Our Guest: Laura Iosue, Iosue Law, LLC
Today’s podcast guest challenged my assumptions about diversion intervention in a way I never expected. Join me as I break down this surprising case with legal expert Laura Iosue. We’ll discuss taking the right steps, navigating unexpected outcomes, and the crucial role of defense attorneys in the process.
Transcript:
Terri
Welcome back, listeners. My guest today is Laura Iosue. I have interviewed Laura before, and I do highly recommend that you go back and listen to that interview if you have not heard it already. Laura is a litigator with 30 years of experience. Some of the areas of her practice are now focused on professional attorney discipline and licensing and criminal defense. She represents her share of healthcare professionals in some sort of trouble, an accusation of drug diversion being one of those reasons that she may be representing them. I want to welcome you back, Laura.
Laura
Thanks. Thanks for having me. It’s great to see you, as always.
Terri
Absolutely. I asked Laura back because she does work that is not typically seen by people in similar positions as myself. And I think it’s good to understand a bit about what that side of things looks like, especially if you are someone who is involved interventions and interviews. And when you’re talking to that healthcare professional, you are very much in a position to give them, you know, not legal advice, but to tell them what they could expect next or to encourage them or let them know there are people out there like Laura that can help them. So that’s why I wanted Laura back and to talk a little bit more of the legal side of things.
Terri
So what might it look like after we identify a healthcare professional with a substance use disorder who’s diverting from a hospital, and then we report them to the licensing agency? I want to start with something, Laura. You said to me previously when we talked, and that is, when do you need to report to the board about some action? And I don’t think you meant, when does the facility need to report to the board? I think it related to the healthcare professional that has a substance use disorder. When do they need to report? So what does that mean? What does that look like?
Laura
So that is such a good question. And it’s something that I just recently came across with two new clients. You know, in talking about the hospital and advice about what things might look like, one thing that I think that nursing supervisors or HR, they need to be very cautious about giving legal advice.
Terri
Yes.
Laura
Because last week I had two new clients who were given legal advice by their supervisors that was wrong. And that legal advice was, you need to report this to the board, and they’re wrong. So in both cases, one, it was an allegation of a HIPAA violation, but the other one was a diversion, an allegation of diversion. And both of them were told by their supervisors that they need. That they needed to report it to the board. And indiana, that is not the case. So. And I think I touched on this somewhat in the last podcast that we did, is that indiana, we have a system that is different than most states, and it kind of matters. It kind of doesn’t matter in most states.
Laura
It’s my understanding that in most states, the board of nursing, or the board of pharmacy, or the medical board, they have their own team of investigators who will then investigate, and then they have their own legal team that then prosecute cases before the board. That’s how attorney discipline is here indiana. But with medical, it is not like that indiana. In Indiana, the boards are administered by the Indiana professional licensing Agency, IPLA. But investigations and decisions about whether or not a case is going to be prosecuted is done by the attorney general’s office here indiana. And there was a case that got a lot of attention here indiana about a doctor earlier this year, and it was critical to note that it is the attorney general’s office that makes that decision.
Laura
So what I would advise people to do is, first of all, the hospitals or supervisors should not be giving that advice. But when a person, you know, is accused of diversion at work or anything else at work, if they don’t know if they need to report anything to the board, then the best thing they can do. There are two things they can do. One, in my opinion, find a good lawyer who can tell you what to do. Right? I mean, yes. Am I biased? Sure. Absolutely. However, you know, and I’ve said this to you before, Terri, people don’t come to lawyers because things are good. Right? Absent and adoption are a business acquisition. It’s not because things are good. It’s because something hit the fan, right? Well, getting accused of diversion and losing your job, guess what?
Laura
It’s hitting the fan. And so if you think you need a lawyer. Yeah, you probably do, right? Okay. That’s the first thing. But if that’s not an option because of finances or whatever else, go on to your state board’s website and there should just look at it, and there should be something in the menu about statutes and rules and read it. You know, take a look, and it should say, there might be faqs, but. But if the statutes and rules are there, look at it and see if you think you need to report it. Okay. Some states may require that if you’re terminated or if you’re accused of diversion, or if you check into a place, you know, if you seek treatment for substance use, there are some states that say that is something you have to report to the board.
