rationalize, but maybe there was one or not 100% sure, but in your gut feeling, so then you put them on your purview. You may be watching them a little bit closer than you may be someone else, just to make sure they do nothing. Everything is perfect. You know, that was during COVID There was a lot of volume. Things level out, you know, and you don’t see those trends anymore. So that person falls off your purview.
Maggie
Those are the kinds of things that I think need to happen. Like in one of the nurses instance, you know, talking about a case, not going to disclose the state, but drug her through a process where you get evaluated for fitness to practice. That is when you get any types of these allegations. That’s what is under. For. Under the National Council for State Boards of Nursing and or the rules and regulations under the board says, are you fit to practice? And it doesn’t matter what discipline you’re in. We all have criteria for that. And that’s how you will be evaluated. So she, out of her own pocket, got to pick three providers that the board selects, right. That you have to go see for this screening.
Maggie
And I’m not a doctor, but it’s six, 7 hours long to decide whether you have a diagnosis that requires you to be inpatient, outpatient, or whether you don’t. So then that cost her money. That’s time. An investigation could take up to two years, and just. That seems like a long time, but that door swings both ways. When you reached out, when I got the complaint, I then had to type up the complaint. I also had two to 300 cases. That was my workflow as an investigator in various different stages. Then I had to send your allegations. Then I had to send the hospital, who all these people have 30 days to get back. Then I’m doing my stuff. I’m reviewing it. Well, I now go down another rabbit hole. Now I need this. I have to subpoena this.
Maggie
So that investigation, if I’m doing my due diligence, should take me maybe three to four months, right. Because I need to make sure that I’m getting everything back. But now who’s on the other end of that investigation? A nurse. Right. And drugged through that process. Do I have to tell my employer? Do I have to tell anyone? So these are the things that the nurses and the lawyers will come to me, and I’ll give them some guidance. Like, we’ll call the board if you have a question. Most boards have on their frequently asked questions. If I get a complaint, do I have to tell anyone while it’s in the investigative process? No, it’s confidential. But then that’s where you would want to go to your respective board. Or I can help you do that. But that’s scary to a nurse. Right.
Maggie
Or anyone who holds a professional license. And now, okay, you get the allegations. You’ve responded. One piece of what I feel like you’re lacking a due process is they send your allegations. So I send you as the pharmacist, an allegation on a case two years ago, and I want your response within 30 days. Do you remember what happened? Is that fair? Three sentences and asked something. Is that fair? And so, innately, as providers, what do we want to do? Comply. Right. And we talked about this on a lot, last podcast. So then now you start going down this rabbit hole, and I’m like, stop. Because, again, what was the allegation? Now you started talking about Bob and this, the body temperature. I’m like, that’s not even what was in these words. So what are you doing right now? You know what I mean?
Maggie
And that’s where the board, I feel like, should be adhering to due process, not just me. I mean, the constitution says that it’s not just Maggie, that.
Terri
So what. What’s an example of the due process that they don’t adhere to that.
Maggie
Sure.
Terri
That you’ve seen.
Maggie
I’ve yet to see where a board, and I’ve helped a nurse and everything in their legal team in every single state automatically produce part of the record. Now, are some a little bit better? They are. They’ll give the nurse the actual allegation. So the complaint, and they get to see who it is and might provide them with some medical records.
Terri
Some.
Maggie
Some will provide that more often than not. No. You get your allegations, and then you’re expected to respond within 30 days and get nothing else unless you say, I want my phone complete file. But do you think a nurse knows that language?
Terri
And now they just give you a little bit of, like, on September 14, you had a patient that date while.
Maggie
You were hired here. This is the conduct. And I wrote those allegations. I got a complaint from you, the pharmacist, that said Sally was diverting drugs. I then wrote an email to allegation to Sally Eleanor, about this date. While you employed at this, you diverted to Vicodin. Tell me what you did, and I want you to respond with me within 30 days.
Terri
That’s not a lot. That’s not a lot to go on.
