SB 799: Nursing.
- Session Year: 2017-2018
- House: Senate
- Latest Version Date: 2017-10-05
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. The act requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act prescribes various fees to be paid by licensees and applicants for licensure, and requires these fees to be credited to the Board of Registered Nursing Fund, which is a continuously appropriated fund as it pertains to fees collected by the board.
This bill would delete the continuous appropriation, thereby subjecting all moneys in the fund to appropriation by the Legislature.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and that offers options for consistent and reasonable reporting mechanisms.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program. Under the act, neither acceptance nor participation in the intervention program precludes the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would authorize the board to investigate at its discretion complaints against registered nurses participating in the intervention program. The bill would prohibit disciplinary action with regard to acts committed before or during participation in the intervention program, unless the registered nurse withdraws or is terminated from the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, including a requirement that the standards be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees.
This bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities, and, by January 1, 2020, to report to the appropriate legislative committees on its progress implementing this plan. The bill would require that the alternative forms of continuing education available to licensees include online forms of continuing education.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act. The bill would define insurer for those purposes.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. The act requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act prescribes various fees to be paid by licensees and applicants for licensure, and requires these fees to be credited to the Board of Registered Nursing Fund, which is a continuously appropriated fund as it pertains to fees collected by the board.
This bill would delete the continuous appropriation, thereby subjecting all moneys in the fund to appropriation by the Legislature.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and that offers options for consistent and reasonable reporting mechanisms.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program. Under the act, neither acceptance nor participation in the intervention program precludes the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would authorize the board to investigate at its discretion complaints against registered nurses participating in the intervention program. The bill would prohibit disciplinary action with regard to acts committed before or during participation in the intervention program, unless the registered nurse withdraws or is terminated from the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, including a requirement that the standards be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees.
This bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities, and, by January 1, 2020, to report to the appropriate legislative committees on its progress implementing this plan. The bill would require that the alternative forms of continuing education available to licensees include online forms of continuing education.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act. The bill would define insurer for those purposes.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. The act requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act prescribes various fees to be paid by licensees and applicants for licensure, and requires these fees to be credited to the Board of Registered Nursing Fund, which is a continuously appropriated fund as it pertains to fees collected by the board.
This bill would delete the continuous appropriation, thereby subjecting all moneys in the fund to appropriation by the Legislature.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require an employer, as defined, of a registered nurse to report to the board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employment agency or nursing registry to also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for termination. The bill would make the willful failure of an employer to make a report as required by the bill punishable by an administrative fine up to $5,000 per violation. the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and that offers options for consistent and reasonable reporting mechanisms.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program. Under the act, neither acceptance nor participation in the intervention program precludes the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would authorize the board to investigate at its discretion complaints against registered nurses participating in the intervention program. The bill would prohibit disciplinary action with regard to acts committed before or during participation in the intervention program, unless the registered nurse withdraws or is terminated from the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, including a requirement that the standards be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees.
This bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities, and, by January 1, 2020, to report to the appropriate legislative committees on its progress implementing this plan. The bill would require that the alternative forms of continuing education available to licensees include online forms of continuing education.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act. The bill would define insurer for those purposes.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. The act requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act prescribes various fees to be paid by licensees and applicants for licensure, and requires these fees to be credited to the Board of Registered Nursing Fund, which is a continuously appropriated fund as it pertains to fees collected by the board.
This bill would delete the continuous appropriation, thereby subjecting all moneys in the fund to appropriation by the Legislature.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require an employer, as defined, of a registered nurse to report to the board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employment agency or nursing registry to also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for termination. The bill would make the willful failure of an employer to make a report as required by the bill punishable by an administrative fine up to $5,000 per violation.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program. Under the act, neither acceptance nor participation in the intervention program precludes the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would authorize the board to investigate at its discretion complaints against registered nurses participating in the intervention program. The bill would prohibit disciplinary action with regard to acts committed before or during participation in the intervention program, unless the registered nurse withdraws or is terminated from the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, including a requirement that the standards be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees.
This bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities, and, by January 1, 2020, to report to the appropriate legislative committees on its progress implementing this plan. The bill would require that the alternative forms of continuing education available to licensees include online forms of continuing education.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act. The bill would define insurer for those purposes.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. Existing law The act requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act prescribes various fees to be paid by licensees and applicants for licensure, and requires these fees to be credited to the Board of Registered Nursing Fund, which is a continuously appropriated fund as it pertains to fees collected by the board.
This bill would delete the continuous appropriation, thereby subjecting all moneys in the fund to appropriation by the Legislature.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require a registered nurse who has knowledge that another person has committed any act listed as grounds for discipline or a denial of application to make a written report to the board and cooperate with the board in furnishing information or assistance, as required. The bill would require an employer, as defined, of a registered nurse to report to the board the suspension or board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employer employment agency or nursing registry to also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for suspension or termination. The bill would make the willful failure of a registered nurse or an employer to make a report as required by the bill punishable by an administrative fine up to $10,000 $5,000 per violation.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program. Under the act, neither acceptance nor participation in the intervention program precludes the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would require authorize the board to investigate all at its discretion complaints against registered nurses participating in the intervention program. The bill would prohibit disciplinary action with regard to acts committed before or during participation in the intervention program, unless the registered nurse withdraws or is terminated from the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, and prohibits the standards from exceeding 30 hours of continuing education. including a requirement that the standards be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees.
This bill would revise those continuing education provisions to require that each person renewing his or her license submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nursing field or relevant to the practice of the licensee. The bill would prohibit the board from renewing existing continuing education providers or approving individual continuing education providers or courses. The bill would permit continuing education courses from providers approved by the board before January 1, 2018, or approved by accrediting agencies or associations deemed appropriate by the board, to include specified entities. The bill would require the board to promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing. The bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities. opportunities, and, by January 1, 2020, to report to the appropriate legislative committees on its progress implementing this plan. The bill would require that the alternative forms of continuing education available to licensees include online forms of continuing education.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act. The bill would define insurer for those purposes.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. Existing law requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require a registered nurse who has knowledge that another person has committed any act listed as grounds for discipline or a denial of application to make a written report to the board and cooperate with the board in furnishing information or assistance, as required. The bill would require an employer, as defined, of a registered nurse to report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employer to report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for suspension or termination. The bill would make the failure of a registered nurse or an employer to make a report as required by the bill punishable by an administrative fine up to $10,000 per violation.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would require the board to investigate all complaints against registered nurses participating in the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, and prohibits the standards from exceeding 30 hours of continuing education.
This bill would revise those continuing education provisions to require that each person renewing his or her license submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nursing field or relevant to the practice of the licensee. The bill would prohibit the board from renewing existing continuing education providers or approving individual continuing education providers or courses. The bill would permit continuing education courses from providers approved by the board before January 1, 2018, or approved by accrediting agencies or associations deemed appropriate by the board. board, to include specified entities. The bill would require the board to promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing. The bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. Existing law requires the board to appoint an executive officer to perform duties delegated by the board.
The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require a registered nurse who has knowledge that another person has committed any act listed as grounds for discipline or a denial of application to make a written report to the board and cooperate with the board in furnishing information or assistance, as required. The bill would require an employer employer, as defined, of a registered nurse to report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employment agency or nursing registry employer to report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for suspension or termination. The bill would make the failure of a registered nurse, an employer, or an employment agency or nursing registry nurse or an employer to make a report as required by the bill punishable by an administrative fine up to $10,000 per violation. The bill would make the implementation of these reporting requirements contingent upon the necessary funding in the annual Budget Act.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would require the board to investigate all complaints against registered nurses participating in the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, and prohibits the standards from exceeding 30 hours of continuing education.
This bill would revise those continuing education provisions to require that each person renewing his or her license to submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nurse nursing field or relevant to the practice of the licensee. The bill would permit continuing education courses from providers approved by the board before January 1, 2018, or approved by accrediting agencies or associations deemed appropriate by the board. The bill would require the board to promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing. The bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. Existing law requires the board to appoint an executive officer to perform duties delegated by the board.
Existing law,The act on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
The act requires the board, by February 1, 2016, to contract with the California State Auditors Office to conduct a performance audit of the boards enforcement program, as specified.
This bill would repeal the performance audit provisions.
The act authorizes the board to take disciplinary action against certified or licensed nurses or to deny an application for a certificate or license for various acts and offenses.
This bill would require a registered nurse who has knowledge that another person has committed any act listed as grounds for discipline or a denial of application to make a written report to the board and cooperate with the board in furnishing information or assistance, as required. The bill would require an employer of a registered nurse to report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. The bill would require an employment agency or nursing registry to report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to certain acts that would be cause for suspension or termination. The bill would make the failure of a registered nurse, an employer, or an employment agency or nursing registry to make a report as required by the bill punishable by an administrative fine up to $10,000 per violation. The bill would make the implementation of these reporting requirements contingent upon the necessary funding in the annual Budget Act.
The act provides for an intervention program to identify and rehabilitate registered nurses whose competency may be impaired due to abuse of alcohol and other drugs, or due to mental illness. The act authorizes a registered nurse under current investigation by the board to request entry into the intervention program by contacting the board. The act authorizes the board to close an investigation of a registered nurse who enters the program under specified circumstances and requires the board to reopen the investigation only if the registered nurse withdraws or is terminated from the program.
This bill would delete those provisions providing for the suspension of a current investigation while a registered nurse is in the program and, instead, would require the board to investigate all complaints against registered nurses participating in the intervention program.
The act requires a person renewing his or her license to submit proof satisfactory to the board that, during the preceding 2-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. The act requires the board to adopt regulations establishing standards for continuing education for licensees, as specified, and prohibits the standards from exceeding 30 hours of continuing education.
This bill would revise those continuing education provisions to require that each person renewing his or her license to submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nurse field or relevant to the practice of the licensee. The bill would permit continuing education courses from providers approved by the board before January 1, 2018, or approved by accrediting agencies or associations deemed appropriate by the board. The bill would require the board to promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing. The bill would require the board, by January 1, 2019, to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
Existing law requires insurers that provide liability insurance to certain licensees, including persons licensed by the board, to report to the licensing agency certain settlement or arbitration awards over $3,000.
This bill would increase the report threshold to $10,000 for a person licensed under the act.
Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs and sets forth its powers and duties regarding the licensure and regulation of registered nurses. Existing law requires the board to appoint an executive officer to perform duties delegated by the board.
Existing law, on January 1, 2018, repeals the provisions establishing the board and the executive officer position.
This bill would extend the repeal date of those provisions to January 1, 2022.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
(h)For purposes of this section, insurer means the following:
(1)The insurer providing professional liability insurance to the licensee.
(2)The licensee, or his or her counsel, if the licensee does not possess professional liability insurance.
(3)A state or local governmental agency, including, but not limited to, a joint powers authority, that self-insures the licensee. As used in this paragraph, state governmental agency includes, but is not limited to, the University of California.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.It is the intent of the Legislature to provide for a study of reporting mechanisms to the board so that it can identify methods of receiving timely information on nurses who may have violated this chapter. The California Research Bureau shall prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and offers options for consistent and reasonable reporting mechanisms. The report shall include, but not be limited to, the following:
(a)A review of existing mandatory reporting requirements that alert the board to nurses who may have violated this chapter.
(b)A review of existing laws permitting, prohibiting, encouraging, or discouraging voluntary reporting to the board.
(c)An analysis of the number of employer reports to the board, the number of those reports investigated by the board, and the final action taken by the board for each report.
(d)Employer reporting requirements of other boards within the department.
(e)Nursing reporting requirements of other states.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action in accordance with this section.
(c)(1)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or, except as provided in this subdivision, taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(2)The board may investigate at its discretion complaints against registered nurses participating in the intervention program.
(3)Disciplinary action with regard to acts committed before or during participation in the intervention program shall not take place unless the registered nurse withdraws or is terminated from the program.
(d)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(e)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b)Notwithstanding Section 10231.5 of the Government Code, the board, in compliance with Section 9795 of the Government Code, shall do the following:
(1)By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2)By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(c)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(d)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(e)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(f)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:
(1)Pain and symptom management, including palliative care.
(2)The psychosocial dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(g)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(h)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
SEC. 8.Section 2814 of the Business and Professions Code is amended to read:2814.All money in the Board of Registered Nursing Fund shall be available, upon appropriation by the Legislature, to carry out this chapter and the promotion of nursing education in this state.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
(h)For purposes of this section, insurer means the following:
(1)The insurer providing professional liability insurance to the licensee.
(2)The licensee, or his or her counsel, if the licensee does not possess professional liability insurance.
(3)A state or local governmental agency, including, but not limited to, a joint powers authority, that self-insures the licensee. As used in this paragraph, state governmental agency includes, but is not limited to, the University of California.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.It is the intent of the Legislature to provide for a study of reporting mechanisms to the board so that it can identify methods of receiving timely information on nurses who may have violated this chapter. The California Research Bureau shall prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and offers options for consistent and reasonable reporting mechanisms. The report shall include, but not be limited to, the following:
(a)A review of existing mandatory reporting requirements that alert the board to nurses who may have violated this chapter.
(b)A review of existing laws permitting, prohibiting, encouraging, or discouraging voluntary reporting to the board.
(c)An analysis of the number of employer reports to the board, the number of those reports investigated by the board, and the final action taken by the board for each report.
(d)Employer reporting requirements of other boards within the department.
(e)Nursing reporting requirements of other states.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action in accordance with this section.
(c)(1)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or, except as provided in this subdivision, taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(2)The board may investigate at its discretion complaints against registered nurses participating in the intervention program.
(3)Disciplinary action with regard to acts committed before or during participation in the intervention program shall not take place unless the registered nurse withdraws or is terminated from the program.
(d)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(e)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b)Notwithstanding Section 10231.5 of the Government Code, the board, in compliance with Section 9795 of the Government Code, shall do the following:
(1)By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2)By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(c)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(d)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(e)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(f)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:
(1)Pain and symptom management, including palliative care.
(2)The psychosocial dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(g)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(h)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
SEC. 8.Section 2814 of the Business and Professions Code is amended to read:2814.All money in the Board of Registered Nursing Fund shall be available, upon appropriation by the Legislature, to carry out this chapter and the promotion of nursing education in this state.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
(h)For purposes of this section, insurer means the following:
(1)The insurer providing professional liability insurance to the licensee.
(2)The licensee, or his or her counsel, if the licensee does not possess professional liability insurance.
(3)A state or local governmental agency, including, but not limited to, a joint powers authority, that self-insures the licensee. As used in this paragraph, state governmental agency includes, but is not limited to, the University of California.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)An employer of a registered nurse shall report to the board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of a registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The fact that an employer reported a registered nurse to the board shall be kept confidential and shall not be subject to discovery in civil cases.(b)An employment agency or nursing registry shall also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for termination as described in subdivision (d).(c)For purposes of this section, termination or resignation for cause and rejection from assignment are defined as termination or resignation from employment, or rejection from assignment, for any of the following reasons:(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice registered nursing.(2)Unlawful sale or possession of a controlled substance or other prescription items.(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.(d)Willful failure of an employer to make a report required by this section is punishable by an administrative fine not to exceed five thousand dollars ($5,000) per violation and shall not be punished pursuant to Section 2799. As used in this subdivision, willful means a voluntary and intentional violation of a known legal duty.(e)Pursuant to Section 43.8 and subdivision (b) of Section 47 of the Civil Code, a person shall not incur a civil penalty as a result of making a report to the board that is required by this chapter or to protect the public.(f)For purposes of this section, employer includes employment agencies and nursing registries.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.It is the intent of the Legislature to provide for a study of reporting mechanisms to the board so that it can identify methods of receiving timely information on nurses who may have violated this chapter. The California Research Bureau shall prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and offers options for consistent and reasonable reporting mechanisms. The report shall include, but not be limited to, the following:
(a)A review of existing mandatory reporting requirements that alert the board to nurses who may have violated this chapter.
(b)A review of existing laws permitting, prohibiting, encouraging, or discouraging voluntary reporting to the board.
(c)An analysis of the number of employer reports to the board, the number of those reports investigated by the board, and the final action taken by the board for each report.
(d)Employer reporting requirements of other boards within the department.
(e)Nursing reporting requirements of other states.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action in accordance with this section.
(c)(1)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or, except as provided in this subdivision, taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(2)The board may investigate at its discretion complaints against registered nurses participating in the intervention program.
(3)Disciplinary action with regard to acts committed before or during participation in the intervention program shall not take place unless the registered nurse withdraws or is terminated from the program.
(d)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(e)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b)Notwithstanding Section 10231.5 of the Government Code, the board, in compliance with Section 9795 of the Government Code, shall do the following:
(1)By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2)By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(c)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(d)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(e)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(f)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:
(1)Pain and symptom management. management, including palliative care.
