Nursing Law & Order

Ready or Not: the $2,500.00 State Nursing Board case

http://www.youtube.com/watch?v=W7MUKF2uE6k&feature=related

http://www.youtube.com/watch?v=0GfUPXfw5Mg&feature=related

Lauryn Hill says it best: Ready or Not.....

Ready or not and (regardless of) whether you realize it or not:

1. The State Nursing Board is investigating you if you receive a Notice of Complaint from the Kentucky Nursing Board or Indiana Board of Nursing or if you receive a Potential Violation Report, telephone call, email, or official correspondence from a Compliance Agent (investigator) or Adjudication Coordinator (Juris Doctor (law degree) prepared Staff) from the Ohio Nursing Board.  

a. It is not the role, responsibility, job, or function of the State Nursing Board or anyone who works for the Board to explain to you what this means to you, for you, and what you shoulda, coulda, maybe, or mighta do or do not. The Board's role is pubic protection: no ifs, no ands, and certainly not buts.

b. You are representing yourself anytime you are not represented by an attorney in legal proceeding. YES, Board of Nursing investigations and complaints are legal proceedings. Therefore anything you do or don't do and how you proceed in the legal proceeding before the State Nursing Board, you are representing yourself.

c. Self-Representation in a legal proceeding is a right just like deciding whether or not you want to retain legal counsel (private or have one appointed  in a criminal matter) in a legal proceeding. No, sorry, attorneys are not provided by the State to represent healthcare professionals in licensure matters.

d. You are an educated and licensed healthcare professional i.e. you have something to lose: your employability, your career, your license, your....... Therefore ANYTIME you as a licensed nurse are involved in a legal proceeding, you MUST ask yourself, do I need a lawyer?

No one is going to hold up a sign and walk a picket line in front of your home saying "Retain a Lawyer."

No one is going to tell you "you are required to hire a lawyer."

No one is going to tell you "you are nuts if you attempt to work through this on your own."

Everyone will tell you:

1. Just tell your side of the story and it will be okay (this is my grandmother's favorite that I figured out to disregard at age 9);

2. This is not a big deal as I am sure the Board of Nursing has bigger fish to fry. I love this one because not only do I like to fish for sport but I also like to eat fish: the bigger the better.

3. It is going to be okay. When anyone tells me this, I immediately think "how and why would you know how it is really doing to be or be not for me?"

4. This is just a misunderstanding, just be honest and it will work itself out. Like what, a knot?

Lawyers can be expensive for corporate litigation and other matters but license defense is actually affordable because the fees are quoted to an individual healthcare professional. Most license defense attorneys will quote you a flat fee or a retainer and hourly fee based on your case and the complexities which is actually affordable when you consider your monthly, annual, or lifetime income as a LPN, RN, or APRN.

If you are NOT willing to spend $2,500 to $__________ to defend your license in a Complaint filed against you for whatever reason, what does this mean to you and for you?

This is why I have legal malpractice insurance that covers malpractice and Bar disciplinary investigations of my license. This is why I still maintain my nursing liability insurance. This is why I just purchased media insurance for my blog and online projects. Because I am a professional, I am licensed, and there is always always a chance I can be sued or reported because of legal, professional,and personal accountability, responsibility, duties, and obligations.

I know this isn't explained in school or discussed in the workplace this way but that's a fact Jack and if you are not comfortable or PREPARED for this, get prepared or surrender your license (as a teacher, nurse, lawyer, dentist, physician, PT, etc.) and work in a field that does not require a State issued license and does not have the regulatory complexities of healthcare.

A Notice of Complaint is a Notice of Complaint and a PVR is a PVR from the Nursing Board regardless of whether or not you appreciate the significance, complexities, or law, legalities, and legal issues therein: it is what is it.

The cases I am seeing in 2010/2011 vs. 2003/2004 before the State Nursing Boards are like day and night. http://www.youtube.com/watch?v=hlbQhD2sxz8

The cases now are much more complex than the $2500 fee from yesteryear. $2500 was the standard fee I quoted years ago but very rarely do I quote a $2500 fee anymore because of the issues involved. That's why I do my own initial phone calls to nurses who contact my office because I need to listen, listen, and ask a question or two before I can quote a flat fee for representation because the $2500 standard State Nursing Board case only comes around once every blue moon and every other purple sun. I also need to review a few documents for myself to get a feel for your case because although I understand what you are telling me, I need to see the paper: black and white.