Laura
Indiana, that is not the case indiana, you have to, the only things that you have to report to the board is if you are convicted of a felony or a misdemeanor other than a driving offense. But OwI is a driving offense, but you would still have to report it within 90 days of the conviction. Not charging, but a conviction. Right. So let’s say that it’s a drug diversion and you end up getting charged criminally, okay, for theft of the drugs, for whatever that’s called in your state right here, it would be obtaining controlled substance by fraud. And generally there are a couple other things that go along with it for the falsifying the records or whatever. Okay. You get charged with that, you still don’t have to say anything to the board. Now, this is Indiana specific.
Laura
Within 90 days of conviction, then it has to be reported to the board.
Terri
Okay.
Laura
Other time that things have to be reported is when the practitioner renews their license. And there’s always a series of questions on your renewal application indiana for nurses. I have to admit, and I think I said this to you before, they’re not written very well, and nurses are confused all the time about what they actually need to be reporting. There are a couple of, there are a couple of questions that do that. One is, since you last renewed, have you been arrested, charged or convicted of any felony or misdemeanor? Other than. I should have pulled up the questions before we started this, but to me, that’s a fairly obvious question. But still, sometimes people are like, well, no, I got a summons. I wasn’t arrested. Right. So they wrong. Okay, well, then the answer is, okay, but you got a summons for what?
Laura
A criminal charge. Right. So I think that for me, it’s really easy to say that because this is my language.
Terri
Right.
Laura
So I think there’s a lot of people who really don’t understand it.
Terri
Right.
Laura
But another question that is, that trips people up all the time is, since you last renewed, have you been. It’s something like disciplined, terminated, suspended from your employment, you know, and that’s really the question. Okay, well, then the question becomes, well, I didn’t think that I was, that was discipline. It was a teaching moment. And you know what? They’re not wrong. You know, or I have someone else who she said, well, it was unsubstantiated. So I answered no. You know, very often, as you know, when someone is suspected of diversion, they are suspended pending the investigation.
Terri
Well, is that discipline still under investigation?
Laura
Right.
Terri
Yeah.
Laura
And the question is, it’s written indiana, doesn’t say suspended pending investigation. It does for other luck, for other practitioners, like anesthesiology assistant, who I had specifically, but nurses it doesn’t. And, you know, I even, you know, had an interaction with the advisory, legal advisory to the board. And she said, well, she knew she couldn’t go back to work the next day. And I said, yeah, but if that’s what you want to know, that’s what your questions should ask.
Terri
Right, right.
Laura
So my advice is, when it comes time to renew, read the questions carefully, and if the. That’s what I say, you know, just read the question carefully and answer as best as you can.
Terri
Legal stuff never seems to be straightforward, but then it’s not. I don’t speak that language at all. It’s like, just talk English. Like, what are you.
Laura
Right. Don’t expect me to figure out what you want. What you want. Why don’t you just ask me?
Terri
Right. Yeah, yeah.
Laura
But. But to me, you know, if there are other boards that are asking the specific question and you’re not, then you must not be looking for that.
Terri
Right, right.
Laura
So why should I have to guess to know what you’re asking me?
Terri
Right. Yeah.
Terri
I’ve never. I know when I renew my pharmacist license, there are questions on there, but it. Nothing has ever happened, so I don’t even know what it says. It’s just like, nope, nope.
Laura
Right, right.
Terri
But never had to think it through. Like, Does this apply?
Laura
Right.
Terri
Yeah. So, yeah. So that’s interesting. So in some states, if. I’m just thinking, because I think what happens a lot of times is during the intervention, the nurse manager, director, whoever may say to them, you know, I’m going to give you 24 hours to report before I report. Because the facility is supposed to report. Right. But they think that it will go better for the nurse if they report rather. So that might not really be the best.
Laura
That is not my experience.
Terri
Okay.
Laura
And this is a case that you and I talked about last time in particular, that it makes, you know, I recently had a nurse, and I know we talked about this, that nurse recognized they had a problem. Work did not catch them. They went to work and said, I’ve got a problem. They sought help.
Terri
Yeah.
Terri
Which is great.