Maggie
And that it’s not due process. If you had an attorney for civil criminal law, do you think they would ever let you respond to any of those? No, that’s called discovery. It’s called discovery in the. In the civil world, criminal. Right. They. That’s part of the discovery process, is that you get the evidence right. That’s why we’re waiting for the discovery. You hear this right in court, law and order. That’s part of your right under, is that you know what the full and complete file is, and then you can then go back to the medical record. Well, it says right here that I did remove and that the pain score was this, and I did give that drug next. And that you have the opportunity to respond to that, not to something vague, and then you could possibly open yourself up for other things.
Maggie
Well, I thought I did. I did this. And then who knows what you say? And now you just added on allegations.
Terri
So when anybody with a professional license gets that initial honor about this happened, tell us what happened. What is your recommendation? What should they do?
Maggie
Get a lawyer. You need legal counsel. Hopefully you have malpractice insurance. You probably do. Physicians do NP’s, do crnas, do rns, oftentimes don’t. And I don’t know if you know this, it’s the culture of the RNA in our world not to do that. Like why would you have your own. No, no. The hospital, the facility going to protect me. It’s the culture of nursing for the RN and below not to have medical malpractice insurance. I say the opposite because who knows that you have it. Yes. If an organization is sued or something, a bad outcome happens. Right. Patient dies from medication error, you know, all feel very bad about that. Yes. The facility should write them a check. Right.
Maggie
And so you are covered by the nurse or pharmacist under respondent, superior, under, you may have your own malpractice insurance, but you’re covered under that entity, under that language, respondents superior and. But if it goes to the board of nursing or medicine or pharmacy or whatever is, they’re not responsible to provide legal representation for you. That’s civil litigation, not administrative litigation. But will that liability insurance will get you an administrative lawyer. A medical malpractice attorney will not get you criminal to my knowledge.
Terri
Yeah. No, that’s important. Yeah, I’ve always had my own. I didn’t realize that nurses didn’t traditionally have their own as well. You would like to think you’ll be covered and taken care of, but.
Maggie
Do you think there’s a conflict of interest there? I mean, do you think that there’s.
Terri
Well, again, this also goes back to what we talked about in our first podcast. We, as we’re embarking on our career, we’re going to do everything right. Why would there ever be a problem? You know, I’m a good pharmacist, I’m a good nurse and I make solid decisions. But yeah, things don’t always go the way you plan, or maybe you are and you didn’t do anything wrong, but you find yourself in this situation because somebody else has jumped the gun or misinterpreted something or behaved, you know, poorly. And so now here you are. Okay, so get a lawyer, everybody out there.
Maggie
If you don’t talk to the board of nursing, I would be doing a general denial letter. That’s what an attorney would do. That when they get ahold of me, when I’ve been the expert, that’s what I do. Right. We, you would type up a general denial letter. You’re complying, you’ve responded back to them. You’re giving them a general denial because you don’t know. It’s vague. And you. And you know, that’s what we talk about. And then you start listing out. I’ll take the camera footage. I’ll take everything you would want to list out. And I do everything that you would need. Again, you leave nothing unturned because I want it. It’s part of my right to know if you’re going to be using that against me to include evidence based science or research. You have an expert that you’re calling that.
Maggie
I get to know who that is and I get to see the report. Right. That’s part of my due process. Do you get all that? You don’t, but even if you get a mere fraction of that’s something. That’s at least something that. So you have to work off of to say, no, I didn’t do that. And let’s look at page five, where it clearly says that, but times the boards do what they want. No one oversees them. There’s no one boards anymore. It doesn’t matter which one it is. There’s no over. And something happens, and then who will you tell?
Terri
Yeah, and I think this is a good time to remind the listeners, too. They may not be aware that the board, the licensing board, and this goes, I think, for all of them, they’re looking after the public’s best interest. They’re not looking after the nurses or the pharmacist best interest. You kind of would think they are because they are your licensing board, but it’s the public’s best interest. And so it’s their mission.