(2)The psychosocial dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(g)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(h)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
SEC. 8.Section 2814 of the Business and Professions Code is amended to read:2814.All money in the Board of Registered Nursing Fund shall be available, upon appropriation by the Legislature, to carry out this chapter and the promotion of nursing education in this state.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
(h)For purposes of this section,insurer means the following:
(1)The insurer providing professional liability insurance to the licensee.
(2)The licensee, or his or her counsel, if the licensee does not possess professional liability insurance.
(3)A state or local governmental agency, including, but not limited to, a joint powers authority, that self-insures the licensee. As used in this paragraph, state governmental agency includes, but is not limited to, the University of California.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)An employer of a registered nurse shall report to the board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of a registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The fact that an employer reported a registered nurse to the board shall be kept confidential and shall not be subject to discovery in civil cases.
(b)An employment agency or nursing registry shall also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for termination as described in subdivision (d).
(c)For purposes of this section, termination or resignation for cause and rejection from assignment are defined as termination or resignation from employment, or rejection from assignment, for any of the following reasons:
(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice registered nursing.
(2)Unlawful sale or possession of a controlled substance or other prescription items.
(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
(d)Willful failure of an employer to make a report required by this section is punishable by an administrative fine not to exceed five thousand dollars ($5,000) per violation and shall not be punished pursuant to Section 2799. As used in this subdivision, willful means a voluntary and intentional violation of a known legal duty.
(e)Pursuant to Section 43.8 and subdivision (b) of Section 47 of the Civil Code, a person shall not incur a civil penalty as a result of making a report to the board that is required by this chapter or to protect the public.
(f)For purposes of this section, employer includes employment agencies and nursing registries.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action in accordance with this section.
(c)(1)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or, except as provided in this subdivision, taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(2)The board may investigate at its discretion complaints against registered nurses participating in the intervention program.
(3)Disciplinary action with regard to acts committed before or during participation in the intervention program shall not take place unless the registered nurse withdraws or is terminated from the program.
(d)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(e)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b)Notwithstanding Section 10231.5 of the Government Code, the board, in compliance with Section 9795 of the Government Code, shall do the following:
(1)By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2)By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(c)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the evidence-based scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(d)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(e)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(f)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psychosocial dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(g)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(h)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
SEC. 8.Section 2814 of the Business and Professions Code is amended to read:2814.All money in the Board of Registered Nursing Fund shall be available, upon appropriation by the Legislature, to carry out this chapter and the promotion of nursing education in this state.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
(h)For purposes of this section,insurer means the following:
(1)The insurer providing professional liability insurance to the licensee.
(2)The licensee, or his or her counsel, if the licensee does not possess professional liability insurance.
(3)A state or local governmental agency, including, but not limited to, a joint powers authority, that self-insures the licensee. As used in this paragraph, state governmental agency includes, but is not limited to, the University of California.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)If a registered nurse has knowledge that another person has committed any act listed as grounds for discipline or a denial of application pursuant to Section 2761, the registered nurse shall report this information to the board in writing and shall cooperate with the board in furnishing information or assistance as may be required.(b)An 2761.5.(a)An employer of a registered nurse shall report to the board the suspension or board, within 30 days of the termination, termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of a registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The information reported or disclosed fact that an employer reported a registered nurse to the board shall be kept confidential and shall not be subject to discovery in civil cases.
(c)(b)An employer shall employment agency or nursing registry shall also report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for suspension or termination as described in subdivision (d).
(d)(c)For purposes of this section, suspension, termination, termination or resignation for cause or and rejection from assignment are defined as suspension, termination, termination or resignation from employment, or rejection from assignment, for any of the following reasons:
(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice registered nursing.
(2)Unlawful sale or possession of a controlled substance or other prescription items.
(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
(4)Falsification of medical records.(5)Gross negligence or incompetence.(6)Theft from patients or clients, other employees, or the employer.(e)Failure of a registered nurse or an employer to make a report required by this section is punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation and shall not be punished pursuant to Section 2799.(d)Willful failure of an employer to make a report required by this section is punishable by an administrative fine not to exceed five thousand dollars ($5,000) per violation and shall not be punished pursuant to Section 2799. As used in this subdivision, willful means a voluntary and intentional violation of a known legal duty.
(f)(e)Pursuant to Section 43.8 and subdivision (b) of Section 47 of the Civil Code, a person shall not incur any a civil penalty as a result of making any report a report to the board that is required by this chapter. chapter or to protect the public.
(g)(f)For purposes of this section, employer includes employment agencies and nursing registries.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action in accordance with this section.
(c)The board shall investigate all complaints against registered nurses participating in the intervention program. (d)(c)(1)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or or, except as provided in this subdivision, taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(2)The board may investigate at its discretion complaints against registered nurses participating in the intervention program.
(3)Disciplinary action with regard to acts committed before or during participation in the intervention program shall not take place unless the registered nurse withdraws or is terminated from the program.
(e)(d)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(f)(e)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nurse field or relevant to the practice of the licensee. that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board.
(b)Continuing education courses may be from a continuing education provider either approved by the board before January 1, 2018, or approved by accrediting agencies or associations as the board deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, and the American Association of Nurse Anesthetists. The board shall promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing. (c)(b)Notwithstanding Section 10231.5 of the Government Code, the board, by January 1, 2019, in compliance with Section 9795 of the Government Code, shall deliver do the following:
(1)By January 1, 2019, deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(2)By January 1, 2020, report to the appropriate legislative committees on its progress implementing this plan.
(d)The board shall not renew existing continuing education providers or approve individual continuing education providers or courses.(e)(c)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, online, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the evidence-based scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(f)(d)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(g)(e)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(h)(f)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, families, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social psychosocial dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(i)In establishing standards for continuing education, the board may include a course on pain management.(j)(g)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(k)(h)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
SEC. 8.Section 2814 of the Business and Professions Code is amended to read:2814.All money in the Board of Registered Nursing Fund is hereby appropriated shall be available, upon appropriation by the Legislature, to carry out the provisions of this chapter, this chapter and the promotion of nursing education in this state.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)If a registered nurse has knowledge that another person has committed any act listed as grounds for discipline or a denial of application pursuant to Section 2761, the registered nurse shall report this information to the board in writing and shall cooperate with the board in furnishing information or assistance as may be required.
(b)An employer of a registered nurse shall report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of a registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The information reported or disclosed shall be kept confidential and shall not be subject to discovery in civil cases.
(c)An employer shall report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for suspension or termination as described in subdivision (d).
(d)For purposes of this section, suspension, termination, or resignation for cause or rejection from assignment are defined as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice registered nursing.
(2)Unlawful sale of a controlled substance or other prescription items.
(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
(4)Falsification of medical records.
(5)Gross negligence or incompetence.
(6)Theft from patients or clients, other employees, or the employer.
(e)Failure of a registered nurse or an employer to make a report required by this section is punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation and shall not be punished pursuant to Section 2799.
(f)Pursuant to Section 43.8 of the Civil Code, a person shall not incur any civil penalty as a result of making any report required by this chapter.
(g)For purposes of this section, employer includes employment agencies and nursing registries.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board.
(c)The board shall investigate all complaints against registered nurses participating in the intervention program.
(d)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(e)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(f)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nurse field or relevant to the practice of the licensee.
(b)Continuing education courses may be from a continuing education provider either approved by the board before January 1, 2018, or approved by accrediting agencies or associations as the board deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, and the American Association of Nurse Anesthetists, American Nurses Credentialing Center, and the National Association for Practical Nurse Education. Anesthetists. The board shall promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing.
(c)Notwithstanding Section 10231.5 of the Government Code, the board, by January 1, 2019, in compliance with Section 9795 of the Government Code, shall deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(d)The board shall not renew existing continuing education providers or approve individual continuing education providers or courses.
(e)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the evidence-based scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care.
(f)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(g)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(h)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(i)In establishing standards for continuing education, the board may include a course on pain management.
(j)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(k)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer.
SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)If a registered nurse has knowledge that another person has committed any act listed as grounds for discipline or a denial of application pursuant to Section 2761, the registered nurse shall report this information to the board in writing and shall cooperate with the board in furnishing information or assistance as may be required.
(b)An employer of a registered nurse shall report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of a registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The information reported or disclosed shall be kept confidential except as provided in subdivision (d) and shall not be subject to discovery in civil cases.
(c)An employment agency or nursing registry employer shall report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for suspension or termination as described in subdivision (d).
(d)For purposes of this section, suspension, termination, or resignation for cause or rejection from assignment are defined as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice vocational registered nursing.
(2)Unlawful sale of a controlled substance or other prescription items.
(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
(4)Falsification of medical records.
(5)Gross negligence or incompetence.
(6)Theft from patients or clients, other employees, or the employer.
(e)Failure of a registered nurse, an employer, nurse or an employment agency or nursing registry employer to make a report required by this section is punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation and shall not be punished pursuant to Section 2799.
(f)Pursuant to Section 43.8 of the Civil Code, a person shall not incur any civil penalty as a result of making any report required by this chapter.
(g)The board shall implement this section contingent upon the necessary funding in the annual Budget Act. (h)(g)For purposes of this section, employer includes employment agencies and nursing registries.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board.
(c)The board shall investigate all complaints against registered nurses participating in the intervention program.
(d)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(e)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(f)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that he or she has completed at least 30 hours of continuing education by pursuing a course or courses in the registered nurse field or relevant to the practice of the licensee.
(b)Continuing education courses may be from a continuing education provider either approved by the board before January 1, 2018, or approved by accrediting agencies or associations as the board deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, American Association of Nurse Anesthetists, American Nurses Credentialing Center, and the National Association for Practical Nurse Education. The board shall promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing.
(c)Notwithstanding Section 10231.5 of the Government Code, the board, by January 1, 2019, in compliance with Section 9795 of the Government Code, shall deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(d)The board shall not renew existing continuing education providers or approve individual continuing education providers or courses.
(e)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the evidence-based scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care.
(f)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(g)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(h)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(i)In establishing standards for continuing education, the board may include a course on pain management.
(j)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(k)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
(a)Except as provided in Section 801.01 and subdivisions (b), (c), and (d) (d), and (e) of this section, every insurer providing professional liability insurance to a person who holds a license, certificate, or similar authority from or under any agency specified in subdivision (a) of Section 800 shall send a complete report to that agency as to any settlement or arbitration award over three thousand dollars ($3,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(b)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 13 (commencing with Section 4980), Chapter 14 (commencing with Section 4990), or Chapter 16 (commencing with Section 4999.10) shall send a complete report to the Board of Behavioral Sciences as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(c)Every insurer providing professional liability insurance to a dentist licensed pursuant to Chapter 4 (commencing with Section 1600) shall send a complete report to the Dental Board of California as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(d)Every insurer providing liability insurance to a veterinarian licensed pursuant to Chapter 11 (commencing with Section 4800) shall send a complete report to the Veterinary Medical Board of any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or injury caused by that persons negligence, error, or omission in practice, or rendering of unauthorized professional service. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)Every insurer providing professional liability insurance to a person licensed pursuant to Chapter 6 (commencing with Section 2700) shall send a complete report to the Board of Registered Nursing as to any settlement or arbitration award over ten thousand dollars ($10,000) of a claim or action for damages for death or personal injury caused by that persons negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties.
(e)(f)The insurer shall notify the claimant, or if the claimant is represented by counsel, the insurer shall notify the claimants attorney, that the report required by subdivision (a), (b), or (c) has been sent to the agency. If the attorney has not received this notice within 45 days after the settlement was reduced to writing and signed by all of the parties, the arbitration award was served on the parties, or the date of entry of the civil judgment, the attorney shall make the report to the agency.
(f)(g)Notwithstanding any other provision of law, no insurer shall enter into a settlement without the written consent of the insured, except that this prohibition shall not void any settlement entered into without that written consent. The requirement of written consent shall only be waived by both the insured and the insurer. This section shall only apply to a settlement on a policy of insurance executed or renewed on or after January 1, 1971.
SECTION 1.SEC. 2.Section 2701 of the Business and Professions Code is amended to read:2701.(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 2.SEC. 3.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date.
SEC. 4.Section 2718 of the Business and Professions Code is repealed.2718.(a)(1)By February 1, 2016, the board shall contract with the office to conduct a performance audit of the boards enforcement program. The board shall reimburse the office for the cost of the performance audit. The office shall report the results of the audit, with any recommendations, to the Governor, the department, and the appropriate policy committees of the Legislature by January 1, 2017.(2)The performance audit shall include, but not be limited to, an evaluation of all the following:(A)The quality and consistency of, and compliance with, complaint processing and investigation.(B)The consistency and adequacy of the application of board sanctions or discipline imposed on licensees.(C)The accuracy and consistency in implementing the laws and rules affecting discipline, including adherence to the Division of Investigation Case Acceptance Guidelines (Consumer Protection Enforcement Initiative Model), as revised July 1, 2014.(D)The timeframes for completing complaint processing, investigation, and resolution.(E)Staff concerns regarding licensee disciplinary matters or procedures.(F)The appropriate utilization of licensed professionals to investigate complaints.(G)The adequacy of the boards cooperation with other state agencies charged with enforcing related laws and regulations regarding nurses.(H)Any existing backlog, the reason for the backlog, and the timeframe for eliminating the backlog.(I)The adequacy of board staffing, training, and fiscal resources to perform its enforcement functions.(b)Board staff and management shall cooperate with the office and shall provide the office with access to data, case files, employees, and information as the office may, in its discretion, require for the purposes of this section.(c)For the purposes of this section, office means the California State Auditors Office.SEC. 5.Section 2761.5 is added to the Business and Professions Code, to read:2761.5.(a)If a registered nurse has knowledge that another person has committed any act listed as grounds for discipline or a denial of application pursuant to Section 2761, the registered nurse shall report this information to the board in writing and shall cooperate with the board in furnishing information or assistance as may be required.
(b)An employer of a registered nurse shall report to the board the suspension or termination for cause, or resignation for cause, of any registered nurse in its employ. In the case of registered nurse employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194. This required reporting shall not constitute a waiver of confidentiality of medical records. The information reported or disclosed shall be kept confidential except as provided in subdivision (d) and shall not be subject to discovery in civil cases.
(c)An employment agency or nursing registry shall report to the board the rejection from assignment of a registered nurse by a health facility or home health care provider due to acts that would be cause for suspension or termination as described in subdivision (d).
(d)For purposes of this section, suspension, termination, or resignation for cause or rejection from assignment are defined as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
(1)Use of controlled substances or alcohol to the extent that it impairs the licensees ability to safely practice vocational nursing.
(2)Unlawful sale of a controlled substance or other prescription items.
(3)Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
(4)Falsification of medical records.
(5)Gross negligence or incompetence.
(6)Theft from patients or clients, other employees, or the employer.
(e)Failure of a registered nurse, an employer, or an employment agency or nursing registry to make a report required by this section is punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation and shall not be punished pursuant to Section 2799.
(f)Pursuant to Section 43.8 of the Civil Code, a person shall not incur any civil penalty as a result of making any report required by this chapter.
(g)The board shall implement this section contingent upon the necessary funding in the annual Budget Act.
(h)For purposes of this section, employer includes employment agencies and nursing registries.
SEC. 6.Section 2770.7 of the Business and Professions Code is amended to read:2770.7.(a)The board shall establish criteria for the acceptance, denial, or termination of registered nurses in the intervention program. Only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program.
(b)A registered nurse under current investigation by the board may request entry into the intervention program by contacting the board. Prior to authorizing a registered nurse to enter into the intervention program, the board may require the registered nurse under current investigation for any violations of this chapter or any other provision of this code to execute a statement of understanding that states that the registered nurse understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action.
(c)If the reasons for a current investigation of a registered nurse are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol under Section 2762, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, the board shall close the investigation without further action if the registered nurse is accepted into the boards intervention program and successfully completes the program. If the registered nurse withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the board.(c)The board shall investigate all complaints against registered nurses participating in the intervention program.
(d)Neither acceptance nor participation in the intervention program shall preclude the board from investigating or continuing to investigate, or taking disciplinary action or continuing to take disciplinary action against, any registered nurse for any unprofessional conduct committed before, during, or after participation in the intervention program.
(e)All registered nurses shall sign an agreement of understanding that the withdrawal or termination from the intervention program at a time when the program manager or intervention evaluation committee determines the licentiate presents a threat to the publics health and safety shall result in the utilization by the board of intervention program treatment records in disciplinary or criminal proceedings.
(f)Any registered nurse terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action by the board for acts committed before, during, and after participation in the intervention program. A registered nurse who has been under investigation by the board and has been terminated from the intervention program by an intervention evaluation committee shall be reported by the intervention evaluation committee to the board.