Also do you want an attorney to quote you a fee of $1,110.56 for Nursing Board representation? Do you know how long these cases take to be worked up and eventually resolved? What type of representation do you honestly think the attorney will provide to you for $1,110.56? Does this $1,110.56 include any research or prep work? What is included for $1,110.56?

This is your State Nursing Board LICENSE, not a muni court case or a will. I do not quote low ball fees just to get a case or bring someone on board and then not work up the case or answer client calls. If you want an extremely low fee, I am probably (99.99% of the time) not that nurse license defense lawyer.  

So even when you say, I called Lawyer A and he told me $2500. I called Lawyer B and she told me $5000, don't expect for me to yell out "BINGO, I can represent you for $3,750.53 and a pack of Apple Now Laters."   

I represent my clients how I would want a lawyer to represent me if: my license, my career, my livelihood and my essence was at stake because I am my license. Sorry. I know others will say you are more than what you do for a living and "your job" but not me.  I am RNBSNJD and LDW Law.  I haven't decided which I want to have on my vanity license plates, what do you think? 

I am committed to my law practice, my nursing career, and the nurses I represent. http://solopracticeuniversity.com/2011/07/12/back-to-the-root-of-things-the-role-of-servant-lawyers/.

Also think about this: are you providing the service each and everyday you practice as a nurse that you expect other service providers to provide to you and your family? If not, Houston, we have a problem.....

NO LICENSE or RESTRICTED LICENSE means a lot to you as a LPN, RN, APRN who is LICENSED or a nursing student, NCLEX-PN or NCLEX-RN on the road to licensure. Your license is always at stake in a State Nursing Board case and ready or not, regardless of whether you realize it or not, it is what it is and what it is usually just the beginning because the Nursing Board investigation is a starting point on a dim and winding path and you may not see the forest because of the trees.

Take a look at these articles.

Download BillofRightsforNursespdf

Download Nurselicensedefenseattorney

 

Worst Traffic Jams on I-71 South and North: Blowing Money Fast and a Hot Pickle

I actually wanted to cry yesterday (I am being dramatic) as I sat in traffic on I-71 South. It normally take the Nursing Law Bandit 90 minutes to drive from Cincinnati to the KY Nursing Board office in Louisville, Kentucky. I always give myself 2 hours for the drive because of the "cut in the hill" in Northern Kentucky and construction as there is always construction on either I-71 or I-75.

Well guess what? Once you turn on I-71 in Northern Kentucky it is essentially one-lane to the Speedway because of the construction barrels. Okay this slowed me down by 60 minutes.

Then guess what? Outside of Louisville BEFORE and AFTER exit 14 and 3 miles before the Synder Freeway there were two accidents. TWO. I sat in traffic here for 3 hours. The expressway was closed for almost 90 minutes.

I left Cincinnati for a 1pm meeting at the KBN office around 11am and I arrived at 3:30pm. Oh and my meeting was for 1pm.

Okay, so I had my meeting and left Louisville, KY around 4:30pm and guess what? More traffic. I had a 6:30pm meeting back in Cincinnati.

There was an accident on I-71 North which slowed traffic and there are construction barrels on 1-71 North making most of the drive a one lane highway.  

I made it back to Cincinnati for my meeting around 7:30pm.  I met with a nurse from 7:30pm to 9:15pm and then returned a few calls.  

Do you know what I ate yesterday? I had a Pepsi, a Mountain Dew, 4 bottles of spring water, and a hot pickle. This was how I ate at age 13.

I rushed in the door at home to let my dogs out of the utility room (my son put the dogs in the utility room around 3pm) and Luke ran by me so fast I fell (it does not take much for me to fall anyway).

I took two Tylenol, reviewed a case file, and went to bed at 1130pm. I spent most of yesterday in my car. But guess what? I have a new car and I reallllllllllllllly didn't mind!!!!