Laura
Yeah. And it was a hospital system here, which is very good for second chances. They’re like, you go get some help, and we’re going to, you know, we’ll put you in a case management position. We’re going to have you in Eap, we’re going to do all of this. But as we said. Yeah, they have to report to the board. Right. Or, you know, to the attorney general’s office. Well, in this case, this nurse was working at two different hospitals for the same healthcare system, ended up and. And was accused of diverting from both had two consumer complaints, which is, you know, the confidential, under investigation complaint. Not only was their license investigated, but they got charged criminally in both cases.
Laura
And I had to fight tooth and nail for this nurse to end up with misdemeanor convictions instead of a felony, because if this nurse was charged, was convicted of felonies that related to controlled substances, they would automatically be placed on the office of inspector general, Medicaid Medicare exclusion list for five years.
Terri
Mandatory.
Laura
But if it’s a misdemeanor, it’s a permissive exclusion, which they still might get excluded, but they might not. And it’s a three year guideline. So it was critical that this person get the misdemeanor. And I had. I mean, the. And that was also prosecuted by the attorney general’s office here indiana. They took the criminal case instead of it going to the county, which is an option sometimes. And I believed that this person. Of course, I am defense oriented. Right. My client was never saying that they shouldn’t have consequences. Right. They knew they should have consequences. But this person’s background was. They had sacrificed a lot for the community, and that sacrifice manifested in. I mean, this person had seen stuff that you can’t unsee. And so those mitigators were huge to me.
Laura
They were exposed to that kind of trauma in a different profession that was also a service industry, and then as a nurse. And that person self reported to their Boss, which is big.
Laura
Huge. Why? Because they wanted help. Right? That hospital wanted to keep them, and did keep them, moved them into case management was entirely behind them. And yet, the best that I could get, the best plea offer that I could get was open to argue to a misdemeanor conviction instead of a felony. And so I had to argue that in two different counties. And I’m very thrilled and happy for my client that both judges saw it our way and that person was then convicted of misdemeanors. So. But to me, I thought, geez, you know, my client. Oh, and the biggest piece. My clients been sober for, like, two and a half years, something like that.
Terri
They’ve done the work.
Laura
And, you know, and that those clients, they’re in caduceus groups, right? They’re talking to other practitioners. So what possible incentive would someone else have to come forward self report? Yeah, none. So unless the statutes mandate that the person self report, I don’t think they should. That’s separate from getting help with their recovery monitoring agency. And we’ll talk about that in a bit. I know, because there are two pieces. There’s the recovery piece, which is internal. Right. That you have, but then there’s also your licensing piece. And, you know, that’s another reason that I think it’s good to get a lawyer, because then a lot of, you know, a big part of recovery. I’m not in recovery.
Laura
I have never been diagnosed with a substance use disorder, but I know enough to get myself in trouble to know that, you know, a big piece of recovery is accountability and making amends. Right. So you feel like you’re not being forthcoming. Is that going to impact your recovery? Well, if you hire an attorney, that’s off your plate. Let your attorney worry about that. I mean, it’s just, you know, because that’s a very. For someone new in recovery, what I’ve been told is that’s a really hard piece. So just turn it over to your attorney and let them deal with it. Then you can focus on the other. On the other pieces.
Terri
Yeah, I guess on the one hand, it feels like the first step to recovery is admitting I need help and I need to get in recovery. But you have to be careful thinking a few steps down the line.
Terri
It’s not that your intention is to deny that you did it, but you want someone professional representing you and knows how to have that conversation and to go about that.
Laura
I think so, yeah.
Terri
Wow. Okay. So I think what I, part of what I’m taking away from this is that everybody needs to know what their state licensing requirements are. And then wouldn’t it be nice if were kind of all on the same page? I mean, I know from a legal perspective, defendants and plaintiffs, I mean, you wouldn’t need both sides of the aisle if everyone would just agree on everything. Right. But it would be nice if accountability was part of it, but not from, you know, I have to wonder what was going through the attorney general’s office’s mind, whoever had that case that they thought that they should really throw the book at this one, given all of the things that you had talked.
Laura
About, I will have to say in their defense. I mean, they could have charged my client with. With more. Right. Because there were, you know, however many instances. Right. They could have charged them with every single instance.