SEC. 7.Section 2811.5 of the Business and Professions Code is amended to read:2811.5.(a)Each person renewing his or her license under Section 2811 shall submit proof satisfactory to the board that, during the preceding two-year period, he or she has been informed of the developments in the registered nurse field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either that he or she has completed at least 30 hours of continuing education by pursuing a course or courses of continuing education in the registered nurse field or relevant to the practice of the licensee, and approved by the board, or by other means deemed equivalent by the board. licensee.
(b)Continuing education courses may be from a continuing education provider either approved by the board before January 1, 2018, or approved by accrediting agencies or associations as the board deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, American Association of Nurse Anesthetists, American Nurses Credentialing Center, and the National Association for Practical Nurse Education. The board shall promulgate emergency regulations to establish a list of approved entities based on the entities history of sanctioning learning opportunities appropriate to the practice of registered nursing.
(c)Notwithstanding Section 10231.5 of the Government Code, the board, by January 1, 2019, in compliance with Section 9795 of the Government Code, shall deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
(d)The board shall not renew existing continuing education providers or approve individual continuing education providers or courses.
(b)(e)For purposes of this section, the board shall, by regulation, establish standards for continuing education. The standards shall be established in a manner to ensure that a variety of alternative forms of continuing education are available to licensees, including, but not limited to, academic studies, in-service education, institutes, seminars, lectures, conferences, workshops, extension studies, and home study programs. The standards shall take cognizance of specialized areas of practice, and content shall be relevant to the practice of nursing and shall be related to the evidence-based scientific knowledge or technical skills required for the practice of nursing or be related to direct or indirect patient or client care. The continuing education standards established by the board shall not exceed 30 hours of direct participation in a course or courses approved by the board, or its equivalent in the units of measure adopted by the board.
(c)(f)The board shall audit continuing education providers at least once every five years to ensure adherence to regulatory requirements, and shall withhold or rescind approval from any provider that is in violation of the regulatory requirements.
(d)(g)The board shall encourage continuing education in spousal or partner abuse detection and treatment. In the event the board establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
(e)(h)In establishing standards for continuing education, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(f)(i)In establishing standards for continuing education, the board may include a course on pain management.
(g)(j)This section shall not apply to licensees during the first two years immediately following their initial licensure in California or any other governmental jurisdiction.
(h)(k)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for licensees residing in another state or country, or for reasons of health, military service, or other good cause.
(a)There is in the Department of Consumer Affairs the Board of Registered Nursing consisting of nine members.
(b)For purposes of this chapter, board, or the board, refers to the Board of Registered Nursing. Any reference in state law to the Board of Nurse Examiners of the State of California or the California Board of Nursing Education and Nurse Registration shall be construed to refer to the Board of Registered Nursing.
(c)The board shall have all authority vested in the previous board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board.
(d)This section shall remain in effect only until January 1, 2018, 2022, and as of that date, is repealed, unless a later enacted statute that is enacted before January 1, 2018, 2022, deletes or extends that date. Notwithstanding any other law, the repeal of this section renders the board subject to review by the appropriate policy committees of the Legislature.
SEC. 2.Section 2708 of the Business and Professions Code is amended to read:2708.(a)The board shall appoint an executive officer who shall perform the duties delegated by the board and who shall be responsible to it for the accomplishment of those duties.
(b)The executive officer shall be a nurse currently licensed under this chapter and shall possess other qualifications as determined by the board.
(c)The executive officer shall not be a member of the board.
(d)This section shall remain in effect only until January 1, 2018, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2018, 2022, deletes or extends that date.
|
Date
|
Status
|
|---|---|
| Oct 5, 2017 | Chaptered by Secretary of State. Chapter 520, Statutes of 2017. |
| Oct 5, 2017 | Approved by the Governor. |
| Sep 19, 2017 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 13, 2017 | Assembly amendments concurred in. (Ayes 39. Noes 0.) Ordered to engrossing and enrolling. |
| Sep 8, 2017 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 7, 2017 | Read third time. Passed. Ordered to the Senate. |
| Sep 5, 2017 | Read second time. Ordered to third reading. |
| Sep 1, 2017 | From committee: Do pass. (Ayes 16. Noes 0.) (September 1). |
| Sep 1, 2017 | Joint Rule 62(a) suspended. |
| Aug 30, 2017 | August 30 set for first hearing. Placed on APPR. suspense file. |
| Aug 29, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (August 29). Re-referred to Com. on APPR. |
| Aug 24, 2017 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B. & P. |
| Aug 24, 2017 | Joint Rule 61(a)(10) suspended. |
| Jul 11, 2017 | July 11 set for first hearing canceled at the request of author. |
| Jul 3, 2017 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B. & P. |
| Jun 15, 2017 | Referred to Com. on B. & P. |
| Jun 1, 2017 | In Assembly. Read first time. Held at Desk. |
| May 31, 2017 | Read third time. Passed. (Ayes 40. Noes 0. Page 1338.) Ordered to the Assembly. |
| May 26, 2017 | Read second time and amended. Ordered to third reading. |
| May 25, 2017 | From committee: Do pass as amended. (Ayes 7. Noes 0. Page 1190.) (May 25). |
| May 19, 2017 | Set for hearing May 25. |
| May 15, 2017 | May 15 hearing: Placed on APPR. suspense file. |
| May 4, 2017 | Set for hearing May 15. |
| May 1, 2017 | Read second time and amended. Re-referred to Com. on APPR. |
| Apr 27, 2017 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 8. Noes 0. Page 826.) (April 24). |
| Apr 20, 2017 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B., P. & E.D. |
| Apr 17, 2017 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B., P. & E.D. |
| Mar 31, 2017 | Set for hearing April 24. |
| Mar 9, 2017 | Referred to Com. on B., P. & E.D. |
| Feb 21, 2017 | From printer. May be acted upon on or after March 23. |
| Feb 17, 2017 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 13, 2017 | Unfinished Business SB799 Hill Concurrence | Senate Floor |
Passed |
|
| Sep 7, 2017 | SB 799 Hill Senate Third Reading By LOW | Assembly Floor |
Passed |
|
| Sep 1, 2017 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Aug 29, 2017 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
|
| May 31, 2017 | Senate 3rd Reading SB799 Hill | Senate Floor |
Passed |
|
| May 25, 2017 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| May 15, 2017 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 24, 2017 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Nurses Association/California | * Support | Apr 24, 2017 |
| Assembly Floor: 71-0, 9 | ** Against | Sep 8, 2017 |
| Board of Registered Nursing | * Support | Apr 24, 2017 |
| California Association For Health Services At Home | ** Against | Sep 8, 2017 |
| California Association of Colleges of Nursing | ** Support | Apr 20, 2017 |
| California Association of Nurse Anesthetists | ** Support | Apr 20, 2017 |
| California Hospital Association | ** Support | Sep 8, 2017 |
| California Labor Federation | ** Against | Sep 8, 2017 |
| California Nurse-Midwives Association | ** Support | Apr 20, 2017 |
| California Nurses Association | ** Against | Sep 8, 2017 |
| California Pharmacists Association | ** Against | Sep 8, 2017 |
| California School Nurses Organization | ** Support | Sep 8, 2017 |
| California Society Of Addiction Medicine | * Against | Aug 29, 2017 |
| California Society Of Addition Medicine | ** Against | Sep 8, 2017 |
| International Longshore And Warehouse Union, Local 29 | ** Against | Sep 8, 2017 |
| Northern California District Council - Ilwu | ** Against | Sep 8, 2017 |
| Prepared By: Sarah Huchel | ** Against | Sep 8, 2017 |
| SEIU 121 RN | * Against Unless Amend | Aug 29, 2017 |
| SEIU California | * Against Unless Amend | Aug 29, 2017 |
| SEIU California Nurses Alliance | * Against Unless Amend | Aug 29, 2017 |
| United Nurses Association Of California/Union Of Health Care Professionals | * Against | Aug 29, 2017 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
UNFINISHED BUSINESS
Bill No: SB 799
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 4/24/17
AYES: Hill, Fuller, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk
NO VOTE RECORDED: Dodd
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/25/17
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
SENATE FLOOR: 40-0, 5/31/17
AYES: Allen, Anderson, Atkins, Bates, Beall, Berryhill, Bradford, Cannella, De León, Dodd, Fuller, Gaines, Galgiani, Glazer, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leyva, McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell, Newman, Nguyen, Nielsen, Pan, Portantino, Roth, Skinner, Stern, Stone, Vidak, Wieckowski, Wiener, Wilk
ASSEMBLY FLOOR: 71-0, 9/7/17 - See last page for vote
DIGEST:
This bill extends the sunset date on the Board of Registered Nursing (BRN) and makes other statutory changes to improve the effectiveness and efficiency of this regulatory and licensing entity.
Assembly Amendments
remove the requirement that certain continuing education (CE) courses be evidence-based, require the BRN to include palliative care among those subjects considered in establishing CE standards, remove the employer reporting mandate and instead require the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, evaluating to what extent employers voluntarily report disciplined nurses to the BRN.
Existing law:
- Establishes the BRN under the Department of Consumer Affairs until January 1, 2018. (Business and Professions Code (BPC) § 2701)
- Requires every insurer providing professional liability insurance to a registered nurse (RN) to send a complete report to the BRN as to any settlement or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by that person’s negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties. (BPC § 801 (a))
- Authorizes an RN under current investigation by the BRN to request entry into the intervention program by contacting the BRN. Prior to authorizing an RN to enter into the intervention program, the BRN may require the RN to execute a statement of understanding that states that the RN understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action. (BPC § 2770.7 (b))
- Requires the BRN to close the investigation if the reasons for an investigation of an RN are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol, as specified, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, and the RN is accepted into, and successfully completes, the BRN’s intervention program. If the RN withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the BRN.
(BPC § 2770.7 (c))
This bill:
- Extends the sunset date of the BRN until January 1, 2022.
- Raises the threshold for reporting settlement or arbitration awards from an RN professional liability insurer from $3,000 to $10,000.
- Defines “insurer” as the insurer providing professional liability insurance to the licensee; the licensee, or his or her counsel, if the licensee does not possess professional liability insurance; or a state or local governmental agency, including, but not limited to, a joint powers authority that self-insures the licensee. As used in this paragraph, “state governmental agency” includes, but is not limited to, the University of California.
- Deletes provisions of law requiring the BRN to close investigations related to certain causes of action if an RN is accepted into the intervention program, and instead authorizes the BRN to investigate at its discretion complaints against RNs participating in the intervention program.
- Prohibits the BRN from taking disciplinary action with regard to acts committed before or during participation in the intervention program unless the RN withdraws or is terminated from the program.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving CE opportunities by January 1, 2019, and report on its progress by January 1, 2020.
- States that monies in the BRN Fund be available to the BRN upon appropriation of the Legislature for the purposes of the Nursing Practice Act.
- Requires the BRN to include palliative care among those subjects considered in establishing standards for CE.
- Requires the California Research Bureau to prepare a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the BRN and offers options for consistent and reasonable reporting mechanisms, as specified.
- Makes technical changes.
Background
BRN. The BRN regulates the practice of RNs in California. BRN implements and enforces the Nursing Practice Act, the laws and regulations related to nursing education, licensure, practice, and discipline.
BRN regulates over 500,000 licensees in California. In addition to licensing RNs, BRN issues permits for pending licensees and certificates to the following advanced practice registered nurses (APRN): nurse practitioners (NPs), nurse anesthetists, nurse midwives (NMs), and clinical nurse specialists. BRN also issues furnishing numbers to NPs and NMs with furnishing authority, maintains a list of psychiatric/mental health nurse specialists, issues certificates to public health nurses, and approves continuing education providers (CEPs).
BRN is responsible for setting educational standards for RN, NP, and NM programs, approving such programs, approving CEPs, evaluating and licensing RN and APRN applicants, administering discipline, managing a intervention program for licensees with substance use disorders or mental illness, and providing stakeholder information and outreach.
BRN investigations of RNs in the intervention program. As reported by the Auditor, state law requires the BRN to close the investigation of certain types of complaints against a RN if the RN is determined to be eligible for, and chooses to participate in, the BRN’s voluntary intervention. The investigation remains closed unless the RN exits the program early or he or she fails to successfully complete it.
If the nurse chooses not to participate in the intervention program or fails to successfully complete it, BRN refers the complaint to the appropriate unit for investigation and possible disciplinary action. However, an investigation may not occur or be completed until several years after BRN receives the complaint, due to the RN’s participation in the intervention program, restricting BRN’s ability to access evidence and potentially impose discipline when warranted.
To the extent BRN finds that evidence is no longer available, it will close the complaint without taking action against the nurse’s license. The BRN reports that 36% of complaints from intervention cases are closed without action due to insufficient evidence.
This bill authorizes BRN to investigate complaints against RNs participating in the intervention program.
CEPs. All licensees are required by statute to complete 30 hours of CE during each two-year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. CEPs are approved by BRN based on the evaluation of a single course, and then are on their honor to ensure the balance of their offerings meet established criteria. The BRN is the sole agency tasked with defining and interpreting the practice of nursing and is required to exercise their discretion to “withhold or rescind approval from any [CE] provider that is in violation of the regulatory requirements.”
Prior to 2002, the BRN conducted random audits of RNs CE and CEPs, averaging 2,700 RNs CE and 282 CEPs per year. The BRN has not completed any CEP audits since 2001, citing lack of staff and “the current structure of the CRNE [continuing registered nursing education] laws and regulations on its inability to do its job. This is particularly concerning because the BRN acknowledges that CE compliance is “essential to ensure public safety and protection.” It is unclear why BRN feels that current law does not facilitate the exercise of their enforcement obligations, because the plain reading of statute gives them authority to approve and disapprove CEPs based on multiple CE content criteria.
This bill requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities by January 1, 2019, and update the Legislature on its progress the following year.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Assembly Appropriations Committee:
- $41 million per year for an additional four years, until January 1, 2022, for continued operation of the BRN (Board of Registered Nursing Fund).
- Costs of $50,000 to $75,000 for a study on CE issues (Board of Registered Nursing Fund).
- Unknown, potentially significant cost pressure to conduct investigations of nurses who are enrolled in the intervention program. Although investigations are at the BRN's discretion, it would increase the universe of potential investigations (Board of Registered Nursing Fund).
California Hospital Association
California School Nurses Organization
California Association for Health Services at Home
California Labor Federation
California Nurses Association
California Pharmacists Association
California Society of Addition Medicine
California State Council of the Service Employees International Union
International Longshore and Warehouse Union, Local 29
Northern California District Council – ILWU
ARGUMENTS IN SUPPORT: The California Hospital Association (CHA) writes, “CHA and its member hospitals are encouraged with the new leadership at the BRN and the numerous changes that have occurred in a relatively short time period. We are supportive of the new SB 799 amendments that removed mandatory reporting and now provide for a study of reporting mechanisms to the board so that the BRN can identify methods of receiving and processing timely information on nurses who may have violated the nurse practice act. CHA is supportive of this process to improve historical operational issues through a researched approach. CHA underscores, however, the need for the California Research Bureau to assure inclusion of how long the Board is taking to investigate and take action.”
ARGUMENTS IN OPPOSITION: California Association for Health Services at Home (CAHSAH) writes, “CAHSAH believes that the BRN should develop and implement an action plan to prioritize and resolve its deficiencies in disciplining nurses and should not rely on a state-funded study to resolve their internal deficiencies related to the disciplining of nurses. The bill already proposes a method in which professional liability insurers will have increased reporting requirements for cases of negligence when a nurse is involved. Any efforts by BRN to focus on employer reporting obligations will be opposed by CAHSAH.”
ASSEMBLY FLOOR: 71-0, 9/7/17 AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Brough, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Choi, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Eggman, Flora, Fong, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Voepel, Waldron, Weber, Wood, Rendon NO VOTE RECORDED: Bonta, Chiu, Chu, Frazier, Holden, Nazarian, Thurmond, Ting
9/8/17 15:28:09
SENATE THIRD READING
STR Bill Id:SB 799
Author:(Hill)
As Amended Ver:August 24, 2017
Majority vote
SENATE VOTE: 40-0
Committee | Votes | Ayes | Noes |
Business & Professions | 9-0 | Low, Baker, Bloom, Cunningham, Gipson, Grayson, Irwin, Mullin, Steinorth | |
Appropriations | 16-0 | Gonzalez Fletcher, Bigelow, Bloom, Bocanegra, Bonta, Brough, Calderon, Chau, Eggman, Fong, Friedman, Gallagher, Eduardo Garcia, Jones-Sawyer, Obernolte, Reyes |
|
SUMMARY: Extends the operation of the Board of Registered Nursing (BRN) until January 1, 2022; increases the threshold for insurers that provide liability insurance to Registered Nurses (RNs) to report specified settlement or arbitration awards to the BRN; defines "insurer" to include a licensee or the licensee's counsel; requires the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates RN complaint reporting mechanisms; requires the BRN to report to the Legislature its plan for the approval of continuing education opportunities and its progress implementing the plan; and makes other technical and clarifying changes. Specifically, this bill:
- Raises the threshold under Business and Professions Code (BPC) Section 801 for reporting settlement or arbitration awards for an insurer providing professional liability insurance to an RN from $3,000 to $10,000.
