Ir(regulation) of the Health Professions

The state seal of Virginia.
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This is a cautionary tale about what I have experienced in dealing with the Virginia Department of Health’s Board of Nursing over my own nursing license—and the records they have of my case. It highlights what I believe to be second victim issues stemming from the unfair abuse of power of such health regulatory boards. It is my personal story, based on my own experience. In addition, it is based on research I have conducted, including interviews and an extensive review of public records relating to my own case. From what I know of the Washington State Department of Health’s Health Professions Regulatory Boards, there are similar—if not worse—issues, some of which have come into play in the recent high-profile cases of nurses at Seattle Children’s Hospital.  That will be a topic of a follow-up post once I have gathered more information on Washington State.

First, here is some necessary background for people who aren’t familiar with health professions regulation. Each state regulates health professionals licensed to practice in their specific state. The main purpose of health regulatory boards is to ensure safe and competent delivery of health care services. Each health care profession or division is charged with regulating its ‘own kind.’ The health regulatory boards are included in each state’s department of health and are governed by state laws. As in all other states’ rights issues, there is variability in quality and oversight of the health regulatory boards, as well as considerable variation within a state in terms of the different divisions. Thus, the common perception that Boards of Nursing are more likely than Boards of Medicine to be overly strict is backed by independent audits.

In my home state (Commonwealth) of Virginia, a Joint Legislative Audit of the health regulatory boards in 1999 found that “The Board of Medicine does not adequately protect the public from substandard care by physicians. It rarely sanctions physicians for standard of care violations.” The Board of Nursing was twice as likely as the Board of Medicine to suspend licenses or impose other extreme sanctions for the similar practice violations.

This is the highly condensed version of my initial saga with the Virginia Health Regulatory Board. As soon as I graduated/got my nurse practitioner license in the Spring of 1986, I ran the Cross-Over Health Clinic at the Richmond Street Center. This was a multi-service center for Richmond’s burgeoning homeless adult population. I was the sole health care provider, with physician back up by telephone. Several volunteer physicians would also have Saturday morning clinic hours for our more medically complex patients. I had written and co-signed practice protocols in place, which were required for nurse practitioners in Virginia at the time (and still are). By the end of our first year, I had seen over 1,600 patients for 4,000 clinic visits. The clinic’s entire yearly budget–including medications– was $30,000.

In early October 1987, I received a surprise visit by an downtrodden-looking field investigator from the Health Regulatory Board. He said they had received complaints from Richmond physicians about my practice, and specifically about the scope of my practice as a nurse practitioner. At the time there were no other nurse-managed clinics in Virginia, and I soon found out why. Powerful physician groups did not want them. This began an almost nine-month saga of informal hearings with the State Attorney General’s office, times of our clinic being closed by the Regulatory Board, and long stretches of wondering if my license (and livelihood) would be revoked. At the beginning of the investigation I had a six-month old son and my clinic job was my family’s only source of income. To state that this time of being investigated by the Health Regulatory Board was stressful is an understatement. I lost so much weight my doctor advised me to stop breast-feeding my son. My marriage disintegrated. I became disillusioned about nursing in general and took pre-med courses and applied to med school. I became homeless. I seriously contemplated suicide. More than a few times.

But here’s the irony. I’ve gotten past all of that. My son survived early weaning and is in graduate school. I own my home and have a reasonably stable job. I have a happy and rewarding long term relationship. I now like and even love nursing. I have almost completed a book about that time of my life. In researching that specific part of my story I realized I never had any closure on it—as in I never received any documentation about the outcome of their investigation. I knew it had ended, as had my marriage, as had my job. But I had no proof, and I was curious to find the documentation of the investigation into my practice.

So in January of this year I sent an e-mail inquiry to Jay P. Douglas, RN, MSM, CSAC (that means, I believe, that she is a certified substance abuse counselor and a nurse midwife), who is the current Executive Director of the Virginia Board of Nursing. I briefly explained who I was, that I was writing a book and wanted to get copies of the records/documentation of the investigation of my nursing license. I didn’t hear back from her, so after a month I called her office. It was lunchtime, but the woman who answered the phone happened to know about my case, as she had typed up my reports back in 1988 (really—strange things like this have happened to me with this book project.) She said she didn’t see why I couldn’t have copies of my own report, but that she’d have to defer that decision to Jay P. Douglas. She told me that Frank M. Cody was the Assistant Attorney General who had investigated my case, and that they had closed the case in May 1988 without a hearing, for insufficient evidence. She added that they now try to hire more qualified field investigators than what I’d had—that back then they hired former food and/or rat control inspectors.

I got a letter dated 2-4-11 from Jay P. Douglas stating, “Please be aware that according to section 54.1.2400.2 of the Code, any reports, information, or records received and maintained by any health regulatory board in connection with possible disciplinary proceedings, including any material received or developed by a board during an investigation or proceeding, shall be strictly confidential. A board may only disclose such confidential information pursuant to an order of a court or competent jurisdiction for good cause arising from extraordinary circumstances being shown. Therefore, I am unable to comply with your request.”

In a follow-up telephone conversation I had with her (very civil conversation by the way), Ms. Douglas said that she had sought advise on this from the Virginia Attorney General’s Office. I pointed out that I wasn’t asking to know individual identifiers of who said what about my practice, but then she said that since I wasn’t a Virginia State resident now, she couldn’t release any information. So as of this writing I still have no written documentation that my case was ever resolved, much less what the ‘case’ really involved to begin with. It makes me wonder what they have to hide. It makes me wonder who regulates the health regulatory boards in our country.

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