Maggie
I would encourage everyone who holds a professional license. This is like a two minute read. Check out what the mission of your board is. It’s not you. It’s not you. So you need to know, and you need to understand that they have a duty to other things, but it’s not to you. And so when you’re under investigation and you know, there have been medical boards, I mean, the Texas brought down, what, three, four sessions ago? The medical board, the public health committee brought them on down for some of the stuff that I’m talking about. Right. For what I feel like is happening at the board of nursing. So it’s not just nursing boards, it’s other boards. And part of the problem is it’s the way that administrative law is written in general.
Maggie
It’s written in the fashion where they don’t understand what each board does respectively. They hand it over to the state board of nursing figures stuff out, write your rules and regulations and go ahead and hold yourself accountable to those. Go ahead. We’re good with that. And, you know, and there it is. Right? And now you have the fox overseeing the henhouse. That just can’t happen. You know, when I hear a judge, the last time I testified for a nurse, an administrative case, say, we’re in the breakout room. It’s ridiculous. Everyone knows this is three years of her life. She’s not working. We go through all 33, like, didn’t give the bank exhibit a. That’s her, you know, cause again, I’m helping to prep her. Didn’t give the fluids be. So the judge asked her, why do you think you’re here?
Maggie
The board of nursing is away making their decision. Oh, by the way, any judge in administrative court, it doesn’t matter what your discipline is, never has a final decision. So I just want you people to know that providers, if you go to state office of Administrative Hearing, which is trial for us, for a license holder, the judge is called a proposed decision. So as to why do you think that you’re here? She looks at us, her lawyer and myself, and I shake my head, because again, I don’t want her to talk about retaliation. You know what I want to do? Smack him with the facts. And I did. And she said, why do you think you’re here? She looked at me, I said, go ahead. She said, retaliation. The judge said to us, I oftentimes see nurses here due to retaliation.
Maggie
My blood pressure was 500. But I’m there as an expert and not as an activist. I’m not there as CEO advocate. Maggie. Right. And so I was just like, oh my gosh. I was like, oh, ma’am, will you please repeat that? She said the same thing. So it’s not just me, right? Obviously a judge is saying that she’s seeing nurses here due to retaliation. And again, the question bears, whom will the nurse tell?
Terri
Okay. And a judge doesn’t have the final decision. It’s the licensing board that ultimately does. Even if it goes before a judge. Yep.
Maggie
And this is just not me making this up. Anyone could do their own due diligence, as I have over the last decade, to introduce myself to this because I knew was affecting my people, myself. And so I’ve done this research. Yes, it is called proposed decision. It’s right there, in fact, right there under the law.
Terri
Okay. Have you, do you have a case in mind that you have seen? Where had the licensee been aware of that? Maybe the board wasn’t representing their interests, that they had these other due diligence that they were entitled to. And it went completely like either in the end, it ended up being okay, maybe because it was figured out, the truth was figured out, or maybe it didn’t go okay, but after you looked at all of the evidence, it’s like, oh, this did not go the way it was supposed to go. I mean, I imagine that happens all the time. Yeah.
Maggie
I mean, hers is a perfect example. Or even the nurse that I talked about for the. She did have a good outcome, right? She. The. I apologize. The first one is the one I referenced, the one sitting there with the judge. And the judge was saying retaliation. Right. Because I had the board looked at that evidence. Oh, I don’t know from the beginning that they had. It wasn’t unique to us. It was all there, right. Through three decades of her career. Right. Three years. They formally charged her, which means she’s on nurses. So if people don’t know what nurses is, and you are sys.com, the nurses call it the wall of shame. It’s the once you get reported and disciplined, then you go on there for life. And your orders, your agreed orders, what you sign, get scanned in.
Maggie
Any nurse that’s on the wall of shame, you can look at what they did. They’re finding a task, their resumes, all of it. So have they done their due diligence just like I did? Have they called an expert? Which they don’t. Let me just say that again, because a consultant within the board of nursing does not meet the criteria for an expert. I’ve been a civil expert. There’s expert rules in every state. Texas is chapter 74, where there’s certain criteria for an expert. An expert is different from a consultant. Right. An expert shouldn’t be getting their cut. Check from the board of nursing. Right.