- Defines "insurer," for purposes of the reporting requirement for all insurers providing professional liability insurance to licensees listed under BPC Section 801, as follows:
- The insurer providing professional liability insurance to the licensee.
- The licensee, or the licensee's counsel, if the licensee does not possess professional liability insurance.
- A state or local governmental agency, including, but not limited to, a joint powers authority that self-insures the licensee, as defined.
- Extends operation of the BRN from January 1, 2018 until January 1, 2022.
- Deletes the completed California State Auditor investigation provisions.
- Declares that it is the intent of the Legislature to provide for a study of reporting mechanisms to the BRN so that it can identify methods of receiving timely information on nurses who may have violated the Nursing Practice Act.
- Requires the California Research Bureau (CRB) to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and offers options for consistent and reasonable reporting mechanisms.
- Requires the CRB report to include, at a minimum:
- A review of existing mandatory reporting requirements that alert the BRN to nurses who may have violated this chapter.
- A review of existing laws permitting, prohibiting, encouraging, or discouraging voluntary reporting to the BRN.
- An analysis of the number of employer reports to the BRN, the number of those reports investigated by the BRN, and the final action taken by the BRN for each report.
- Employer reporting requirements of other boards within the DCA.
- Nursing reporting requirements of other states.
- Deletes provisions of law requiring the BRN to close investigations related to certain causes of action if an RN is accepted into the intervention program and instead authorizes the BRN to investigate, at its discretion, complaints against RNs participating in the intervention program.
- Prohibits the BRN from taking disciplinary action with regard to acts committed before or during participation in the intervention program unless the RN withdraws or is terminated from the program.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education (CE) opportunities by January 1, 2019, and report on its progress by January 1, 2020.
- Deletes the BRN Fund's continuous appropriation and instead makes the funds available upon appropriation by the Legislature.
- Makes technical changes and clarifying changes.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- $41 million per year for an additional 4 years, until January 1, 2022, for continued operation of the BRN (Board of Registered Nursing Fund).
- Costs of $50,000 to $75,000 for a study on CE issues (Board of Registered Nursing Fund).
- Unknown, potentially significant cost pressure to conduct investigations of nurses who are enrolled in the intervention program. Although investigations are at the board's discretion, it would increase the universe of potential investigations (Board of Registered Nursing Fund).
COMMENTS:
Purpose. This bill is sponsored by the author. According to the author, "The Author's office is proud to present a solution to concerns raised through the Sunset Process. Current law does too little to encourage reporting by those who are both closest to these dangerously unqualified licensees, as well as the most qualified to recognize an improper deviation from California nursing protocol. [This bill] is a calculated and measured response drafted as a result of considerable research, constituent and stakeholder interaction, and deliberation."
Background. The BRN regulates the practice of nursing in California and implements and enforces the Nursing Practice Act, which contains the laws related to nursing education, licensure, practice, and discipline. The BRN regulates over 420,000 RNs.
Sunset Review. In February and March of this year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development (Committees) conducted joint oversight hearings to review various regulatory entities. During the sunset review hearings, the Committees heard testimony from the entities and stakeholders and evaluated entities scheduled to be repealed the following year. The reviewed entities will sunset unless the Legislature enacts a law to extend them.
This bill is one of the several sunset bills intended to implement legislative changes recommended in the respective background reports drafted by the Committees for the entities reviewed. Because this is the BRN's supplemental sunset review report after a two-year extension (extensions are typically four years), this bill also addresses the outstanding issues from the BRN's 2015 sunset review.
California State Auditor Report. In response to issues raised during the BRN's 2015 sunset review, the BRN's 2015 sunset bill (SB 466 (Hill), Chapter 489, Statutes of 2015) required the California State Auditor to conduct an audit of the BRN's enforcement program. The State Auditor noted issues with the BRN's complaint processing timelines, data collection and use, complaint referrals, and investigator training. It made a total of 25 recommendations, three of which were directed at the Legislature:
- "To ensure that BRN receives timely and consistent notification of nurses' alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
- "If BRN does not develop and implement an action plan by March 1, 2017, to prioritize and resolve its deficiencies, as mentioned in the first recommendation to BRN, the Legislature should consider transferring BRN's enforcement responsibilities to Consumer Affairs.
- "The Legislature should amend state law to require BRN to conduct investigations of complaints alleging substance abuse or mental illness against nurses who choose to enter the intervention program."
Mandatory Judgment and Settlement Reporting. This bill changes the amount in a settlement or arbitration award that would require insurers of RNs to report to the BRN from $3,000 to $10,000. The BRN is currently collecting data to determine whether $3,000 is an appropriate amount. The $3,000 figure was set in 1975, and BRN gets many low-dollar reports that do not represent sufficiently egregious violations to warrant investigation.
Currently, the BRN indicates that 199 cases were reported from January 1, 2014 through October 24, 2016. Of those, 39 were between $3,000 and $29,999, and 150 were between $30,000 and $6,000,000, with the average being $345,908.
CE Providers. This bill requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities by January 1, 2019, and update the Legislature on its progress the following year.
All licensees are required by statute to complete 30 hours of CE during each two-year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. According to the author, the BRN continues to be lax in its approval standards for CE providers.
BRN Position. The BRN supports the sunset extension portion of this bill but has a support if amended position. The BRN "voted to support the version of the bill introduced on February 17, 2017, which extends the [BRN's] sunset date until 2022, and to watch the subsequent amendments from the version of the bill amended May 26, 2017."
In addition, while it is in favor of the amendments, it writes, "we are extremely concerned about several issues expressed in the current revision of the Bill which include the following: 1) Although not explicitly stated, the potential cost associated with the [CRB] conducting the research; 2) The accuracy of the data collecting, sharing, and reporting by the CRB and the need for the BRN to be involved in the process, and 3) The short time period allotted to collect sufficient data and provide a comprehensive report to the committee by 2019.
"Respectfully, we request that these matters be considered…. and that the [BRN] be exempted from paying any cost associated with conducting the research mentioned in the amendments. However, the [BRN] should be involved in the data mining and reviewing the accuracy of the information prior to reporting to the Committee. Finally, we are suggesting that the final report be delivered by January 2020 instead of January 2019 which will allow additional time for the BRN to become better staffed in order to assign personnel to work collectively with the CRB staff with data collating and reporting."
ARGUMENTS IN SUPPORT:
The California Hospital Association (CHA) writes in support, "California hospitals seek to employ the most qualified staff to ensure the highest quality of patient care. To this end, we will continue to support the BRN's efforts to ensure that nurses who jeopardize quality care are held accountable as would be required by this bill. CHA supports this important step to provide research and ample time for the BRN to make successful changes. We will continue to underscore the need to highlight that the BRN act judiciously with the information provided, as the employer's report is an administrative obligation on the employer without demonstrable benefits if there is not timely, efficient and effective processing of the reports."
The California Association for Nurse Practitioners writes in support, "With reforms to the healthcare system on the horizon, proper oversight is necessary to protect California patients and ensure healthcare providers are practicing to the highest standard of care. The [BRN] provides this necessary oversight of registered nurses, including [nurse practitioners (NPs)]…. As the number of NPs practicing the California increases, the [BRN's] continued oversight of the profession is critical to develop programs and regulations that protect the scope of practice, govern continuing competency, and ensure NPs can continue to serve patients and meet the demand for healthcare."
ARGUMENTS IN OPPOSITION:
The California Nurses Association (CNA) supports the sunset extension but requests amendments limiting the CRB reporting provisions and opposes the intervention provisions of this bill. CNA believes that the reporting provision is too broad and "presupposes a result by its underlying assumption that employers are supposed to be reporting 'disciplined' nurses." Specifically, CNA requests that 1) the intent language be removed, 2) the report due date be delayed to January 1, 2020, 3) the scope of the report be narrowed to the listed subdivisions, 4) the analysis of the employer report be based solely on data from the BRN's BreEZe system, and 5) the requirements of other boards within the DCA and other states be deleted.
On the intervention portion of the bill, CNA writes that it "removes the incentive to participate in the intervention program and does not promote recovery. The promise of no discipline is a way to get struggling nurses into treatment before they become a danger to patients." With the limiting amendments and the deletion of the intervention provisions, CNA would support this measure.
The California State Council of the Service Employees International Union (SEIU) State Council), supports the sunset extension, is neutral on the CRB report so long as due process is factored into the report, opposes the intervention provision of this bill, and requests amendments to the continuing education portion of the bill.
On the intervention provisions, SEIU State Council notes that the "new requirement would impose a large amount of costs to the Board and would require the BRN to hire additional staff. It is unclear why this measure has proposed to overhaul the intervention program and imposes large costs for an issue that affects a scant amount of the licensee population and where there is no identified problem. We believe an unintended consequence of the proposed revisions would be to disincentivize voluntary treatment, which helps to keep patients safe."
On the continuing education portions of the bill, "SEIU proposes to amend the sunset bill to require a report to the legislative policy committees by January 1, 2019 detailing the proposed changes in staffing and fees that will be required to comply with the existing CEU provider audit requirements contained in Business and Professions Code (BPC) Section 2811.5.
"Any proposed policy change related to course content or provider criteria should be developed as part of a broader stakeholder process…. While the measure sought to address a real problem (i.e. the BRN has failed to adequately audit CEU providers and courses), as currently proposed, the BRN would unilaterally implement the new CEU approval process without any outside input."
California Labor Federation, International Longshore and Warehouse Union, Local 29, and Northern California District Council – ILWU, support the sunset extension, were concerned about the mandatory reporting requirements, but are opposed unless amended to delete the provisions related to the intervention program. They write that, without the requirement that the BRN close any investigation on RNs entering the program, there will be a chilling effect on the number of RNs who may enter and complete the program.
The California Pharmacists Association opposes the intervention provisions of this bill. "For licensees already struggling with addiction issues, the discontinuation of a board investigation is a strong incentive to enter treatment and to stick with the program until completion.
"The Board of Pharmacy has a similar intervention program in place, and CPhA believes that the current system is working well for licensees. It is important to note, similar to the BRN, the Board of Pharmacy only refers licensees into the intervention program when the complaint does not apply to allegations that involve actual or direct harm to the public. Moreover, the DCA's Diversion Program average relapse rate is almost four times better than the expected relapse rate of the general public. Given this information, it is unclear why the proposed changes to the intervention program have been put forth in BRN sunset measure."
POLICY ISSUES:
Mandatory Employer Reporting. This bill explores the State Auditor recommendation of establishing employer reporting requirements for RNs like those for the employers of LVNs. This recommendation is one part of the broader goal of improving the BRN's enforcement program. The State Auditor noted that the "BRN should improve its collaboration with other state agencies and health boards to ensure effective enforcement." Specifically, the State Auditor noted that the "BRN's relationship and sharing of information with other entities involved in the enforcement of complaints against nurses could be improved." To that end, the State Auditor made three specific recommendations, two to the BRN and one to the Legislature:
- To ensure that it has prompt access to adequate information that could affect the status of a nurse's license, BRN should do the following by June 2017:
- Establish formal agreements with other agencies and other health boards that have information pertaining to a nurse's misconduct.
- Work with Consumer Affairs and other health boards to determine whether modifying BreEZe to include a capability that would allow it to promptly notify BRN when another health board receives a complaint or takes disciplinary action against a licensed nurse is cost‑effective. If it is, add this functionality to BreEZe.
- To ensure that BRN receives timely and consistent notification of nurses' alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
The BRN is currently implementing its two recommendations on this issue. This bill explores the legislative recommendation. The State Auditor's reason for the recommendation was that state law does not require employers of RNs to report complaints or discipline to BRN. However, it requires employers of an LVN who resigns, is suspended, or terminated for cause. The State Auditor also noted that "the [BRN's] assistant executive officer stated that she does not know why BRN was excluded from this law, but she believes BRN would benefit greatly if employers were required to report to it nurses who violate the Nursing Act."
According to the BRN's 2016 Supplemental Sunset Report, it wrote that it "has been reviewing the language that has been included for [LVNs] in B&P Code section 2878.1" (page 14). The BRN also wrote that it has been "meeting with other healing arts boards to review their malpractice settlement and mandatory reporting practices." The BRN stated that it will continue to review and move forward in the near future with these issues for possible legislative change proposals but, according to its Legislative Committee, it does not currently support it.
In any event, as with all consumer protections, the benefits should be weighed against any potential burdens on the licensees. However, the BRN aggregates enforcement data in a way that makes it difficult to perform this comparison (this is consistent across the DCA licensing entities). For example, page 44 of the BRN's 2016 Supplemental Sunset Report provides a breakdown of complaint data:
Complaints | FY 14/15 | FY 15/16 |
Total | 6,783 | 7,757 |
Intake/Consumer | ||
Received | 3,464 | 3,383 |
Closed | 182 | 0 |
Referred to Investigation | 1,766 | 3,393 |
Source of Complaint | ||
Public | 1,037 | 1,015 |
Licensee/Professional Groups | 513 | 622 |
Governmental Agencies | 4,943 | 5,711 |
Other | 263 | 251 |
Conviction/Arrest Notice | ||
Conviction Received | 3,319 | 4,374 |
Conviction Closed | 104 | 100 |
Referred to Investigation | 2,455 | 4,224 |
The table shows a total of 7,757 complaints in Fiscal Year (FY) 15/16, of which 3,383 are complaints received which are not based on a conviction or arrest notice (intake/consumer). The complaints from outside sources are split between Public (1,015), Industry (622), Governmental Agencies (1,337 after subtracting arrest/conviction notices), and Other (251). Other is typically an "internal complaint," or a complaint based on data already available to staff. Given this, the apparent comparison groups are Public, Industry (employers and peers), and Governmental Agencies (health boards, law enforcement, other oversight agencies, and potentially state employers).
Between the comparison groups, those that could include employers appear to have reported about twice the number of complaints from the public. For example, health facilities licensed under the Department of Public Health may submit RN employee violations to the Department or to the Office of Statewide Health Planning and Development, and those agencies may then forward that on the BRN. Therefore, this bill requires the CRB to review existing requirements and reports to determine whether there are additional reporting mechanisms that can provide the BRN consistent and timely complaint information.
BRN Investigations of RNs in the Intervention Program. This bill authorizes the BRN to investigate complaints against RNs participating in the intervention program. It also prohibits the BRN from taking disciplinary action against RNs who successfully complete the program (unless found to have committed unprofessional conduct as stated in existing law).
The State Auditor noted that state law requires the BRN to close the investigation of certain types of complaints against an RN if that RN chooses to participate in the BRN's voluntary intervention program and the BRN determines that the RN qualifies. The investigation remains closed unless the RN exits the program early or fails to successfully complete it.
In the event the RN exits the program or fails to complete it, the BRN refers the complaint to the appropriate unit for investigation. However, depending on when the RN leaves the program, the investigation may not start or be completed until several years after the BRN initially received the complaint, restricting BRN's ability to access evidence. According to the BRN's Internet Web site, the "average length of time is three to five years for RNs to successfully complete the program" (http://www.rn.ca.gov/intervention/int-faqs.shtml, accessed July 5, 2017).
In theory, if an RN is terminated from the program closer to five years, investigators may have to deal with the degradation of primary eye witness testimony, corroborating evidence, and authenticated documents. In one case provided by the BRN's Legislative Committee, an RN was terminated from the intervention program for missing a random lab test after four years. The information reviewed by the State Auditor showed "that those who did not successfully complete the program left it an average of eight months after they began." Arguably, there may be cases where patients, employers, and coworkers are difficult to find after eight months.
According to the State Auditor, if state law required BRN to conduct investigations of all complaints against nurses while they participate in the intervention program, it would increase the likelihood that investigators have access to the necessary evidence. As a result, the BRN would not have to spend more time in the field or seek stale evidence if an RN fails to complete the program. The BRN would already have collected the necessary evidence to pursue disciplinary action. While the RN will lose the incentive to participate in the program to halt an investigation, those RNs that do and see the program to completion will continue to be shielded from disciplinary action. This could still be a strong incentive for some RNs in the program. Further, if the BRN has the discretion to investigate, it can choose not to investigate cases where evidence would be available later on or where RN's willingness to participate would be affected (the BRN is the one that accepts the RN into the program in the first place).
According to the BRN's 2016 Supplemental Sunset Report, in the past two FYs, the intervention program has had an annual average of 415 participants, 127 of which were new participants and 39 of which were relapses (page 45). It also had an average of 171 participants leaving, which included 95 successful completions and 76 terminations (including 26 for public threat). While the number of intervention participants is small compared to the BRN's overall licensing population, the issue is whether completing the investigation ahead of time will benefit the BRN's enforcement timelines and process overall.