I purchased a Cadillac Crossover with all the fixins. It is a present to me for me for behaving and being nice during  my divorce (sort of but not really), for my 40th birthday, and the prequel to my mid-life crisis. I also purchased myself a touchscreen computer for my birthday earlier this month. I also purchased 12 (yes 12) summer dresses (can be dressed up or down) at Macy's sale last Saturday. These dresses are popping. I plan to buy a new matching purse and handbag set from V. Wang, an Android tablet (for video conferences; I cannot do a video conference with my I-Pad), and at least 2 pairs of patent leather sandals this month on or before 31st. I also plan to eat at Cheesecake factory at least once a week until the 31st. I am spending a little but certainly not Blowing Money Fast (BMF).

If you are driving I-71 to Louisville, KY, considering taking I-75 to Lexington and then driving to Louisville, Kentucky. I will consider this next time. I really need a magic carpet, broom, or the ability to fold space and time like the navigators in Dune!

It is Going Down like Charlie Brown: Nursing Students will Sue!

I attended nursing school "back in the day" when nursing students viewed their instructors and professors with admiration, respect, and "awe." This was in the early 90s for me. I received my ASN in 1993 and my BSN in 1994.

Things have changed in the almost 20 years and nursing students are willing to file complaints against instructors and professors with the State Nursing Board, file complaints against their schools of nursing with the Board of Nursing, and sue! That's right baby, litigate!

I tell you there is nothing like a civil law suit and the discovery process.  I tell you a Complaint for Damages smells like a warm strawberry PopTart with sprinkles to a defense attorney. Sometimes I miss med and dental malpractice defense work (only for 3 seconds).

Former Viriginia Western nursing students were awarded damages. http://www.roanoke.com/news/roanoke/wb/291572

I expect more of these lawsuits especially from nursing students are crim-ed out, attend nursing school and spend $30k+, only to find a restricted nursing license and little to "zip" employability because of the restricted license and being crim-ed out.

What is crim-ed out? I picked this up over the weekend while out and about. You know I am a single now and I am out and about and on the loose, 60 to 90 minutes every week now. It is start. But anyway.

It is crim like brim. So crim-ed out. Crim-ed out means multiple criminal convictions, either Misters or Fellows. I picked this up to this weekend also. And no, I did not visit anyone in jail or prison and pick this up and no, I didn't pick this up at a Bar association event.

Personally I think nursing students should be more proactive as adult learners. You are seeing this now with law students who take on 100k to 150k in debt from law school to realize most attorney positions start at 35k to 55k.

http://www.nytimes.com/2011/07/17/business/law-school-economics-job-market-weakens-tuition-rises.html?_r=1

http://www.nytimes.com/2011/01/09/business/09law.html?pagewanted=all

If you are a nursing student or NCLEX-Applicant and you have felonies or misdemeanors, you need to speak with a nursing law attorney before you submit your application for licensure to the State Nursing Board. Anytime you are REQUIRED to make affirmative disclosures on a renewal or initial application for licensure, you should talk to a nursing law, nurse license defense, or administrative law attorney in your state.

Who Made the Potatoe Salad? Indiana requiring FBI Criminal Background Checks for Licensure

I knew it was coming in the good State of Indiana and here it is; the beginning of the end or the end of the beginning (depending on your views) for Initial Applications for Licensure by Examination.

Effective July 1, 2011, the Indiana Board of Nursing requires a national criminal history background check at the cost of the individual. Can you say FBI?

http://www.in.gov/pla/files/Criminal_Background_Checks_PLA.pdf

Maybe this will be a sign for nursing students and NCLEX-Applicants for initial licensure before the Indiana State Nursing Board to really consider their situation, the circumstances, and consult with an attorney before appearing before the Board to respond to affirmative responses for criminal convictions.

The State of Indiana was relying on the self-disclosure of all criminal history by applicants for licensure in healthcare professions which frankly did not work.  http://www.in.gov/pla/3242.htm

The State website also notes that 31 states require a criminal background check for nursing licensure already. Give it another 5 years and it will be close to all 50 states.