Terri
How does that. Yeah, that’s bias. I mean, you’re. You’re with one side versus the other.
Maggie
Correct. So how they consulted an expert like myself than the same evidence. Because I look at stuff unbiasedly and I have no problem telling nurse, you messed up. This is what you know when you got to own it. You know what I mean? You. You’re a professional. Uphold the integrity of our profession. But if you didn’t do it, why isn’t the board of nursing doing their due diligence and. Or getting an expert? And that’s all I want for a nurse. If a nurse is called, then why aren’t you calling an expert? If we’re getting all to this place where you’re charging a nurse formally. Please tell me you had an expert who meets the same qualifications as I do. Right. If I’m an Ice, if the case is in an ICU, then you have to call an ICU nurse. There are nurses.
Maggie
And when I was at the board, investigators, and I have no problems with this, who had only done psych, two years of psych nursing. So how are you opining or giving your opinion on my conduct as an icing nurse in a critical care setting? She didn’t even know what third degree heart block was. She was like, the patient came in with chest pain. I was like, okay, well, let me see the EKG. I didn’t get that for chest pain really is a national standard, but I know that because I’m a critical care nurse. She did not. So why isn’t the same or similar standard held in administrative law? Why wouldn’t they be calling an expert to get their opinion? And just because you’re an advanced practice nurse does not mean that you can opine on my conduct. Have you ever worked in the ICU?
Maggie
You have not. That does not give you the ability to opine on my conduct, nor does that give you the ability to opine on LPN’s conduct. Have you taught lpNs? Have you been an LPN? Just because you’re an advanced practice nurse does not give you that ability.
Terri
So from your experience, what do you see? So the board of nursing receives a complaint, sometimes from a diversion perspective. The complaint is, you know, they admit, and here we’re filing a complaint. Sometimes it is. The person did not admit that the data is overwhelming. And this is what we think. We think they were doing to divert. But sometimes it is. We have some data. There was no admission. We did interview. It was inconclusive. So we’re filing for poor practice, most certainly because it’s, at the minimum, it’s poor practice, but we can’t rule out diversion. So what do you see would be typically the board’s next step then? I mean, I don’t know what happens after it gets to them. You know, I’ve been told, just report. When in doubt, file the complaint, and then we’ll look into it.
Terri
But are they not looking into it very well, and every state is different.
Maggie
Are some worse than others? They are, yes. And it is also dependent on the investigator. There’s so many variables here, and there’s no consistency. Like, when I was at the board, there was no, like, a, B, C, D. I was never taught nor trained to even consider retaliation. But going back to the diversion and or alternative to discipline or fitness to practice. So you’re looking at, is this nurse fit to practice? So what do I have? I have a complaint. So I’m going to start looking at the medical records as well. Do I have a positive uds or not? Did they or did they not? And this is where I see that the failure on the facility side. Please. If you’re suspecting this, and especially if it’s acute, then why aren’t you uds and the nurse?
Terri
Right.
Maggie
Because then that’s, then we, that’s a tool that you have, and it’s, that could, that also could find them to be innocent.
Terri
Not all facilities incorporate that.
Maggie
And so again, there’s another question, and we can come back that to that as well, because what is the responsibility a of the pharmacist and the facility as far as, like, drug testing? So, so it comes to the board. You know, what do I have? Do I have a positive uds? Do I have witness statements? Do I have the. And I can tell you about my own experience where, you know, I was oriented in a place, and she actually put an iv in herself first day there. Right. She had an iv in her arm. I mean, there’s the evidence. So what do I have as the investigator? What do I have? So that does make a difference. Do I have a trend? Okay, so let’s look at the medical records. Do they match up?
Maggie
So I would want to see the orders and then I would want to see the Pixis right where they are. The omnicell, the medication dispensing record. Does it match up? I want to see the pharmacist investigation. Did the facility do a root cause analysis? And RCA, you know, did the nursing side get involved as well? I want to see that.