In FY 15/16, there were a total of 7,607 complaints referred for investigation. The question is whether the 76 terminations from the program involved additional nursing violations (presumably at least 27 for public threat) and whether the inability to investigate the cases at the start of the program affected the BRN's ability to impose discipline if warranted or close the investigation in a timely manner. Further, this bill will likely not impact the RNs who voluntarily enter the program and have no public complaint to investigate.
Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301 FN: 0001680
Date of Hearing: August 30, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
SBPCA Bill Id:SB 799
Author:(Hill) – As Amended Ver:August 24, 2017
Policy Committee: | Business and Professions | Vote: | 9 - 0 |
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill extends the sunset of the Board of Registered Nursing and enacts several changes to the board's operations and activities. Specifically, this bill:
- Extends the operation of the Board of Registered Nursing (BRN) until January 1, 2022.
- Increases the threshold for insurers that provide liability insurance to Registered Nurses (RNs) to report specified settlement or arbitration awards to the BRN and defines “insurer” to include a licensee or the licensee’s counsel.
- Requires the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates RN complaint reporting mechanisms, and states legislative intent to provide for a study of reporting mechanisms to the board so that it can identify methods of receiving timely information on nurses who may have violated licensure requirements.
- Relative to an investigation of a nurse for a substance abuse-related issue that does not cause patient harm, deletes the requirement for the board to close an investigation without further action if a registered nurse is accepted into the board’s intervention program and successfully completes the program. Instead, makes investigation of these cases at the board's discretion.
- Requires the BRN to report to the Legislature its plan for the approval of continuing education opportunities and its progress implementing the plan; and makes other technical and clarifying changes.
- Specifies Board of Registered Nursing Fund is available upon appropriation by the Legislature for specified purposes.
FISCAL EFFECT:
- $41 million per year for an additional 4 years, until January 1, 2022, for continued operation of the BRN (Board of Registered Nursing Fund).
- Costs of $50,000 to $75,000 for a study on CE issues (Board of Registered Nursing Fund).
- Unknown, potentially significant cost pressure to conduct investigations of nurses who are enrolled in the intervention program. Although investigations are at the board's discretion, it would increase the universe of potential investigations (Board of Registered Nursing Fund).
COMMENTS:
- Purpose. This bill extends the sunset for the BRN, and makes changes that the author believes will protect patients. The author notes current law does too little to encourage reporting by those who are both closest to these dangerously unqualified licensees, as well as the most qualified to recognize an improper deviation from California nursing protocol.
- Background. The BRN regulates the practice of nursing in California and implements and enforces the Nursing Practice Act, which contains the laws related to nursing education, licensure, practice, and discipline. The BRN regulates over 420,000 RNs.
- Employer Reporting. This bill addresses a Bureau of State Audits recommendation of establishing employer reporting requirements for RNs like those in place for employers of licensed vocational nurses. This recommendation is one part of the broader goal of improving the BRN’s enforcement program. Prior versions of this bill required employers to report to BRN when disciplining nurses; this bill has recently been amended to instead require a California Research Bureau study of reporting and complaint issues.
- Intervention Program. The board operates an intervention program, which allows nurses to avoid discipline against their professional license if they meet certain criteria and participate successfully in the program. Nurses cannot be investigated or disciplined for certain substance-abuse related charges if they successfully complete the program. This bill would allow the board to investigate participating nurses at the board's discretion, but would maintain that nurses are protected from discipline unless they withdraw or are terminated from the program.
- Support. California Hospital Association supports this bill, stating they continue to support the BRN’s efforts to ensure that nurses who jeopardize quality care are held accountable as would be required by this bill. The California School Nurses Organization supports the sunset extension.
- Opposition. Numerous labor unions representing nurses oppose provisions of this bill that allow investigations of nurses while they are participating in an intervention program. The California Pharmacists Association writes in opposition that the state Board of Pharmacy runs a similar intervention program, and the halting of investigations is a strong enticement to participate in an intervention program. The California Society of Addiction Medicine is opposed to this measure and believe the provisions would impede persons from voluntarily seeking treatment. Labor unions also object to the substance of the study related to employer reporting, and suggest changes to reporting language.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: August 29, 2017
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Evan Low, Chair
SBPCA Bill Id:
Author:() – As Ver:
SENATE VOTE:
SUBJECT:
SUMMARY: Extends the operation of the Board of Registered Nursing (BRN) until January 1, 2022; increases the threshold for insurers that provide liability insurance to Registered Nurses (RNs) to report specified settlement or arbitration awards to the BRN; defines “insurer” to include a licensee or the licensee’s counsel; requires the California Research Bureau to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates RN complaint reporting mechanisms; requires the BRN to report to the Legislature its plan for the approval of continuing education opportunities and its progress implementing the plan; and makes other technical and clarifying changes.
EXISTING LAW:
- Regulates and licenses the practice of nursing under the Nursing Practice Act. (Business and Professions Code (BPC) §§ 2700-2718)
- Establishes the BRN within the Department of Consumer Affairs (DCA) until January 1, 2018, to administer and enforce the Nursing Practice Act. (BPC § 2701)
- Requires every insurer providing professional liability insurance to specified licensees, including RNs, to send a complete report to the relevant licensing agency as to any settlement or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by that person’s negligence, error, or omission in practice, or by the licensee’s rendering of unauthorized professional services, as specified. (BPC § 801(a))
- Requires the BRN to establish criteria for the acceptance, denial, or termination of RNs in its intervention program, and specifies that only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program. (BPC § 2770.7(a))
- Provides the following relating to investigation and discipline of RNs who voluntarily enter the intervention program:
- Authorizes an RN under current investigation by the BRN to request entry into the intervention program by contacting the BRN. Prior to authorizing an RN to enter into the intervention program, the BRN may require the RN to execute a statement of understanding that states that the RN understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action. (BPC § 2770.7(b))
- Requires the BRN to close the investigation if the reasons for the investigation are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol, as specified, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, and the RN is accepted into, and successfully completes, the BRN’s intervention program. If the RN withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the BRN. (BPC § 2770.7(c))
- Provides that neither acceptance nor participation in the intervention program precludes the BRN from investigating or taking disciplinary action against an RN for any unprofessional conduct committed before, during, or after participation in the intervention program. (BPC § 2770.7(d))
- Provides that an RN who is terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action for acts committed before, during, and after participation in the intervention program. (BPC § 2770.7(f))
- Requires an RN renewing a license to submit proof satisfactory that, during the preceding two-year period, the RN has been informed of the developments in the nursing field or in the RN’s special area of practice that have occurred since the last renewal, either by pursuing a course or continuing education (CE) in the RN field or relevant to the RN’s practice, and approved by the BRN, or by other means deemed equivalent by the BRN. (BPC § 2811.5(a))
- Requires the employer of a licensed vocational nurse (LVN) or respiratory care practitioner (RCP) to report to the licensee’s board the suspension or termination for cause, or resignation for cause for LVNs, as specified. (BPC §§ 2878.1, 3758)
- Defines, for purposes of the employer reporting requirements, “suspension, termination, or resignation for cause” or “rejection from assignment” as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
- Use of controlled substances or alcohol to the extent that it impairs the licensee’s ability to safely practice vocational nursing.
- Unlawful sale of a controlled substance or other prescription items.
- Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
- Falsification of medical records.
- Gross negligence or incompetence.
- Theft from patients or clients, other employees, or the employer. (BPC §§ 2878.1(d), 3758(b))
- Makes failure of an employer to make a report under the reporting requirements punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation. (BPC §§ 2878.1(e), 3758(c))
- Provides that, pursuant to Civil Code § 43.8, no employer shall incur a civil penalty for making the reports. (BPC §§ 2878.1, 3759)
THIS BILL:
- Raises the threshold under BPC § 801 for reporting settlement or arbitration awards for an insurer providing professional liability insurance to an RN from $3,000 to $10,000.
- Defines “insurer,” for purposes of the reporting requirement for all insurers providing professional liability insurance to licensees listed under BPC § 801, as follows:
- The insurer providing professional liability insurance to the licensee.
- The licensee, or the licensee’s counsel, if the licensee does not possess professional liability insurance.
- A state or local governmental agency, including, but not limited to, a joint powers authority that self-insures the licensee, as defined.
- Extends operation of the BRN from January 1, 2018 until January 1, 2022.
- Deletes the completed California State Auditor investigation provisions.
- Declares that it is the intent of the Legislature to provide for a study of reporting mechanisms to the BRN so that it can identify methods of receiving timely information on nurses who may have violated the Nursing Practice Act.
- Requires the California Research Bureau (CRB) to prepare and deliver a report to the Legislature by January 1, 2019, that evaluates to what extent employers voluntarily report disciplined nurses to the board and offers options for consistent and reasonable reporting mechanisms.
- Requires the CRB report to include, at a minimum:
- A review of existing mandatory reporting requirements that alert the BRN to nurses who may have violated this chapter.
- A review of existing laws permitting, prohibiting, encouraging, or discouraging voluntary reporting to the BRN.
- An analysis of the number of employer reports to the BRN, the number of those reports investigated by the BRN, and the final action taken by the BRN for each report.
- Employer reporting requirements of other boards within the DCA.
- Nursing reporting requirements of other states.
- Deletes provisions of law requiring the BRN to close investigations related to certain causes of action if an RN is accepted into the intervention program and instead authorizes the BRN to investigate, at its discretion, complaints against RNs participating in the intervention program.
- Prohibits the BRN from taking disciplinary action with regard to acts committed before or during participation in the intervention program unless the RN withdraws or is terminated from the program.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving CE opportunities by January 1, 2019, and report on its progress by January 1, 2020.
- Deletes the BRN Fund’s continuous appropriation and instead makes the funds available upon appropriation by the Legislature.
- Makes technical changes and clarifying changes.
FISCAL EFFECT: According to the Senate Appropriations Committee, this bill will result in ongoing costs of $41 million per year for the continuing operation of the BRN.
COMMENTS:
Purpose. This bill is sponsored by the author. According to the author, “The Author's office is proud to present a solution to concerns raised through the Sunset Process. Current law does too little to encourage reporting by those who are both closest to these dangerously unqualified licensees, as well as the most qualified to recognize an improper deviation from California nursing protocol. [This bill] is a calculated and measured response drafted as a result of considerable research, constituent and stakeholder interaction, and deliberation.”
Background. The BRN regulates the practice of nursing in California and implements and enforces the Nursing Practice Act, which contains the laws related to nursing education, licensure, practice, and discipline. The BRN regulates over 420,000 RNs.
Sunset Review. In February and March of this year, the Assembly Committee on Business and Professions and the Senate Committee on Business, Professions and Economic Development (Committees) conducted joint oversight hearings to review various regulatory entities. During the sunset review hearings, the Committees heard testimony from the entities and stakeholders and evaluated entities scheduled to be repealed the following year. The reviewed entities will sunset unless the Legislature enacts a law to extend them.
This bill is one of the several sunset bills intended to implement legislative changes recommended in the respective background reports drafted by the Committees for the entities reviewed. Because this is the BRN’s supplemental sunset review report after a two-year extension (extensions are typically four years), this bill also addresses the outstanding issues from the BRN’s 2015 sunset review.
California State Auditor Report. In response to issues raised during the BRN’s 2015 sunset review, the BRN’s 2015 sunset bill (SB 466 (Hill), Chapter 489, Statutes of 2015) required the California State Auditor to conduct an audit of the BRN’s enforcement program. The State Auditor noted issues with the BRN’s complaint processing timelines, data collection and use, complaint referrals, and investigator training. It made a total of 25 recommendations, 3 of which were directed at the Legislature:
- “To ensure that BRN receives timely and consistent notification of nurses’ alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
- If BRN does not develop and implement an action plan by March 1, 2017, to prioritize and resolve its deficiencies, as mentioned in the first recommendation to BRN, the Legislature should consider transferring BRN’s enforcement responsibilities to Consumer Affairs.
- The Legislature should amend state law to require BRN to conduct investigations of complaints alleging substance abuse or mental illness against nurses who choose to enter the intervention program.”
Mandatory Judgment and Settlement Reporting. This bill changes the amount in a settlement or arbitration award that would require insurers of RNs to report to the BRN from $3,000 to $10,000. The BRN is currently collecting data to determine whether $3,000 is an appropriate amount. The $3,000 figure was set in 1975, and BRN gets many low-dollar reports that do not represent sufficiently egregious violations to warrant investigation.
Currently, the BRN indicates that 199 cases were reported from January 1, 2014 through October 24, 2016. Of those, 39 were between $3,000 and $29,999, and 150 were between $30,000 and $6,000,000, with the average being $345,908.
CE Providers. This bill requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities by January 1, 2019, and update the Legislature on its progress the following year.
All licensees are required by statute to complete 30 hours of CE during each two-year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. According to the author, the BRN continues to be lax in its approval standards for CE providers.
Response from the BRN. The Board of Registered Nursing supports the sunset extension portion of this bill. The BRN “voted to support the version of the bill introduced on February 17, 2017, which extends the [BRN’s] sunset date until 2022, and to watch the subsequent amendments from the version of the bill amended May 26, 2017.”
Further, the BRN notes that while it “is in favor of the amendments we are extremely concerned about several issues expressed in the current revision of the Bill which include the following: 1) Although not explicitly stated, the potential cost associated with the California Research Board (CRB) conducting the research; 2) The accuracy of the data collecting, sharing, and reporting by the CRB and the need for the BRN to be involved in the process, and 3) The short time period allotted to collect sufficient data and provide a comprehensive report to the committee by 2019.
Respectfully, we request that these matters be considered by the [Assembly] B & P Committee members and that the Board be exempted from paying any cost associated with conducting the research mentioned in the amendments. However, the Board should be involved in the data mining and reviewing the accuracy of the information prior to reporting to the Committee. Finally, we are suggesting that the final report be delivered by January 2020 instead of January 2019 which will allow additional time for the BRN to become better staffed in order to assign personnel to work collectively with the CRB staff with data collating and reporting.”
ARGUMENTS IN SUPPORT:
The California Hospital Association (CHA) writes in support, “California hospitals seek to employ the most qualified staff to ensure the highest quality of patient care. To this end, we will continue to support the BRN’s efforts to ensure that nurses who jeopardize quality care are held accountable as would be required by this bill. CHA supports this important step to provide research and ample time for the BRN to make successful changes. We will continue to underscore the need to highlight that the BRN act judiciously with the information provided, as the employer’s report is an administrative obligation on the employer without demonstrable benefits if there is not timely, efficient and effective processing of the reports.”
The California School Nurses Organization (CSNO) supports the sunset extension portion of this bill, stating “we are in strong support of the continuance of this board until 2022. The need for a nursing board to oversee and regulate the profession of nursing is paramount for the practitioners as well as to assure the health and safety of the consumers they serve.”
ARGUMENTS IN OPPOSITION:
The California Nurses Association (CNA) supports the sunset extension but requests amendments limiting the CRB reporting provisions and opposes the intervention provisions of this bill. CNA believes that the reporting provision is too broad and “presupposes a result by its underlying assumption that employers are supposed to be reporting ‘disciplined’ nurses.” Specifically, CNA requests that 1) the intent language be removed, 2) the report due date be delayed to January 1, 2020, 3) the scope of the report be narrowed to the listed subdivisions, 4) the analysis of the employer report be based solely on data from the BRN’s BreEZe system, and 5) the requirements of other boards within the DCA and other states be deleted.
On the intervention portion of the bill, CNA writes that it “removes the incentive to participate in the intervention program and does not promote recovery. The promise of no discipline is a way to get struggling nurses into treatment before they become a danger to patients.” With the limiting amendments and the deletion of the intervention provisions, CNA would support this measure.
The California State Council of the Service Employees International Union (SEIU) State Council), supports the sunset extension, is neutral on the CRB report so long as due process is factored into the report, opposes the intervention provision of this bill, and requests amendments to the continuing education portion of the bill.
On the intervention provisions, SEIU State Council notes that the “new requirement would impose a large amount of costs to the Board and would require the BRN to hire additional staff. It is unclear why this measure has proposed to overhaul the intervention program and imposes large costs for an issue that affects a scant amount of the licensee population and where there is no identified problem. We believe an unintended consequence of the proposed revisions would be to disincentivize voluntary treatment, which helps to keep patients safe.”
On the continuing education portions of the bill, “SEIU proposes to amend the sunset bill to require a report to the legislative policy committees by January 1, 2019 detailing the proposed changes in staffing and fees that will be required to comply with the existing CEU provider audit requirements contained in Business and Professions Code (BPC) Section 2811.5.
Any proposed policy change related to course content or provider criteria should be developed as part of a broader stakeholder process…. While the measure sought to address a real problem (i.e. the BRN has failed to adequately audit CEU providers and courses), as currently proposed, the BRN would unilaterally implement the new CEU approval process without any outside input.”