Laura
And they could have said, well, no, we want this person to plead not only to obtaining controlled substance with, by fraud, but also falsifying records and also, you know, sure, whatever, right. They could have done that. Right. And, and they didn’t. So, you know, to say, throw the book at them, I feel like that, and I’m, that part of that is because of me that I kind of, you know, played that up. Okay. But it just, to me, I really felt like, so there was, that they did show that kind of grace, right. That they said, okay, fine, he can plead to one in each county. I had to push for the alternative misdemeanor argument. Right. But, you know, I just didn’t think that it was fair to, for, you know, so for that, although. Did they completely throw the book? No, they didn’t.
Laura
They could have made it worse. So, you know, they weren’t completely unreasonable. But in that aspect, I felt like, come on, you know, this person has, you know, this person is going to be talking to other nurses and other practitioners. And to me, the fact that they self disclosed was a big mitigator.
Terri
Right.
Terri
Is there now you’re, you know, like you said, you’re always with the defense side, and so your goal is to always get it not to be criminal. I’m sure. But can you think of a time where if you took on a client where you thought or could think if, you know, in the future, if you haven’t had one already, it’s like, okay, I can see why they’re going for criminal, and I’ll do my best to defend that. But, you know, they kind of deserve it.
Terri
You know what I mean?
Terri
I know you’re always trying to get them off.
Terri
Right.
Terri
And help them through with accountability.
Laura
Well, you know, I was with the attorney general’s office for, you know, almost seven years, and I was in a position where I ran the team that investigated nurses and other medical professionals and then towards, like the last two years, also pharmacists and doctors and all that. But so I did have that aspect of it. Now, my team was not part of the AG’s team that did the criminal prosecutions because the only team that keeps the criminal prosecutions here indiana is the Medicaid fraud control unit. And I wasn’t with Medicaid fraud control unit. And so I think it’s my understanding, and I could be wrong about that some of those policies of the felony versus not felony come from the federal Medicaid fraud control unit.
Laura
But I don’t know the inner workings. I’m not privy to that. So, you know, are there times I can certainly appreciate the criminal prosecution. Right. I mean.
Terri
So it’s more of a checkbox. I mean, they did this. They did this, they did this. They fall under.
Laura
I don’t know. Yeah, I don’t know because I have other clients who did the exact same thing.
Laura
And they don’t get that. They’re not, they’re not criminally charged.
Terri
Interesting.
Laura
Or, or, and I think we touched on this a little bit the last time. Did the exact same thing. And their case, if they are criminally charged and it’s handled by the county prosecutor, they go to drug treatment court. And in drug treatment court, it’s intensive probation. And if the person completes it, I mean, really intensive with a drug treatment aspect of it, if they complete that term of probation, the case is dismissed. But if it stays with EAG, with Medicaid fraud control unit, they won’t let it go to drug treatment court. Instead, they want a felony. So for the exact same conduct, the county prosecutor is saying treatment, no criminal char. No criminal conviction, which indiana, if you’re charged with a felony and it is ultimately dismissed, it’s also expunged. That’s new in the past couple years.
Laura
So you have that, which is dismissal and expungement and treatment, which I think helps everybody. And then on the other side of the spectrum, same conduct, criminal charges, asking for a felony. Even when it’s the same hospital system.
Terri
So we in my circle all know that we need some standards with policies and procedures from institution to institution within the same states, outside of, you know, there needs to be some standardization, but it sounds like the legal system needs a little standardization as well.
Laura
Well, I think that is a conversation that is bigger than what we’re talking about. Right. Because really what you’re talking about is, you know, should things be handled? Should those policies be handled at the local level? What are the local views on those things versus a countrywide view?
Laura
And I, you know, I. And that’s a whole other political thing. Right. And so if it is, if it’s federal Medicaid fraud control unit making those decisions, that’s a different policymaker. Right. But for a local county prosecutor, well, if the local community doesn’t like it, they can vote them out. And so, you know, I suppose you could say the same thing about, you know. Okay. You could vote out who’s ever making the decision at the federal level, too. But I don’t think those changes happen as quickly.
Terri
Right. Right.
Terri
Well, then it comes down to judges too, then, I mean, how they. What they decide to.
Laura
Right, right. And whether you’re in a place that appoints judges or elects judges, you know, well, you don’t like that this person. Okay, fine. Vote them out.