Terri
Is this essentially you’re looking at all of the stuff should be if I’m involved in the investigation that I’ve already looked at and I did not come to a conclusion. So what.
Maggie
But I still have to do my due diligence as well as that. Of course.
Terri
Yeah, yeah, of course. But what do you do then on top of that? That would get you to a conclusion? Does it end up like where I ended up?
Maggie
Like.
Terri
Well, I don’t know. So I guess it’s a no. You know, they’re not diverting or does the board do something extra? Is that where the fit for duty.
Maggie
Would come in fitness to practice? So then they do have a responsibility more often than not, they are going to have you evaluated just like you said. If nothing else, this is a medication documentation error. So even you don’t divert. You go see a fitness to practice provider, which is one of three people, if they feel like it rises to that level, if they don’t necessarily feel like it rises to that level and it’s truly, you know, and you’re admitting it’s a documentation error. You know what I mean? And you’re not suspecting, like, it matches up, right. It’s matching up. There’s no suspecting of, like, the diversion, clear documentation errors that then they’re getting a warning with stipulation. They’re getting, you know, some form of reprimand, a reprimand. Maybe they get, you know, it’s a lot of them, they’re getting a suspension.
Maggie
They’re staying their suspension. They’re getting righting the wrong Medicaid for classes, documentation classes. Some states give you fines and then you do go on that wall of shame. You are found by this. There are some discrepancies. There is probably a question whether you do have, you know, some fitness to practice or even they still want you to be evaluated to fitness to practice. So you go, you see a provider, one of three, who evaluates you for fitness to practice based on their recommendation, dictates whether you meet the criteria for the program alternative to discipline. If they feel like that you meet the criteria for basically rehab and or diversion, then they’ll give their recommendation with your diagnosis based off your mds that score that they do. And I’m not a psych provider.
Maggie
That screening, which is supposed to be, you know, you’re supposed to have a diagnosis if they’re recommending inpatient and or outpatient. But I’ve seen where that’s not, you know, always the case either. But the recommendation on that, then the nurse goes into a diversion program. You’re not disciplined by the board of nursing. You’re handed over to another program like you. If you got a DUI, it’s not funded by the board of nursing. It’s independent of them. And you follow the program, whatever it is, your meetings, all your drug screening, all that stuff. You have to go, you have to follow all the instructions. You fail a drug screen, then you’re going to be back up on the nurses. The board of nursing’s purview.
Terri
Okay. All right. So I guess if I had to summarize, if you’re filing a complaint, don’t take it lightly because there are ramifications down the line, of course, which I think we all know intuitively, we have to just be careful to remember this is a human being, and it does make a difference. I mean, if you feel there’s a reason to file and obviously file, but don’t just willy nilly file, everybody out there should have their own liability insurance so that if they get a letter from the board saying a complaint has been filed, they should turn to that liability insurance and get a lawyer to help them up front, because that could save them a lot down the line.
Maggie
Correct. An administrative lawyer. An administrative lawyer for a border nursing case, and then a civil lawyer if it’s a medical malpractice case.
Terri
Okay. Yeah. And remembering again that the licensing agency is there to protect the public, not the licensee. Yeah. Which kind of goes counterintuitive.
Maggie
Correct. And then just still pivoting off on that. I’ve seen where the nurse gets evaluated or the provider gets evaluated by this provider, and then they’re not allowed to see their mental health screening. No, no. And I’ve had nurses and lawyers reach out to me, and then I’ve helped type up the language and remind not only the provider, but the board of nursing or the entity that falls under HIPAA, and it’s their right. And in one case. Right. That produced that. And then all of a sudden, you know, there was no. Everything from the board of nursing went away because it took, you know, saying we, that nurse, that provider has a right. Not only that, if you’re saying that I need inpatient treatment, I have a diagnosis. I have a right to know what my diagnosis is.
Maggie
So those are some of the things that I keep hearing on my purview, or nurses come to me or lawyers come to me, and I’m just like, I can’t even believe this is happening. And then you find out that the physician owns the rehab center and. Or they have some kind of investment in this rehab center. Right. And then why is it as a provider, not like that. Why aren’t you telling me? My diagnosis is you’re setting up over to the board of nursing. But I also even know the evaluation is because of that does not mean that I don’t get to know what my mental health status is.