California Labor Federation, International Longshore and Warehouse Union, Local 29, and Northern California District Council – ILWU, support the sunset extension, were concerned about the mandatory reporting requirements, but are opposed unless amended to delete the provisions related to the intervention program. They write that, without the requirement that the BRN close any investigation on RNs entering the program, there will be a chilling effect on the number of RNs who may enter and complete the program.
The California Pharmacists Association opposes the intervention provisions of this bill. “For licensees already struggling with addiction issues, the discontinuation of a board investigation is a strong incentive to enter treatment and to stick with the program until completion.
The Board of Pharmacy has a similar intervention program in place, and CPhA believes that the current system is working well for licensees. It is important to note, similar to the BRN, the Board of Pharmacy only refers licensees into the intervention program when the complaint does not apply to allegations that involve actual or direct harm to the public. Moreover, the DCA’s Diversion Program average relapse rate is almost four times better than the expected relapse rate of the general public. Given this information, it is unclear why the proposed changes to the intervention program have been put forth in BRN sunset measure.”
The California Society of Addition Medicine (CSAM) is opposed to this measure and writes, “[We oppose] provisions that would impede persons voluntarily going into treatment by allowing the board to activate an investigation of someone who has voluntarily entered treatment. This is the wrong way to attempt to keep the public safe.”
POLICY ISSUES:
Mandatory Employer Reporting. This bill explores the State Auditor recommendation of establishing employer reporting requirements for RNs like those for the employers of LVNs. This recommendation is one part of the broader goal of improving the BRN’s enforcement program. The State Auditor noted that the “BRN should improve its collaboration with other state agencies and health boards to ensure effective enforcement.” Specifically, the State Auditor noted that the “BRN’s relationship and sharing of information with other entities involved in the enforcement of complaints against nurses could be improved.” To that end, the State Auditor made three specific recommendations, two to the BRN and one to the Legislature:
- To ensure that it has prompt access to adequate information that could affect the status of a nurse’s license, BRN should do the following by June 2017:
- Establish formal agreements with other agencies and other health boards that have information pertaining to a nurse’s misconduct.
- Work with Consumer Affairs and other health boards to determine whether modifying BreEZe to include a capability that would allow it to promptly notify BRN when another health board receives a complaint or takes disciplinary action against a licensed nurse is cost‑effective. If it is, add this functionality to BreEZe.
- To ensure that BRN receives timely and consistent notification of nurses’ alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
The BRN is currently implementing its two recommendations on this issue. This bill explores the legislative recommendation. The State Auditor’s reason for the recommendation was that state law does not require employers of RNs to report complaints or discipline to BRN. However, it requires employers of an LVN who resigns, is suspended, or terminated for cause. It also noted that “the [BRN’s] assistant executive officer stated that she does not know why BRN was excluded from this law, but she believes BRN would benefit greatly if employers were required to report to it nurses who violate the Nursing Act.”
According to the BRN’s 2016 Supplemental Sunset Report, it wrote that it “has been reviewing the language that has been included for [LVNs] in B&P Code section 2878.1” (page 14). The BRN also wrote that it has been “meeting with other healing arts boards to review their malpractice settlement and mandatory reporting practices.” The BRN stated that it will continue to review and move forward in the near future with these issues for possible legislative change proposals but, according to its Legislative Committee, it does not currently support it.
Still, as with all consumer protections, the benefits should be weighed against any potential burdens on the licensees. The author asserts that the BRN’s complaint data for the last two years shows that, when compared to public complaints, the BRN receives “only a fraction of those complaints from employers. Ideally, the complaint totals should be similar.”
However, it is not clear that the number of complaints from members of the public should match the number of complaints from employers or peers. A complaint is an unsubstantiated allegation. In general, a medical professional will have a better sense of the severity of a mistake (which is distinguished from harm) and who may be at fault than a patient or family member. As a result, the rate at which the average member of the public makes a complaint to the BRN will differ from the rate at which a hospital makes a complaint against its own employee or an RN makes a complaint against a colleague.
Ideally, the number of complaints from the public that result in formal discipline after an investigation would match or be lower than that of other comparison groups (given a lack of other confounding variables, such as variations in available evidence). However, the BRN aggregates enforcement data in a way that makes it difficult to perform this comparison (this is consistent across the DCA).
For example, page 44 of the BRN’s 2016 Supplemental Sunset Report provides a breakdown of complaint data:
Complaints | FY 14/15 | FY 15/16 |
Total | 6,783 | 7,757 |
Intake/Consumer | ||
Received | 3,464 | 3,383 |
Closed | 182 | 0 |
Referred to Investigation | 1,766 | 3,393 |
Source of Complaint | ||
Public | 1,037 | 1,015 |
Licensee/Professional Groups | 513 | 622 |
Governmental Agencies | 4,943 | 5,711 |
Other | 263 | 251 |
Conviction/Arrest Notice | ||
Conviction Received | 3,319 | 4,374 |
Conviction Closed | 104 | 100 |
Referred to Investigation | 2,455 | 4,224 |
The table shows a total of 7,757 complaints in FY 15/16, of which 3,383 are complaints received which are not based on a conviction or arrest notice (intake/consumer). The complaints from outside sources are split between Public (1,015), Industry (622), Governmental Agencies (1,337 after subtracting arrest/conviction notices), and Other (251). Other is typically an “internal complaint,” or a complaint based on data already available to staff. Given this, the apparent comparison groups are Public, Industry (employers and peers), and Governmental Agencies (health boards, law enforcement, other oversight agencies, and potentially state employers). Between the comparison groups, those that could include employers appear to have reported about twice the number of complaints from the public. For example, health facilities licensed under the Department of Public Health may submit RN employee violations to the Department or to the Office of Statewide Health Planning and Development, and those agencies may then forward that on the BRN.
Still, it is not clear from the data how many of the complaints are from the employers of the RN named in the complaint, whether there were cases in which an investigation would have benefited from an employer report, or whether there were cases in which no complaint was made at all where an employer should have reported. In addition, it is not clear which of the investigated complaints were serious enough to warrant formal discipline (as noted above, complaints from the public may not always merit discipline). While nearly all of the 7,757 total complaints were referred to investigation, the BRN only filed 1,113 accusations (101 of which were withdrawn, dismissed, or declined), but it is unclear what types of complaints resulted in the accusations. Therefore, this bill requires the CRB to review existing requirements and reports to determine whether there are additional reporting mechanisms that can provide the BRN consistent and timely complaint information.
BRN Investigations of RNs in the Intervention Program. This bill authorizes the BRN to investigate complaints against RNs participating in the intervention program. It also prohibits the BRN from taking disciplinary action against RNs who successfully complete the program (unless found to have committed unprofessional conduct as stated in existing law).
The State Auditor noted that state law requires the BRN to close the investigation of certain types of complaints against an RN if that RN chooses to participate in the BRN’s voluntary intervention program and the BRN determines that the RN qualifies. The investigation remains closed unless the RN exits the program early or fails to successfully complete it.
In the event the RN exits the program or fails to complete it, the BRN refers the complaint to the appropriate unit for investigation. However, depending on when the RN leaves the program, the investigation may not start or be completed until several years after the BRN initially received the complaint, restricting BRN’s ability to access evidence. According to the BRN’s website, the “average length of time is 3 to 5 years for RNs to successfully complete the program” (http://www.rn.ca.gov/intervention/int-faqs.shtml, accessed July 5, 2017). In theory, if an RN is terminated from the program closer to 5 years, investigators may have to deal with the degradation of primary eye witness testimony, corroborating evidence, and authenticated documents. In one case provided by the BRN’s Legislative Committee, an RN was terminated from the intervention program for missing a random lab test after 4 years.
According to the State Auditor, if state law required BRN to conduct investigations of all complaints against nurses while they participate in the intervention program, it would increase the likelihood that investigators have access to the necessary evidence. As a result, the BRN would not have to spend more time in the field or seek stale evidence if an RN fails to complete the program. The BRN would already have collected the necessary evidence to pursue disciplinary action. While the RN will lose the incentive to participate in the program to halt an investigation, those RNs that do and see the program to completion will continue to be shielded from disciplinary action. This could still be a strong incentive for some RNs in the program. Further, if the BRN has the discretion to investigate, it can choose not to investigate cases where evidence would be available later on or where RN’s willingness to participate would be affected (the BRN is the one that accepts the RN into the program in the first place).
In terms of data, the BRN’s 2016 Supplemental Sunset Report showed the following (page 45):
INTERVENTION | FY 14/15 | FY 15/16 |
New Participants | 148 | 106 |
Successful Completions | 97 | 93 |
Participants (close of FY) | 430 | 400 |
Terminations | 57 | 42 |
Terminations for Public Threat | 25 | 27 |
Drug Tests Ordered | 15,230 | 16,229 |
Positive Drug Tests | 494 | 717 |
Relapses | 36 | 42 |
In the past two FYs, the intervention program has had an annual average of 415 participants, 127 of which were new participants and 39 of which were relapses. It also had an average of 171 participants leaving, which included 95 successful completions and 76 terminations (including 26 for public threat). While the number of intervention participants is small compared to the BRN’s overall licensing population, the issue is whether completing the investigation ahead of time will benefit the BRN’s enforcement timelines and process overall.
In FY 15/16, there were a total of 7,607 complaints referred for investigation. The question is whether the 76 terminations from the program involved additional nursing violations (presumably at least 27 for public threat) and whether the inability to investigate the cases at the start of the program affected the BRN’s ability to impose discipline if warranted or close the investigation in a timely manner.
REGISTERED SUPPORT:
California Hospital Association
California School Nurses Organization
REGISTERED OPPOSITION:
California Nurses Association
California Pharmacists Association
California Labor Federation
California Society of Addition Medicine
California State Council of the Service Employees International Union
International Longshore and Warehouse Union, Local 29
Northern California District Council - ILWU
Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Evan Low, Chair
SBPCA Bill Id:
Author:() – As Ver:
SENATE VOTE:
SUBJECT:
SUMMARY: Extends the operation of the Board of Registered Nursing (BRN) until January 1, 2022; increases the threshold for insurers that provide liability insurance to Registered Nurses (RNs) to report specified settlement or arbitration awards to the BRN; defines “insurer” to include a licensee or the licensee’s counsel; requires employers of RNs to report specified terminations or resignations to the BRN; requires the BRN to report to the Legislature its plan for the approval of continuing education opportunities and its progress implementing the plan; and makes other technical and clarifying changes.
EXISTING LAW:
- Establishes the regulatory and licensing program for the practice of nursing under the Nursing Practice Act. (Business and Professions Code (BPC) §§ 2700-2718)
- Establishes the BRN within the Department of Consumer Affairs (DCA) until January 1, 2018. (BPC § 2701)
- Requires every insurer providing professional liability insurance to specified licensees, including RNs, to send a complete report to the relevant licensing agency as to any settlement or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by that person’s negligence, error, or omission in practice, or by the licensee’s rendering of unauthorized professional services, as specified. (BPC § 801(a))
- Requires the BRN to establish criteria for the acceptance, denial, or termination of RNs in its intervention program, and specifies that only those registered nurses who have voluntarily requested to participate in the intervention program shall participate in the program. (BPC § 2770.7(a))
- Provides the following relating to investigation and discipline of RNs who voluntarily enter the intervention program:
- Authorizes an RN under current investigation by the BRN to request entry into the intervention program by contacting the BRN. Prior to authorizing an RN to enter into the intervention program, the BRN may require the RN to execute a statement of understanding that states that the RN understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action. (BPC § 2770.7(b))
- Requires the BRN to close the investigation if the reasons for the investigation are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol, as specified, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, and the RN is accepted into, and successfully completes, the BRN’s intervention program. If the RN withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the BRN. (BPC § 2770.7(c))
- Provides that neither acceptance nor participation in the intervention program precludes the BRN from investigating or taking disciplinary action against an RN for any unprofessional conduct committed before, during, or after participation in the intervention program. (BPC § 2770.7(d))
- Provides that an RN who is terminated from the intervention program for failure to comply with program requirements is subject to disciplinary action for acts committed before, during, and after participation in the intervention program. (BPC § 2770.7(f))
- Requires an RN renewing a license to submit proof satisfactory that, during the preceding two-year period, the RN has been informed of the developments in the nursing field or in the RN’s special area of practice that have occurred since the last renewal, either by pursuing a course or continuing education (CE) in the RN field or relevant to the RN’s practice, and approved by the BRN, or by other means deemed equivalent by the BRN. (BPC § 2811.5(a))
- Requires the employer of a licensed vocational nurse (LVN) or respiratory care practitioner (RCP) to report to the licensee’s board the suspension or termination for cause, or resignation for cause for LVNs, as specified. (BPC §§ 2878.1, 3758)
- Defines, for purposes of the employer reporting requirements, “suspension, termination, or resignation for cause” or “rejection from assignment” as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
- Use of controlled substances or alcohol to the extent that it impairs the licensee’s ability to safely practice vocational nursing.
- Unlawful sale of a controlled substance or other prescription items.
- Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
- Falsification of medical records.
- Gross negligence or incompetence.
- Theft from patients or clients, other employees, or the employer. (BPC §§ 2878.1(d), 3758(b))
- Makes failure of an employer to make a report under the reporting requirements punishable by an administrative fine not to exceed ten thousand dollars ($10,000) per violation. (BPC §§ 2878.1(e), 3758(c))
- Provides that, pursuant to Civil Code § 43.8, no employer shall incur a civil penalty for making the reports (BPC §§ 2878.1, 3759)
THIS BILL:
- Raises the threshold under BPC § 801 for reporting settlement or arbitration awards for an insurer providing professional liability insurance to an RN from $3,000 to $10,000.
- Defines “insurer,” for purposes of the reporting requirement for all insurers providing professional liability insurance to licensees listed under BPC § 801, as follows:
- The insurer providing professional liability insurance to the licensee.
- The licensee, or the licensee’s counsel, if the licensee does not possess professional liability insurance.
- A state or local governmental agency, including, but not limited to, a joint powers authority that self-insures the licensee, as defined.
- Extends operation of the BRN from January 1, 2018 until January 1, 2022.
- Deletes the completed California State Auditor investigation provisions.
- Requires an employer to report to the BRN the termination for cause or resignation for cause of any RN in its employ within 30 days of the termination or resignation, as specified.
- Defines “termination or resignation for cause” and “rejection from assignment” as termination or resignation from employment, or rejection from assignment, for any of the following reasons:
- Use of controlled substances or alcohol to the extent that it impairs the licensee’s ability to safely practice registered nursing.
- Unlawful sale or possession of a controlled substance or other prescription items.
- Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
- Makes willful failure of an employer to make a report punishable by an administrative fine not to exceed $5,000 per violation and not a misdemeanor.
- Defines “willful” as a voluntary and intentional violation of a known legal duty.
- Provides that, pursuant to Civil Code § 43.8, an employer shall not incur a civil penalty for making the report to the BRN.
- Deletes provisions of law requiring the BRN to close investigations related to certain causes of action if an RN is accepted into the intervention program and instead authorizes the BRN to investigate at its discretion complaints against RNs participating in the intervention program.
- Prohibits the BRN from taking disciplinary action with regard to acts committed before or during participation in the intervention program unless the RN withdraws or is terminated from the program.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving CE opportunities by January 1, 2019, and report on its progress by January 1, 2020.
- Deletes the BRN Fund’s continuous appropriation and instead makes the funds available upon appropriation by the Legislature.
- Makes technical changes and clarifying changes.
FISCAL EFFECT: According to the Senate Appropriations Committee:
- Ongoing costs of $41 million per year for the continuing operation of the BRN (BRN Fund).
- Likely ongoing costs in the low hundreds of thousands per year for additional investigations and enforcement actions, due to the provisions in the bill that require additional reporting to the BRN of actions by registered nurses that may require disciplinary action (BRN Fund).
COMMENTS:
Purpose. This bill is sponsored by the author. According to the author, “The Author's office is proud to present a solution to concerns raised through the Sunset Process. Current law does too little to encourage reporting by those who are both closest to these dangerously unqualified licensees, as well as the most qualified to recognize an improper deviation from California nursing protocol. [This bill] is a calculated and measured response drafted as a result of considerable research, constituent and stakeholder interaction, and deliberation.”
Background. The BRN regulates the practice of nursing in California and implements and enforces the Nursing Practice Act, which contains the laws related to nursing education, licensure, practice, and discipline. The BRN regulates over 420,000 RNs.
Sunset Review. In February and March of this year, the Assembly Business and Professions Committee and the Senate Business, Professions and Economic Development Committee (Committees) conducted joint oversight hearings to review various regulatory entities. During the sunset review hearings, the Committees take testimony from the entities and stakeholders and evaluate entities scheduled to be repealed the following year. The reviewed entities will sunset unless the Legislature enacts a law to extend them.