Also this may be a money maker for the State of Indiana as $15.00 of the $42.50 goes to the State's general fund. Really? That's nice to tax students who are maxed out with student loans and who may not be able to obtain a license because of the criminal.

This does not apply to renewal applicants in the State of Indiana, yet! I would hope that State Professional Associations representing the various healthcare regulatory boards would "man up" and legally challenge any law requiringbackground checks for licensure renewal with a State Nursing Board as opposed to self-disclosure. Also I don't think healthcare regulatory boards have the manpower to deal with the influx of cases and headaches that would result from mandatory criminal background checks for renewal applicants.

I would probably have to hire an associate attorney (licensed in at least two states) and two paralegals if the Ohio, Kentucky, and/or Indiana Nursing Boards require mandatory criminal background checks for license renewal. Damn maybe I could finally break the sound barrier from the muddy middle class to the murky lower upper but still middle of the middle.

I have always been intrigued with class, income, and education stratifications in the US since high school when my social science teacher named the characteristics of socio-economic depressed neighborhoods and pointed out which neighborhoods were considered economically depressed by definition. Guess what? I lived in what he termed as an economically depressed neighborhood. He described white collar vs. blue collar. He identified poverty level and the characteristics of poverty. He identified the layers between the classes of US society and the definitions and rationales.

I was not offended because I knew we lived good but the concepts, meanings, and implications (I started critically thinking early boo boo) floored me and I wanted to know more.  

This particular lecture by Mr. Brandenburg enlightened and challenged me. Thank you Mr. Brandenburg.  

These were the days when high school teachers could actually offend "you and your mama" and not have to worry about being sued in civil court, workplace complaints, and State DOE complaints. I told my grandmothers and they were very angry and told me about the rich history and sense of family in predominately black neighborhoods. I listened but I knew there was more and I needed to know and to know I needed to read and read and read and I did. I needed to know more about money, business, race, poverty, and economics. Why at age 16? I don't know.

I was interested in astronomy in my preteens and therefore I read up on astronomy. I wanted to be an astronomer and I had at least three telescopes and two microscopes because I went through a biologist phase because I used to fish with my grandfathers. Yes, I can fish!

I mentioned this to my grandmother and she said that's wonderful and purchased more books. I later became interested in Greek mythology and told my grandmother, I wanted to study mythology more. She grinned and purchased more books. I took home ec and started to help more with cooking, cleaning, and ironing and I told my grandmother I wanted to be a housewife. She laughed (I might have to f/u with her about this one now that I think about it!) and she showed me how to cook "soul food" over the years.

Potatoe Salad (from scratch of course) is the key to a long life baby and the movie, Who Made the Potatoe Salad? is real. http://www.imdb.com/title/tt0452706/. I still laugh because regardless of the number of sides, entrees, meats, and desserts we have at one of our many family functions,  someone asks will ask Who Made the Potatoe Salad?

Right before my high school graduation, I told my grandmother, I want to be a lawyer. She frowned, paused (she almost chocked now that I think about it), and then said "There are too many lawyers, you want to be a nurse."

What have I learned since high school and Mr. Brandenburg?

1. Criminal convictions can make a break or person especially one seeking a state license as a healthcare professional today. Got criminal? Talk to a license lawyer like LaTonia before you apply to a technical, trade, vocational, or professional program requiring a state license or certainly before you attempt to "license up."

2. I can be a RN and an attorney; 

3. Knowing how to cook, clean, and iron will never go out of style; 

4. A prenup written cold is better than chocolate served warm; and

5. I will always see myself as the middle of the middle  (like most) regardless of income, class, status, title, or education. 

 

 

Like Yesterday, Nursing Board Compulsory Examinations and the definition of Routine, Ordinary, Common, or Mundane

If you look up the words ordinary, common, routine, or mundane in any dictionary, you WILL NOT see "State Nursing Board Compulsory Order for Examination" as an example.

Why? There is nothing ordinary, common, routine, or mundate about a Compulsory Order for an Examination.

It is usually written in the Nurse Practice Act that a State Nursing Board can order a licensee or applicant for licensure by examination for a compulsory examination or order, at the expense of the licensee or applicant being investigated by the Nursing Board may have a physical or mental impairment that MAY affect the ability to practice nursing safely.