Terri
Yeah, a little conflict of interest there. So there was a case recently that was huge for a nurse. Criminal charges. What went wrong with that case? Can you expound on that a little bit?
Maggie
Sure. I presume every nurse knows about Redonda. Most pharmacists know who Redonda is. So she was a nurse that had been practicing for about two years in a critical care setting. ICU nurse who was sent down to radiology for another nurse and gave vecaronium instead of versed. She pulled the wrong drug. That institution wasn’t adhering to CMS guidelines where, you know, it’s no longer too. Let her search. And that should have been prior to her doing that. But I digress. Pulls the wrong drug, administers it. Patient has a bad outcome, she gets charged criminally. She does stand in front of the border nurse saying twice, actually, the first time they drop, which is interesting to me, because the first time around, they said, you did nothing wrong.
Maggie
The second time around, once there was already a criminal case involved, and then there are other entities involved, then that’s where they reopened up the case against her. And when you have criminal conduct, in my experience, then the board of nursing normally lets that resolve. Unless it’s so egregious, unless, you know, it’s questionable. Like, if there really was conduct, if you had a gun and you shot someone, it’s really clear then the board of nursing is probably going to revoke your license, spend your license, but more often than not, they’re waiting for the criminal conduct to resolve, make, you know, their. I mean, that’s how I was trained, their, you know, opinion or resolution on that. But there was no intent.
Maggie
Right now, there’s gonna be lots of people, and especially in the legal world, the legal nurse world, they have their own opinion about that. The bedside nurse has their own opinion as well. And so there’s some division as well. The legal nurse is like, she knew what she was drawing up. She knew what she, you know, in real world, we know that there was a lot of mitigating circumstances. There was. She was also precepting someone. That person was in the room with her, you know, while she’s drawing up this medication. I mean, knowing that, when she recognizes that, immediately she goes in and tells her peers, the physicians, that she’s given the wrong medication in front of the family as well. Right. Fully owning her conduct, there was no ill intent. And then to criminally charge her is just crazy.
Maggie
They’ve changed that now, I believe. And she just stood in front of, in the court of law again, not because she’s trying to get her license back, and that’s what people understand. She’s trying to change stuff for nurses on the administrative realm and the civil realm, because now it’s a class B felony, I do believe, and is a mandatory 15. She, I think, believe it was a c not, you know, during the sentencing, they did not give her, you know, jail time, but I believe now it is mandatory 15. So a nurse who gave the wrong medication, no ill intent, patient did have a bad outcome, gave a paralytic instead of a benzodiazepine. But she was charged criminally.
Terri
Was. This is just a question I have. Was there barcode scanning that should have been done?
Maggie
That’s a great question. So she was down in radiology. So she was down in Pet scan. Not even just. I’ve spent a lot of time in radiology. She asked for the scanner multiple times. It was the day after Christmas, so third day in the row, day after Christmas, down in radiology, which anyone who works in a hospital center place knows that not. Nurses are not generally comfortable down. A radiologist, not our department. My husband’s a radiology technologist. He scrubs and cath lab. Right. It’s just not our world. It’s not. There’s doors everywhere. There’s things. There’s. It’s not. It’s not set up for nursing. It’s set up for radiation protection and that. So she does ask for the scanner multiple times. There is no scanner.
Terri
She asked for a scanner prior to that day’s event. She had.
Maggie
But there was no scanner to use down in radiology. Correct. And I think it’s also important to know that they were also onboarding a new charting system. Epic, I believe. And so medications were having to be overridden for a certain period of time. She goes to the omnicell pixis three times. It’s not there. The patients down in PET scan knows that they’ve been given a radioisotope. So basically on a timer for a nurse. Doesn’t really know a lot. Right. The nurse just knows. I’ve been asked, I need to give this. She needs to have a scan. She’s had this drug. They need it. So she goes, it’s not there. The fourth time. If she waited, I think, 11 seconds. She does override the drug in the omnicell pixis and takes it down. Art draws it up in the room and takes it down.