This bill is one of the several sunset bills intended to implement legislative changes recommended in the respective background reports drafted by the Committees for the entities reviewed. Because this is the BRN’s supplemental sunset review report after a two-year extension (extensions are typically four years), this bill also addresses the outstanding issues from the BRN’s 2015 sunset review.
California State Auditor Report. In response to issues raised during the BRN’s 2015 sunset review, the BRN’s 2015 sunset bill (SB 466 (Hill), Chapter 489, Statutes of 2015) required the California State Auditor to conduct an audit of the BRN’s enforcement program. The State Auditor noted issues with the BRN’s complaint processing timelines, data collection and use, complaint referrals, and investigator training. It made a total of 25 recommendations, 3 of which were directed at the Legislature:
- To ensure that BRN receives timely and consistent notification of nurses’ alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
- If BRN does not develop and implement an action plan by March 1, 2017, to prioritize and resolve its deficiencies, as mentioned in the first recommendation to BRN, the Legislature should consider transferring BRN’s enforcement responsibilities to Consumer Affairs.
- The Legislature should amend state law to require BRN to conduct investigations of complaints alleging substance abuse or mental illness against nurses who choose to enter the intervention program.
Mandatory Judgment and Settlement Reporting. This bill changes the amount in a settlement or arbitration award that would require insurers of RNs to report to the BRN from $3,000 to $10,000. The BRN is currently collecting data to determine whether $3,000 is an appropriate amount. The $3,000 figure was set in 1975, and BRN gets many low-dollar reports that do not represent sufficiently egregious violations to warrant investigation.
Currently, the BRN indicates that 199 cases were reported from January 1, 2014 through October 24, 2016. Of those, 39 were between $3,000 and $29,999, and 150 were between $30,000 and $6,000,000, with the average being $345,908.
CE Providers. This bill requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities by January 1, 2019, and update the Legislature on its progress the following year.
All licensees are required by statute to complete 30 hours of CE during each two-year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. According to the author, the BRN continues to be lax in its approval standards for CE providers, approving courses with dubious scientific merit and not directly relating to patient care.
ARGUMENTS IN SUPPORT:
The Board of Registered Nursing supports the sunset extension portion of this bill. The BRN “voted to support the version of the bill introduced on February 17, 2017, which extends the [BRN’s] sunset date until 2022, and to watch the subsequent amendments from the version of the bill amended May 26, 2017.
“In regards to the bill version as amended on May 26, 2017, the board members posed questions regarding the language changes to the bill and would like to discuss further.”
The California School Nurses Organization (CSNO) supports the sunset extension portion of this bill, stating “we are in strong support of the continuance of this board until 2022. The need for a nursing board to oversee and regulate the profession of nursing is paramount for the practitioners as well as to assure the health and safety of the consumers they serve.”
ARGUMENTS IN OPPOSITION:
On behalf of the Board of Registered Nursing, the BRN’s Legislative Committee “respectfully disagrees with the bill’s sections on the Intervention Program and Mandatory Employer Reporting additions.”
The California Association for Health Services at Home (CAHSAH) opposes the mandatory employer reporting provisions of this bill:
The basis for determining alcohol or substance impairment of a nurse is left open to interpretation as the bill does not specify any objective basis for making those type of determinations. Employers will be more likely to report for impairment for fear of being fined $5000. Further exacerbating the issue of determining impairment is the 30-day requirement to report to the [BRN] as posing such a requirement does not allow for remedies and collective bargaining to take place in such a short reporting period. The requirement to report increases the likelihood of bad faith, vindictive or retaliatory reporting and leaves nurses with little protection from employers who may have other reasons for terminating a nurse. This bill will greatly increase the costs to the [BRN] for handling the increase in investigations of which many may have been submitted for fear of the employer being penalized and are not substantiated.
The California Nurses Association (CNA) supports the sunset extension but opposes the mandatory employer reporting and intervention provisions of this bill. On mandatory reporting, CNA believes that this bill “increases the likelihood of bad faith, vindictive, and retaliatory reporting.” It notes that RNs “are required by law to advocate in the sole interest of their patients, which many times puts them in conflict with their employers.” CNA believes this “will allow employers to go after nurses who are trying to protect their patients—thus harming patient care. The bill will adversely impact nurses who are disciplined or terminated by their employers for fulfilling their statutory duties as patient advocates.”
On the intervention provisions, CNA believes it “removes the incentive to participate in the intervention program and does not promote recovery. The promise of no discipline is a way to get struggling nurses into treatment before they become a danger to patients.”
The California State Council of the Service Employees International Union (SEIU State Council) supports the sunset extension but opposes the mandatory employer reporting and intervention provisions of this bill. SEIU State Council believes this bill “would create an incentive to over-report, and potentially jeopardize employment and staffing levels in settings where nurses are critical to the delivery of care. It is unclear why this proposed language is needed, or what problem it is seeking to address. In fact, there are already reporting policies and procedures for nurses and employers to report to the BRN in order to protect the public's health and safety.”
On the intervention provisions, SEIU State Council notes that, because the BRN is currently updating its Uniform Standards Regarding Substance-Abusing Healing Arts Licensees, “it is premature for this measure to change the BRN's diversion program processes when the BRN itself is devising a new set of uniform standards for nurses enrolled in the Intervention program.”
Service Employees International Union Local 1000 Union (SEIU Local 1000) supports the sunset extension but opposes the mandatory employer reporting provisions of this bill:
Specifically, we believe the mandatory reporting requirement will be misused and improperly applied to staff working in state operated facilities, and could potentially detriment nursing staff in all sectors where this provision is applicable.
Mandated reporting would jeopardize our member's licenses because it creates a catch-22 when coupled with mandatory overtime provisions and inadequate staffing. Because of mandatory overtime requirements — only applicable to state workers — our members could be put in a situation where the state would be expected to report them regardless of the choice they made. Often our members are asked to cover shifts and assignments due to inadequate staffing, even when they are already legally mandated to address other assignments. Unfortunately, after a thorough review, the department may still feel compelled to report the issue to the [BRN], even if the alleged misconduct was inevitable. In that instance, the employer is not wrong for reporting, but the misconduct was not the fault of the nurse. Thus, requiring a thorough review before reporting does nothing to solve this dilemma.
United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) supports the sunset extension but opposes the mandatory employer reporting and intervention provisions of this bill. On mandatory reporting, UNAC/UHCP is concerned “that this provision could be abused by unscrupulous employers. Specifically, they could use the threat of mandatory reporting to encourage a nurse to ‘go away quietly’ i.e. with a voluntary resignation (not for cause) rather than face an allegation of a termination for cause that would could jeopardize future employment or cause a blemish on their license.” UNAC/UHCP “understands the desire to ensure that [RNs] behave professionally and that poor performing nurses are not simply ‘recycled’ from facility to facility” but is “not convinced that there is any data yet that demonstrates the benefits of a mandatory reporting system would outweigh the potential harm to nurses who are being treated unfairly by employers” or “that the reporting mandate would have a positive impact on patient safety.”
On the intervention program, “UNAC also has concerns about the possibility that nurses participating in the intervention program may still be subject to investigation while they are trying to complete their recovery. It would be a waste of scarce BRN resources to conduct investigations on nurses who, if they successfully complete the program, are not subject to any discipline.”
POLICY ISSUES:
Mandatory Employer Reporting. This bill implements the State Auditor recommendation to impose employer reporting requirements like those for employers of LVNs. In response to concerns, it has been amended to limit the employer penalties for failure to report and deletes several of the actions that would constitute termination for cause.
This recommendation is one part of the broader goal of improving the BRN’s enforcement program. The State Auditor noted that the “BRN should improve its collaboration with other state agencies and health boards to ensure effective enforcement.” Specifically, the State Auditor noted that the “BRN’s relationship and sharing of information with other entities involved in the enforcement of complaints against nurses could be improved.” To that end, the State Auditor made three specific recommendations, two to the BRN and one to the Legislature:
- To ensure that it has prompt access to adequate information that could affect the status of a nurse’s license, BRN should do the following by June 2017:
- Establish formal agreements with other agencies and other health boards that have information pertaining to a nurse’s misconduct.
- Work with Consumer Affairs and other health boards to determine whether modifying BreEZe to include a capability that would allow it to promptly notify BRN when another health board receives a complaint or takes disciplinary action against a licensed nurse is cost‑effective. If it is, add this functionality to BreEZe.
- To ensure that BRN receives timely and consistent notification of nurses’ alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
The BRN is currently implementing its two recommendations on this issue. This bill implements the legislative recommendation. The State Auditor’s reason for the recommendation was that state law does not require employers of RNs to report complaints or discipline to BRN. However, it does require employers of an LVN who resigns, is suspended, or terminated for cause. It also noted that “the [BRN’s] assistant executive officer stated that she does not know why BRN was excluded from this law, but she believes BRN would benefit greatly if employers were required to report to it nurses who violate the Nursing Act.”
According to the BRN’s 2016 Supplemental Sunset Report, it wrote that it “has been reviewing the language that has been included for [LVNs] in B&P Code section 2878.1” (page 14). The BRN also wrote that it has been “meeting with other healing arts boards to review their malpractice settlement and mandatory reporting practices.” The BRN stated that it will continue to review and move forward in the near future with these issues for possible legislative change proposals but, according to its Legislative Committee, does not currently support it.
Still, as with all consumer protections, the benefits should be weighed against any potential burdens on the licensees. The author asserts that the BRN’s complaint data for the last two years shows that, when compared to public complaints, the BRN receives “only a fraction of those complaints from employers. Ideally, the complaint totals should be similar.”
However, it is not clear that the number of complaints from members of the public should match the number of complaints from employers or peers. A complaint is an unsubstantiated allegation. In general, a medical professional will have a better sense of the severity of a mistake (which is distinguished from harm) and who may be at fault than a patient or family member. As a result, the rate at which the average member of the public makes a complaint to the BRN will differ from the rate at which a hospital makes a complaint against its own employee or an RN makes a complaint against a colleague.
Ideally, the number of complaints from the public that result in formal discipline after an investigation would match or be lower than that of other comparison groups (given a lack of other confounding variables, such as variations in available evidence). However, the BRN aggregates enforcement data in a way that makes it difficult to perform this comparison (this is consistent across the DCA).
For example, page 44 of the BRN’s 2016 Supplemental Sunset Report provides a breakdown of complaint data:
Complaints | FY 14/15 | FY 15/16 |
Total | 6,783 | 7,757 |
Intake/Consumer | ||
Received | 3,464 | 3,383 |
Closed | 182 | 0 |
Referred to Investigation | 1,766 | 3,393 |
Source of Complaint | ||
Public | 1,037 | 1,015 |
Licensee/Professional Groups | 513 | 622 |
Governmental Agencies | 4,943 | 5,711 |
Other | 263 | 251 |
Conviction/Arrest Notice | ||
Conviction Received | 3,319 | 4,374 |
Conviction Closed | 104 | 100 |
Referred to Investigation | 2,455 | 4,224 |
The table shows a total of 7,757 complaints in FY 15/16, of which 3,383 are complaints received which are not based on a conviction or arrest notice (intake/consumer). The complaints from outside sources are split between Public (1,015), Industry (622), Governmental Agencies (1,337 after subtracting arrest/conviction notices), and Other (251). Other is typically an “internal complaint,” or a complaint based on data already available to staff. Given this, the apparent comparison groups are Public, Industry (employers and peers), and Governmental Agencies (health boards, law enforcement, other oversight agencies, and potentially state employers). Between the comparison groups, those that could include employers appear to have reported about twice the number of complaints from the public.
However, it is not clear what the actual number of complaints from employers is. Further, it is not clear how many of the investigated complaints that rose to the level of formal discipline would have benefited from additional reporting from other groups. While nearly all of the 7,757 total complaints were referred to investigation, the BRN only filed 1,113 accusations (101 of which were withdrawn, dismissed, or declined). Therefore, it may be beneficial to have the BRN work with the DCA’s Office of Information Services to run QBIRT reports and disaggregate the enforcement data to determine 1) whether employer reporting is currently needed and 2) whether there are other entities in addition to those the BRN is already working with that, through reporting or collaboration, can assist the BRN in its enforcement process (pursuant the State Auditor’s findings).
BRN Investigations of RNs in the Intervention Program. This bill authorizes the BRN to investigate complaints against RNs participating in the intervention program. It also prohibits the BRN from taking disciplinary action against RNs who successfully complete the program (unless found to have committed unprofessional conduct as stated in existing law).
The State Auditor noted that state law requires the BRN to close the investigation of certain types of complaints against an RN if the chooses to participate in the BRN’s voluntary intervention program and the BRN determines the RN qualifies. The investigation remains closed unless the RN exits the program early or fails to successfully complete it.
If the nurse chooses not to participate in the intervention program or fails to successfully complete it, BRN refers the complaint to the appropriate unit for investigation and possible disciplinary action. However, an investigation may not occur or be completed until several years after BRN receives the complaint, due to the RN’s participation in the intervention program, restricting BRN’s ability to access evidence and potentially impose discipline when warranted. According to the BRN’s website, the “average length of time is 3 to 5 years for RNs to successfully complete the program” (http://www.rn.ca.gov/intervention/int-faqs.shtml, accessed July 5, 2017). In theory, if an RN is terminated from the program closer to 5 years, investigators may have to deal with the degradation of primary eye witness testimony, corroborating evidence, and authenticated documents. In one case provided by the BRN’s Legislative Committee, an RN was terminated from the intervention program for missing a random lab test.
According to the State Auditor, if state law required BRN to conduct investigations of all complaints against nurses while they participate in the intervention program, it would increase the likelihood that investigators have access to the necessary evidence. As a result, the BRN will not have to spend more time in the field or seek stale evidence if an RN fails to complete the program; the BRN would already have collected the necessary evidence to pursue disciplinary action. While the RN will lose the incentive to participate in the program to halt an investigation, those RNs that enter the program and complete it will be shielded from disciplinary action. This could still be a strong incentive for some RNs in the program, particularly if the investigation is complete.
In terms of data, the BRN’s 2016 Supplemental Sunset Report showed the following (page 45):
INTERVENTION | FY 14/15 | FY 15/16 |
New Participants | 148 | 106 |
Successful Completions | 97 | 93 |
Participants (close of FY) | 430 | 400 |
Terminations | 57 | 42 |
Terminations for Public Threat | 25 | 27 |
Drug Tests Ordered | 15,230 | 16,229 |
Positive Drug Tests | 494 | 717 |
Relapses | 36 | 42 |
In the past two FYs, the intervention program has had an annual average of 415 participants, 127 of which were new participants and 39 of which were relapses. It also had an average of 171 participants leaving, which included 95 successful completions and 76 terminations (including 26 for public threat).
IMPLEMENTATION ISSUE:
As with all reporting requirements involving non-licensees, the mandatory reporting requirement under this bill may be difficult for the BRN to enforce. In general, the BRN’s enforcement authority includes administrative actions that are tied to a license. The ability to issue a citation or assess a fine are dependent on the BRN’s ability to withhold renewal or revoke a license. For unlicensed practice and criminal violations rising above administrative action, the BRN may seek an injunction or other equitable remedies in a court of law (BPC § 125.5) or refer the case for criminal prosecution (BPC § 160). While most licensing violations are misdemeanors, they are dependent on a prosecutor’s willingness to pursue the case. In addition, it is not clear how the BRN will know an employer failed to report if the employer failed to report.
AMENDMENTS:
- To provide time to collect data, the author should amend the bill to strike the mandatory reporting requirement (Sec. 5, adding BPC § 2761.5).
- To justify the necessity of the mandatory reporting requirement as well as discover additional areas where collaboration or reporting can be helpful (pursuant to the State Auditor’s findings), the author should instead require the BRN to work with the DCA to collect relevant data and report back to the Legislature:
(a) The board shall work with the department's Office of Information Services to review the board's available complaint and case data using existing tools, including BreEZe and QBIRT, to determine whether there are entities or other information sources that can be utilized, whether through mandatory reporting or formal agreements, to ensure the board receives consistent complaint data.
(b) The board shall report its findings to the Legislature no later than January 1, 2019.
(c) The data in the board’s report shall be aggregated and categorized to remove identifiable information specific to a patient, employer, state agency, or complainant.
REGISTERED SUPPORT:
Board of Registered Nursing (as introduced)
California School Nurses Organization
REGISTERED OPPOSITION:
California Association for Health Services at Home
California Nurses Association
California State Council of the Service Employees International Union
Service Employees International Union Local 1000
United Nurses Associations of California/Union of Health Care Professionals
Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 799
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 4/24/17
AYES: Hill, Fuller, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk
NO VOTE RECORDED: Dodd
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/25/17
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
DIGEST:
This bill extends the sunset date on the Board of Registered Nursing (BRN) and makes other statutory changes to improve the effectiveness and efficiency of this regulatory and licensing entity.