Laura
So. But, you know, but the other thing that I think is important to note is. And this is also who the policymakers are, is the hospital that the diversion, where the diversion occurred. Right. It’s the hospital who had to file the DEA 106. Right. Okay. If that hospital says, we want to keep this person, that ought to mean something, because if the person has a felony conviction, guess what? The hospital can’t keep them.
Terri
Right. Right.
Laura
And so, you know, so to say, oh, you know, we want small government, and I’m getting going a little far afield here. Right. But yet saying we’re not going to let the hospital make that call.
Laura
That doesn’t seem right to me. I think the hospital. If the hospital is saying, we think we would like to be able to keep this person. I think that the. That those policymakers should be listening to that.
Terri
Right.
Terri
And it’s kind of, this might be a really simple generalization, but if, let’s say I was mugged and I decide I don’t want to press charges, that’s my decision. Right. And then there is no legal case anymore because I’m not pressing charges. So is it kind of.
Laura
They could still, in a criminal case, they can still charge the person.
Terri
How do I say?
Terri
Okay.
Laura
However they would need your cooperation. The prosecutor. Right. Because if the case went to trial, you would have to testify, and if you’re not going to testify, you’re not going to test. Right. So. And that’s a whole other, you know. Right. Whether you subpoena the person, are they gonna. Are they gonna come out and if, you know, they’re gonna send a sheriff out to come and get, you know, all that stuff. Right.
Terri
Just thinking if the hospital decides they want to keep them and is essentially saying, we don’t want to press those charges, I think we’ll be done with it.
Laura
Should map. Right. Or not even dump it.
Terri
You know, just be done like accountability. But, like, now let’s move on.
Terri
Yeah.
Laura
Right, right. I mean, misdemeanor. That way we can keep them.
Terri
Well, it’s a, you never know what’s going to happen is kind of the bottom line, which is a little unsettling for somebody going through it.
Laura
Well, and so your question is, what is it going to look like, you know, if they report it to you to the board, which they kind of think is where we started, but then we ended up way over here with my m-o.
Laura
So the hospital is more than likely going to report it, right? The hospital is going to report it. So I guess, you know, the easy thing is, why do I have to report it if the hospital is going to report it? Right. Okay. Other than that, accountability and immense piece. Okay, fine. But when the hospital reports it, you know, the practitioner will get notice either from here indiana, it would be the AG’s office or in another state, the board. I have to warn you, Terri, I feel a sneeze coming on.
Laura
And I have big sneezes. But. So the person will get notified that there is an investigation and they will be informed of what the allegations are and they’ll have an opportunity to respond. Now, I think that at that point, I think the person should have a lawyer.
Laura
And the reason for that is because that whole anything you say can and will be used against you in a court of law. Well, this is one of those times.
Laura
You know, while the investigations are still confidential, if it later becomes public because of a licensing complaint that is filed, that’s when it’s public. Okay, so now we go criminal. And if it’s put in there that you said x y, if it’s put in the complaint against the license that in your response, you admitted to blah, blah, blah, well, now that’s going to be. That could be used against you in your criminal case.
Laura
I think it’s important to get a lawyer in those instances. And I will tell you that I am starting to say a lot less in my responses for clients than I used to. And I thought, you know, and I was putting in a lot of mitigation before because I think it’s important. I think that I have said this to you before, that when I was prosecuting these cases, I understood that people who end up with a substance use disorder, something must have happened. Right. You know, that short circuited how they process stress.
Laura
But I didn’t realize just how severe people’s trauma was and how long it lasted and how pervasive. And, I mean, I just didn’t. So I was putting in a lot of that and I still put. But I realized it doesn’t matter. It doesn’t matter.
Laura
So I’m putting in less than I used to. And then if the person gets charged, well, I still have it. I can still use that as mitigation later.
Laura
But I think so in any event, I’m getting off again. So the practitioner will have an opportunity to respond. I think they ought to have a lawyer so that they don’t, so that they’re not telling the, either the board or the AG, whoever the investigator is, so that they’re not telling that investigator information that is detrimental to the practitioner, that maybe the investigator didn’t know.