In Ohio, see ORC 4728.28(G).

Therefore let's say today you open your mail and you find a Compulsory Examination Order from the State Nursing Board ordering you to submit to:

1. Forensic Psychiatric examination;

2. Medical Examination;

3. Behavorial Examination;

4. Substance Use and Abuse vs. Dependency examination;

5. Neuro-Psychiatric examination; or

6. Psychological examination like a Fitness for Duty

then you need to:

1. Review the document carefully;

a. Sit down and take a cold shot of H20 on the rocks to clear your head;

b. Re-read the document again because I know you didn't read it carefully.

2. If you are represented by an attorney, contact your attorney and discuss; or

3. If you are not represented by an attorney in the Board investigation, you need to speak with an attorney like yesterday.

These Orders for Examination are the real deal. Yes, I know you are a nurse and maybe in one of your nursing roles you were involved in administering, observing, or reviewing these types of examinations for patients, but.....

Ask yourself, what would a reasonable and prudent nurse do at this point in a disciplinary investigation when you receive this type of Order for an Examination/Evaluation?

Do you continue to rep yourself? There is nothing wrong (or wright) about repping yourself before the State Nursing Board. It saves a dollar or two and you can then spend this dollar or two at Walmart, Target, or Lowes. I am all for repping yourself and I advocate repping:

a. Your hood (you can do this with a block party or garage sale. Invite me, please!);

b. Your block (you can do this with a swim party, block party (with a permit), or yard sale); and

c. Your City (next time you are at a professional function, wear a t-shirt saying "I love Columbus, Ohio" or the "Cincinnati Bengals  Superbowl 2020).

But repping yourself in any legal matters can be a train wreck waiting to happen.

You only have one RN or LPN (with State Nursing Board A) and when this license is investigated and you receive an Order for a Compulsory Examination/Evaluation, is saving a dollar or two in the best interest of your nursing career, future employability, future plans for nursing education, and your sanity.

For example, I received three certified letters from the IRS that were not delivered yesterday because of my two horse like dogs which roam the yard stalking birds, bees, and anything that moves. I went into overdrive and contacted the IRS about my estimated taxes for 2011 and whether or not full payment was received for my 2010 tax liability. But I thought about the worse case scenario: Oh frack, I am being audited for 2011! My first thought was will I use my acountant or retain a tax attorney now: like yesterday.  Certified letters from the IRS means "hear ye hear ye" for me as small business owner and attorney just like a Notice of Complaint, Potential Violation Report, or Compulsory Exam Order from the State Nursing Board means "hear ye hear ye" for a RN, LPN, APRN, or RN or PN NCLEX Applicant.

You have to be able to appreciate the best and worst case scenario for any workplace, licensure, legal, or State Nursing Board issue and sometime this requires the assistance of legal counsel for informed decision-making: like yesterday.  I appreciated the best/worst and WTF scenarios from my certified letters from the IRS; the letters are related to my 2010 tax liability and estimated tax payments from 2011.  

When you receive certain items, documents, or information by mail that impact you as a professional and your livelihood as a licensed professional, your natural instincts should flare up and you should go into hyperdrive like the Death Start from Star Wars in less than 10 seconds and start critically thinking about your next steps.

For nurses: it is a medical mal complaint naming you individually as defendant (because you probably do not have your own liability insurance policy), criminal indictments, certified letter from your employer after you have been suspended from work pending an investigation, letters from the State Attorney General's or Department of Health related to a workplace incident, and State Nursing Board Complaints and Compulsory Examinations/Orders.

You have critical thinking skills (if you don't email me and I will send you an invoice to pay me to help you develop those skills) so use those skills to critically think and be objective about your situation. There is nothing routine, ordinary, common, or mundane about receiving a Compulsory Examination Order from your State Nursing Board and the fact that this is "lost" of most nurses and NCLEX Applicants is troubling and speaks volumes to where we are as profession with knowledge and education of the intersection of the nursing law and professional standards of practice and the practical applications in the workplace.