Maggie
And then there is no scanner available. Once she gets down to radiology to scan the drug, she does save it, because when she comes back upstairs further, knowing it’s telling me it’s. She knows. She thinks it’s a benzo because we don’t waste paralytics, we waste benzos. She keeps it because she’s got to waste it with the. With another nurse. So she hands it off to the other icing or saying, hey, we need to waste it. He looks at and says, that’s Beck. That’s not versed. That’s becca ronium, a paralytic. And then that’s when that, you know, process.
Terri
But she realized. Yeah, yeah.
Maggie
But she gets direction from her legal team, from risk management. It’s not documented. She gets poor guidance as a nurse. No one support her. We talked about this on the last, you know, episode. Someone passes. Do you think anyone supports her? No. Was it her fault? Did she do something? But that doesn’t absolve.
Terri
There was an error.
Maggie
No one goes to support her. You know what I mean?
Terri
Did she have an expert witness on her side of the case?
Maggie
Not a very. She had, like, a character witness, and the expert on the other side had not looked at the CMS report. And I feel like, as an expert, that would have been the opportunity for that expert to pause and say, hey, judge, jury, I need to see the CMS report. But no one. No expert to my knowledge to date, actually references the CMS report on either sides. And I don’t feel like she had an expert. She had a character witness more so than an expert on her son.
Terri
So I just. When I first heard about it, my daughter in law is a nurse. She’s the one that told me. And then when the verdict came down, but without knowing, I didn’t follow the case. I didn’t know all the details. But my very first thought was, surely her expert witness, which apparently didn’t exist, would point out that you don’t remove meds with two letters anymore. That’s not. You know, that’s the only way that mistake could have happened. Coming out of a machine. So just that. Right. There was a setup for failure, and it throws the whole Joss. Culture out of the window.
Maggie
Say that again.
Terri
Yeah. Yeah. Sad all around. Okay. All right. So we need to hope that we never end up in these situations, but when we do, we need to take it seriously, because there are certain ramifications that will come of this anytime a complaint has been filed. And so these are good recommendations and document.
Maggie
Right. She got poor guidance and didn’t document either. So there’s no scanning of the drug. There’s documentation only in an incident report. Right. And we never reference an incident report in a medical record ever, ever. We document in both places, but we do never reference an incident report in a medical record. Most people don’t know that. That’s not discoverable. They did produce that, but that’s not discoverable. When you fill out an report, it is protected because, you know, it’s part of process improvement. And we want to keep that communication open.
Terri
Yeah, yeah. That’s, that’s a whole other thing I touched on. Is that just another reminder that we really are not, unless we have worked in the facility in some sort of regulatory risk, have sat in those meetings and been part of those discussions. It’s not until then that we realize there are all these nuances of discoverable, not discoverable. What do you put in the chart? What do you not put in the chart? So there’s a lot. So thank you for the work that you do with advocates for nurses and reaching those nurses that do need some more education on these types of things so that they can do their job, do it well, and protect themselves for what may or may never come their way, but they’re protected from that because they’ve got that extra knowledge.
Terri
So thank you for the work that you do. Thank you.
Maggie
Thank you. Thank you. No, I agree, because it will come down to what you document. And I say, just give yourself credit what you’re already doing. Just drop those words in the chart. You did it. I know you did it. And then there it is. It looks prudent. It’s up on the big screen. The board of nursing is looking at it. It was done. It teach that. Right. Make it your everyday practice. I don’t give you a practice in five years or 30 years. Make some changes in your practice. I promise it. Don’t be. I call them one percenter because it’s the one percenters. It may never be you, and I hope it’s never you. But if it is, if you got solid documentation, there it is. And we’re, you know what I mean? That’s something to work with.
Terri
Right. All right. Great advice.
Maggie
Okay.
Terri
Thank you very much. And you have a great rest of your week. Maggie.
Maggie
Thank you. Thank you.