Terri
Is it safe to say that you feel the same way when a facility sits down with somebody? We’re always looking for that confession. Would that fall under any of this or is that different because it was, there’s no legal, it’s just a different setting. Or would you still advise everybody to not confess anything? Let them report their suspicions? Because we look at it as this is the beginning of how you can begin to get help. You know, let’s, we’ll give you the resources.
Laura
My only concern with that really is that I have some clients who have told me when they called me into that meeting room, I knew I was busted. And man, was I relieved.
Laura
But then I’ve had other clients who were not diverting. They were bad at charting. Right, right.
Laura
You know, they started, they were in a critical care unit and they were assigned six or seven patients. Right. It was bad charting. I have seen hospital investigators push and push and try to get a confession out of people when they didn’t do it. So the assumption is, oh, yeah, if we, if, you know, if you were tagged, if the software, the pharmacy software where pulled you up as one of the highest, you know, whatever, then you must have done it.
Terri
No, there’s other reasons. And sometimes, and sometimes the data just doesn’t, sometimes it’s fairly conclusive as well.
Terri
Like, oh, okay, of course. Yeah.
Terri
But other times it’s like, I don’t know. We won’t know until we talk to them. And then you’re hoping you get some, you know, something when you’re talking to them, either an alternate explanation or sometimes they can’t give you an alternate explanation, but they put up the roadblock and then you’re like, well, but sometimes not.
Laura
Having an explanation, that’s honest. Look, you’re asking me about something that happened in July and it’s now October. I don’t know. And to expect that person to know, because I’ve seen this in these interviews, Terri. Oh, yeah, I’ve seen it. Well, why don’t you know? Do you know what you were doing on July 29 at 07:00 p.m.. No.
Laura
So to me, you know, when you know the person who knows what they were doing on July 29, they’re probably lying or they know they were. Well, yeah, it’s because I was dealing. I was diverting. Right.
Laura
Right. But if you don’t know, I couldn’t tell you why, you know. You know, as a lawyer, I try to document everything. Right. Because anybody can file a complaint against me, too.
Laura
You know, and so if I don’t document it, I don’t know. Well, if you already don’t have time to document it, there’s no way. You know?
Terri
I used to keep my little book, too, when I was in patient care. You know, if something weird happened or I had to challenge a physician on some prescribing or, you know, whatever, and then yielded to them because it was like, well, you know, it wasn’t one of those hard stop things. I just write it down so I’d have it if it ever came up again.
Laura
You know, and for me, I get to sit here at my desk in my office, which is at my house. Right. You know, with usually my dog snoring next to me. Right. And I have the time and the liberty to take my notes and put it all in my case management system, but when I’m triaging stuff. Right, which is what some nurses jobs are every day.
Laura
You’re asking the impossible.
Laura
So whether or not the person should say something in those meetings, you know, I always think the answer is no, because it doesn’t matter if you admit they’re gonna find. In my experience. In my experience, if you admit they’re going to file something with your licensing board or the investigator, if you don’t admit they’re going to file something with.
Terri
The license, they may or may not. Or they may file and, you know, land on bad practice. May. Can’t rule out diversion.
Laura
They may file it and say it was diversion and charge the person with diversion. Charge the person. I’ve had that case, too.
Terri
Oh, wow.
Laura
Charge the person criminally with diversion.
Terri
So now it goes back to. Yeah, now it goes back to standardization amongst hospitals. It’s like how and when.
Laura
I mean, you know, and I think that. I think that there is too much asked of too few practitioners. It’s an impossible workload.
Terri
Especially these days, staffing shortages that we hear about.
Laura
And I’m not convinced there’s actual staffing shortages. I think it’s a shortage of a willing to pay for staffing. That’s my opinion. That is my anecdotal opinion.
Terri
Well, we do hear a lot about hospitals losing money, and. And it’s getting harder, but, yeah, it’s hard to know.
Laura
I just know from my own experience with my mother, who passed away about a year, 15 months ago. I think we’ve talked about this, that, you know, we would be in the ER and they would say, oh, we have to wait for a bed to become available. And I would say, really? Something tells me that you have a bed available upstairs, that you probably have a whole wing closed off because nobody wants to pay for staff for it. But I bet there is a bed available, isn’t there? And guess what would happen. Available.
Terri
And here’s my card.