 

 

Legal Duties vs. Moral and Ethical Obligations: The License is 24/7

IMHO, a test of character and integrity is rising above your legal obligations and duties and doing what is morally and ethically correct although you are not legally obligated to do so.

We live in a time where it is all about the law (this blog is Nursing Law & Order) because you can sue for just about anything these days. A kid gets slapped on the playground now it is suspension from school or expulsion, criminal charges, and a civil suit.

Nurses need to know the law and in particular the practical application of the State Nurse Practice Act and Board of Nursing regulations to everyday practice. This is just a starting point; the bare minimum is the legal. From the legal IMO you can then start to decipher the moral and ethical. In Nursing, the bare legal or barely legal is a matter of perspective.

I make a mighty but still muddled & merely middle class living (I am aspiring to be at the Rick James "I am rich bi$ch" level by my 105 birthday (I just turned 40 on Saturday, July 2nd)) because of "the legal", the gap somewhere between the Nurse Practice Act & Board regs and professional standards and practice and the application to nursing practice and "being" a state licensed nurse 24/7. 

24/7 requires thought and understanding and a big picture view.

24/7 means when you see your best friend throw a punch in the bar after the 6th round of beers you do not start swinging and fighting along side of her and the two of you "go out" like Thelma and Louise. http://en.wikipedia.org/wiki/Thelma_%26_Louise

24/7 means when you get pulled over for drunk driving and you are charged with a DUI, child endangerment, possession of drugs, concealed weapon, and possession of drug paraph., you recognize at some point in the process and actually say "this may be my a## with the BON."

24/7 is 24/7; you are a nurse 24/7. I just renewed by nursing license with the Ohio Nursing Board last week and although there is one person I would really really like to slap, I keep my hands to myself because I am a nurse 24/7 and as a RN (in the Big O only) & a license defense attorney (three states baby) I don't NEED or WANT a DV charge or conviction.

One of my girl friends was arguing with a stranger last month (about the price of gas, the Middle East, and how this impact politics in the US. Why?) when we met for Happy Hour (why are there so many angry folks drinking at Happy Hour anyway?) and I told her, "if you are fighting, I will wait in the car." I am also a lawyer 24/7 and lawyer discipline is another matter.

Every license has benefits and burdens. The benefit of a RN license is the income and career diversity afforded to RNs especially with advanced education or additional experience/expertise and certifications. You can literally write your own ticket in nursing; I am.

The burdens are the legal, ethical, and moral responsibilites, duties, obligations, and liabilities and cross the profession still carries from lack of an entry level to practice, being female dominated, collective bargaining, and from being fractured and operating in environments where nurses have little real control or power. It is always about the money, the power, and the ends & means and the profession still struggles with this and will continue to do so.     

On a Law & Order: SVU episode (I love Detective Stabler; he is nuts!!) one of the detectives commented about being a detective and a police officer and being the job 24/7. Police officers are socialized into this circle and we all have heard about the blue line. Where is this socialization in nursing? Are nursing schools churning out soooo many graduates that there is no time for socialization? Just pat your graduates on the head, give them a business card to a local bail bonds chop shop and an outdated copy of the ANA Code of Ethics, and then say "Go Be Somebody."

24/7. This is the responsibility, accountability, and potential liability that you assume when you get your State Board of Nursing issued RN or LPN license. This is what nursing profs need to tell students and what needs to be stressed to practicing LPNs, RNs, and APRNs.

Who role is it to say this anyway? After I complete my Jedi Knight training, I want to assume part of this role in the profession. Which brings me to my next blog post? Nurse, are you just living or are you living by a code and fulfilling your destiny like Darth Vader or Luke Skywalker?

It ain't all peachy or creamy (I want ice cream) in nursing; it is 24/7 with the license.

Why? Look at the State Nursing Board renewal applications questions. Are you a Misdemeanor Mama or the Felony Father? (I am sorry Mom. I had to say it. I am going to Bible Study this Thursday and early morning service on Sunday. One of my grandmother's reads this blog).

Misdemeanors are misdemeanors and a felony is a felony, whether you are on the job or off the job because you are the job when you can care for John Q. Public; you are a nurse 24/7.