Laura
Every time. Every time, magically, a bed became available. Oh, someone was discharged at 1030 at night. At 02:00 in the morning? I don’t think so. Think the bed was available the whole time.
Terri
Interesting.
Laura
That’s just my anecdotal experience with my dear mother, God rest her soul.
Terri
Well, this was an interesting discussion. I know we kind of, you know, just did a bit of bantering back and forth, but I think it’s good information for people to hear. You know, to me, like, it seems so clear, your goal is to get to the truth, always the truth, not to, you know, force people into a corner to say something that, you know, we hear about that with criminal cases and whatever the, you know, legal, the law enforcement goes at them until they finally admit, but to get to the truth. But now this is kind of interesting take on it to reassess. And maybe the truth is still the goal, but maybe for them to at least admit and want to get help.
Terri
So you offer those resources, no matter what the outcome of the interview is, so that if they have, like, yes, I want this to be over and get some help, they know where to go, as opposed to just be like, okay, if you’re not going to tell us what’s going on, then we can help you. We’ll be in touch. You know, you’re on leave until.
Laura
That’s not to say that the hospital can’t say, listen, if you don’t agree to go to treatment, we’re gonna have to terminate you. I mean, I can appreciate that, too, because sometimes the person might need that push, right? But that’s a person who actually needs to get treatment. Right? So then what happens is the person goes. They get evaluated to see if they need treatment. And guess what? If they don’t have a substance use disorder, there’s no treatment to get.
Terri
So instead of tell us what’s going on, it’s, you know, we feel that, and so we want to encourage you to do this. And so here’s how you can make that happen and start on that.
Laura
Right. I mean, I really think it’s a case by case basis. Absolutely. Hundred percent. Yeah.
Terri
Because like I said, sometimes you go into that interview and it’s like, I don’t see any other way this can play out. This data is so compelling. And then other times it’s like, well, this could be poor practice, but I need some sort of explanation as to why you’re always doing this. Right. So what’s your process? And then you get another explanation, and then, you know, and then other times, you’re still left with, I don’t know. I mean, it looks bad. They don’t have any other reason, and they seemed a little cagey.
Laura
So I also think it’s important for those doing the investigations and that interview that you’re talking about. I think it’s very important for those people to have done some kind of shadowing to know what’s actually going on the floor. Because, you know, while there are all kinds of protocols about wasting and whatever, you know, what if the nurses and whoever are not actually following those protocols, if the culture is, oh, hey, will you sign that? You saw me waste this. And that was true. Right? So, you know.
Laura
And no one’s going to admit that, right? Because they’re afraid of getting right until they say, well, that’s what everybody does. They come to me and they say, look, I’m telling you, nobody does that. Right? This is what we’re supposed to do, but nobody does it. Why? Because we don’t have time.
Terri
I agree 100%.
Laura
So I think it’s really important you know, that legal has great protocols on paper, but without knowing what it’s actually like in practice, there’s no way those protocols are going to be followed.
Terri
Agree. And that’s what I’m a big proponent of, accountability. Before you ever get to this phase, it’s like, you know, the managers of the departments need to know what the policies and procedures are. They need to make sure they’re being followed. If they aren’t being followed, they need to figure out what the barriers are. Correct. You know, are there bad policies and procedures that then we need to adjust, or do we need to, you know, like, if you’re supposed to waste at this location, but you don’t have waste boxes. Well, then how can they even begin to follow it? And there’s a barrier. So I’m a huge proponent of definitely all of that stuff ahead of time before you get to the phase where it’s like, okay, why aren’t you following it? Because everybody else is mad.
Laura
There also has to be a culture where people are comfortable explaining why they’re not following it.
Terri
So we have a lot of work to do out there.
Terri
Still some facilities are probably doing it well.
Laura
But, yeah, of course some are doing it well, you know?
Terri
Well, this was enlightening. I want to thank you for sharing that. I’ve enjoyed the conversation, and it’s some great stuff, but I will tell you, we didn’t get to our other topics. So this is what we’re going to do, is we’re going to have a part b, everybody, because I don’t want this to go so long, listeners don’t have time to as listen to it. So we’re going to sign off from this, and then we are going to be back with our part b, where we’re going to talk about recovery monitoring agreements. Thank you, Laura, for your time.