Existing law:
- Establishes the BRN under the Department of Consumer Affairs until January 1, 2018. (Business and Professions Code (BPC) § 2701)
- Requires every insurer providing professional liability insurance to a registered nurse (RN) to send a complete report to the BRN as to any settlement or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by that person’s negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties. (BPC § 801 (a))
- Authorizes an RN under current investigation by the BRN to request entry into the intervention program by contacting the BRN. Prior to authorizing an RN to enter into the intervention program, the BRN may require the RN to execute a statement of understanding that states that the RN understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action. (BPC § 2770.7 (b))
- Requires the BRN to close the investigation if the reasons for an investigation of an RN are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol, as specified, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, and the RN is accepted into, and successfully completes, the BRN’s intervention program. If the RN withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the BRN.
(BPC § 2770.7 (c)) - Requires each RN renewing his or her license to submit proof satisfactory to the BRN that, during the preceding two-year period, he or she has been informed of the developments in the RN field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education (CE) in the RN field or relevant to the practice of the licensee, and approved by the BRN, or by other means deemed equivalent by the BRN. (BPC § 2811.5 (a))
This bill:
- Extends the sunset date of the BRN until January 1, 2022.
- Raises the threshold for reporting settlement or arbitration awards from an RN professional liability insurer from $3,000 to $10,000.
- Defines “insurer” as the insurer providing professional liability insurance to the licensee; the licensee, or his or her counsel, if the licensee does not possess professional liability insurance; or a state or local governmental agency, including, but not limited to, a joint powers authority that self-insures the licensee. As used in this paragraph, “state governmental agency” includes, but is not limited to, the University of California.
- Requires an RN employer to report to the BRN the termination for cause or resignation for cause of any RN in its employ within 30 days of the termination or resignation. In the case of an RN employed by the state, the report shall not be made until after the conclusion of the review process specified in Section 52.3 of Title 2 of the California Code of Regulations and Skelly v. State Personnel Bd. (1975) 15 Cal.3d 194.
- Defines “employer” to include employment agencies and nursing registries.
- Prohibits the report from constituting a waiver of medical records’ confidentiality, and the fact that an employer reported an RN to the BRN shall be kept confidential and shall not be subject to discovery in civil cases.
- Requires an employment agency or nursing registry to report to the BRN the rejection from assignment of an RN by a health facility or home health care provider due to acts that would be cause for termination, as specified.
- Defines “termination or resignation for cause” and “rejection from assignment” as termination or resignation from employment, or rejection from assignment, for any of the following reasons:
- Use of controlled substances or alcohol to the extent that it impairs the licensee’s ability to safely practice registered nursing.
- Unlawful sale or possession of a controlled substance or other prescription items.
- Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
- States that willful failure of an employer to make a report is punishable by an administrative fine not to exceed $5,000 per violation and shall not be punished as a misdemeanor. “Willful” means a voluntary and intentional violation of a known legal duty.
- States that, pursuant to existing law, a person shall not incur a civil penalty as a result of making this report to the BRN.
- Deletes provisions of law requiring the BRN to close investigations related to certain causes of action if an RN is accepted into the intervention program, and instead authorizes the BRN to investigate at its discretion complaints against RNs participating in the intervention program.
- Prohibits the BRN from taking disciplinary action with regard to acts committed before or during participation in the intervention program unless the RN withdraws or is terminated from the program.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving CE opportunities by January 1, 2019, and report on its progress by January 1, 2020.
- Requires that certain CEs be related to evidence-based scientific knowledge.
- States that monies in the BRN Fund be available to the BRN upon appropriation of the legislature for the purposes of the Nursing Practice Act.
- Makes technical changes.
Background
BRN. The BRN regulates the practice of RNs in California. BRN implements and enforces the Nursing Practice Act, the laws and regulations related to nursing education, licensure, practice, and discipline.
BRN regulates over 500,000 licensees in California. In addition to licensing RNs, BRN issues permits for pending licensees and certificates to the following advanced practice registered nurses (APRN): nurse practitioners (NPs), nurse anesthetists, nurse midwives (NMs), and clinical nurse specialists (CNSs). BRN also issues furnishing numbers to NPs and NMs with furnishing authority, maintains a list of psychiatric/mental health nurse specialists, issues certificates to public health nurses, and approves continuing education providers (CEPs).
BRN is responsible for setting educational standards for RN, NP, and NM programs, approving such programs, approving continuing education providers, evaluating and licensing RN and APRN applicants, administering discipline, managing a intervention program for licensees with substance use disorders or mental illness, and providing stakeholder information and outreach.
Employer Reporting. SB 466 (Hill, Chapter 489, Statutes of 2015) required the California State Auditor (Auditor) to conduct an audit of the BRN’s enforcement program, among other directives. The Auditor found fault with BRN’s complaint processing, data collection and use, complaint referrals, and investigator training.
The Auditor also noted that state law does not require RN employers to report complaints or discipline to BRN, as employers must do for licensed vocational nurses and hospitals/medical staff must do for physicians. The report indicated that “the assistant executive officer stated that she does not know why BRN was excluded from this law, but she believes BRN would benefit greatly if employers were required to report to it nurses who violate the Nursing Act.”
This bill requires an RN employer to report to the BRN the termination for cause or resignation for cause, of any RN in its employ for certain offenses.
BRN Investigations of RNs in the Intervention Program. As reported by the Auditor, state law requires the BRN to close the investigation of certain types of complaints against a RN if the RN is determined to be eligible for, and chooses to participate in, the BRN’s voluntary intervention. The investigation remains closed unless the RN exits the program early or he or she fails to successfully complete it.
If the nurse chooses not to participate in the intervention program or fails to successfully complete it, BRN refers the complaint to the appropriate unit for investigation and possible disciplinary action. However, an investigation may not occur or be completed until several years after BRN receives the complaint, due to the RN’s participation in the intervention program, restricting BRN’s ability to access evidence and potentially impose discipline when warranted.
To the extent BRN finds that evidence is no longer available, it will close the complaint without taking action against the nurse’s license. If state law required BRN to conduct investigations of all complaints against nurses while they participate in the intervention program, it would increase the likelihood that investigators have access to the necessary evidence. Therefore, if a nurse fails to successfully complete the program, BRN would already have collected the necessary evidence to pursue disciplinary action. This approach would also allow BRN to defer any disciplinary decision until it knows whether the nurse successfully completed the program. Essentially, this means that as long as the nurse participates in the program and successfully completes it, BRN would not pursue any disciplinary action related to the original complaint.
This bill authorizes BRN to investigate complaints against RNs participating in the intervention program.
Mandatory Judgment and Settlement Reporting. Current law requires RNs to report any judgment or settlement requiring the licensee or his or her insurer to pay anything above $3,000. BRN is currently collecting data to determine whether this is an appropriate amount. The $3,000 figure was set in 1975, and BRN gets many low-dollar reports that do not represent sufficiently egregious violations to warrant investigation.
BRN indicates that 199 cases were reported from January 1, 2014 through October 24, 2016. Of those, 39 were between $3,000 and $29,999, and 150 were between $30,000 and $6,000,000, with the average being $345,908.
This bill requires BRN liability insurance providers to report incidents over $10,000.
CE Providers. All licensees are required by statute to complete 30 hours of CE during each two-year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. CEPs are approved by BRN based on the evaluation of a single course, and then are on their honor to ensure the balance of their offerings meet established criteria. The BRN is the sole agency tasked with defining and interpreting the practice of nursing and is required to exercise their discretion to “withhold or rescind approval from any [CE] provider that is in violation of the regulatory requirements.”
Prior to 2002, the BRN conducted random audits of RNs CE and CEPs, averaging 2,700 RNs CE and 282 CEPs per year. The BRN has not completed any CEP audits since 2001, citing lack of staff and “the current structure of the CRNE [continuing registered nursing education] laws and regulations on its inability to do its job. This is particularly concerning because the BRN acknowledges that CE compliance is “essential to ensure public safety and protection.” It is unclear why BRN feels that current law does not facilitate the exercise of their enforcement obligations, because the plain reading of statute gives them authority to approve and disapprove CEPs based on multiple CE content criteria.
BRN continues to be lax in its approval standards for CEPs as well, approving courses with dubious scientific merit and not directly relating to patient care.
This bill requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities by January 1, 2019, and update the Legislature on its progress the following year.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Ongoing costs of $41 million per year for the continuing operation of the BRN (BRN Fund).
- Likely ongoing costs in the low hundreds of thousands per year for additional investigations and enforcement actions, due to the provisions in the bill that require additional reporting to the BRN of actions by registered nurses that may require disciplinary action (BRN Fund).
None received
OPPOSITION: (Verified 5/26/17)
California Association for Health Services at Home
California Nurses Association
Service Employees International Union California
ARGUMENTS IN OPPOSITION: California Association for Health Services at Home, California Nurses Association (CAN), and Service Employees International Union California are opposed to the employer reporting provisions. CNA writes, “Nurses are required by law to advocate in the sole interest of their patients, which many times puts them in conflict with their employers. CNA opposes this provision in SB 799 because it will have an adverse impact on nurses who are disciplined or terminated by their employers for fulfilling their statutory duties as patient advocates. Moreover, nurse whistleblowers will be at risk because of these reporting requirements.” CNA also opposes the criteria that certain CE courses be evidence based because it could lead to “dehumanizing care.”
5/27/17 18:54:58
**** END ****
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
SB 799 (Hill) - Nursing
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on May 25, 2017
Bill Summary:
SB 799 would extend the operation of the Board of Registered Nursing until January 1, 2022 and make several changes to the licensing requirements for registered nurses and operations of the Board.
Fiscal Impact:
- Ongoing costs of $41 million per year for the continuing operation of the Board of Registered Nursing (Board of Registered Nursing Fund).
- Likely ongoing costs in the low hundreds of thousands per year for additional investigations and enforcement actions, due to the provisions in the bill that require additional reporting to the Board of actions by registered nurses that may require disciplinary action (Board of Registered Nursing Fund).
Author Amendments:
Delete the requirement for peer reporting, limit employer reporting requirements, give the Board discretion to continue investigations when a licensee has entered the Intervention Program, and strike changes in the bill to continuing education requirements.
Committee Amendments:
Make the Board of Registered Nursing Fund subject to Legislative appropriation.
-- END --
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
SB 799 (Hill) - Nursing
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
SB 799 would extend the operation of the Board of Registered Nursing until January 1, 2022 and make several changes to the licensing requirements for registered nurses and operations of the Board.
Fiscal Impact:
- Ongoing costs of $41 million per year for the continuing operation of the Board of Registered Nursing (Board of Registered Nursing Fund).
- One-time costs of $700,000 and ongoing costs of $650,000 per year for additional investigations and enforcement actions, due to the provisions in the bill that require additional reporting to the Board of actions by registered nurses that may require disciplinary action (Board of Registered Nursing Fund).
Background:
Under current law, the Board of Registered Nursing licenses and regulates the practice of nursing. The Board licenses registered nurses, nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialist. Current law sunsets the operation of the Board on January 1, 2018.
Like several professional licensing boards, the Board operates a voluntary intervention program for nurses who have problems with drugs or alcohol. Under current law, the Board may close an investigation of a registered nurse who enters the program, if certain conditions are met, and only allows the investigation to be reopened if the registered nurse withdraws or is terminated from the program.
Under current law, the Board establishes continuing education requirements for registered nurses and approved continuing education providers.
Proposed Law:
SB 799 would extend the operation of the Board of Registered Nursing until January 1, 2022 and make several changes to the licensing requirements for registered nurses and operations of the Board.
Major provisions of the bill would:
- Extend the operation of the Board until January 1, 2022;
- Require any registered nurse with knowledge that someone has committed an act that is grounds for discipline or denial of an application to report that information to the Board;
- Requires an employer, employment agency, or nursing registry to report specified information to the Board;
- Delete a current provision of law that allows the Board to close an investigation of a registered nurse who has entered its intervention program;
- Prohibit the Board from renewing existing continuing education providers or approving new providers or courses;
- Require the Board to issue regulations establish a list of approved providers;
- Require the Board to prepare a report, by January 1, 2019 with a plan for approving continuing education providers;
- Make other conforming changes.
Related Legislation:
This bill is one of several sunset review bills authored by the chairs of the Senate and Assembly of the Business and Professions Committees.
Staff Comments:
The bill would require a registered nurse to report to the Board if he or she has knowledge that another person has committed an act that is grounds for discipline by the Board. The bill would also require an employer of a registered nurse to report to the Board when a registered nurse is suspended, terminated, or resigns for cause. Based on these requirements to provide information to the Board, there are likely to be additional investigations and enforcement actions, increasing the Board’s enforcement costs.
-- END --
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2017 - 2018 Regular
Bill No: SB 799 Hearing Date: April 24, 2017
Author: | Hill | ||
Version: |
| ||
Urgency: | Fiscal: | ||
Consultant: | |||
Subject: Board of Registered Nursing: sunset extension
SUMMARY:
Extends the sunset date on the Board of Registered Nursing (BRN) and makes other statutory changes to improve the effectiveness and efficiency of this regulatory and licensing entity.
Existing law:
- Establishes the Board of Registered Nursing (BRN) under the Department of Consumer Affairs (DCA) until January 1, 2018. (Business and Professions Code (BPC) § 2701)
- Requires every insurer providing professional liability insurance to a registered nurse (RN) to send a complete report to the BRN as to any settlement or arbitration award over $3,000 of a claim or action for damages for death or personal injury caused by that person’s negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services. The report shall be sent within 30 days after the written settlement agreement has been reduced to writing and signed by all parties thereto or within 30 days after service of the arbitration award on the parties. (BPC § 801 (a))
- Authorizes a RN under current investigation by the BRN to request entry into the intervention program by contacting the BRN. Prior to authorizing a registered nurse to enter into the intervention program, the BRN may require the RN to execute a statement of understanding that states that the RN understands that his or her violations that would otherwise be the basis for discipline may still be investigated and may be the subject of disciplinary action. (BPC § 2770.7 (b))
- Requires the BRN to close the investigation if the reasons for an investigation of a RN are based primarily on the self-administration of any controlled substance or dangerous drug or alcohol, as specified, or the illegal possession, prescription, or nonviolent procurement of any controlled substance or dangerous drug for self-administration that does not involve actual, direct harm to the public, and the RN is accepted into, and successfully completes, the BRN’s intervention program. If the RN withdraws or is terminated from the program by an intervention evaluation committee, and the termination is approved by the program manager, the investigation shall be reopened and disciplinary action imposed, if warranted, as determined by the BRN. (BPC § 2770.7 (c))
- Requires each RN renewing his or her license to submit proof satisfactory to the BRN that, during the preceding two-year period, he or she has been informed of the developments in the RN field or in any special area of practice engaged in by the licensee, occurring since the last renewal thereof, either by pursuing a course or courses of continuing education (CE) in the RN field or relevant to the practice of the licensee, and approved by the BRN, or by other means deemed equivalent by the BRN. (BPC § 2811.5 (a))
This bill:
- Extends the sunset date of the BRN until January 1, 2022.
- Raises the threshold for reporting settlement or arbitration awards from a RN professional liability insurer from $3,000 to $10,000.
- Requires any RN with knowledge that someone has committed any act listed as grounds for discipline or a denial of application to report this information to the BRN and cooperate in furnishing information or assistance.
- Requires a RN employer to report to the BRN the suspension or termination for cause, or resignation for cause, of any RN in its employ.
- Prohibits the mandated employer reporting from constituting a waiver of the confidentiality of medical records. The information reported or disclosed shall be kept confidential except as provided and shall not be subject to discovery in civil cases.
- Requires an employment agency or nursing registry to report to the BRN the rejection from assignment of a RN by a health facility or home health care provider due to acts that would be cause for suspension or termination.
- Defines the terms “suspension, termination, or resignation for cause” or “rejection from assignment” as suspension, termination, or resignation from employment, or rejection from assignment, for any of the following reasons:
- Use of controlled substances or alcohol to the extent that it impairs the licensee’s ability to safely practice registered nursing.
- Unlawful sale of a controlled substance or other prescription items.
- Patient or client abuse, neglect, physical harm, or sexual contact with a patient or client.
- Falsification of medical records.
- Gross negligence or incompetence.
- Theft from patients or clients, other employees, or the employer.
- Establishes an administrative fine not to exceed $10,000 per violation for the failure of a RN, an employer, or an employment agency or nursing registry to make a report required by this bill.
- Defines an “employer” as including employment agencies and nursing registries.
- Prohibits any monetary liability on the part of, and any cause of action for damages rising against, any person on account of the communication of information in the possession of that person to the BRN when the communication is intended to aid in the evaluation of the qualifications, fitness, character, or insurability of a practitioner of the healing arts.
- States that a person renewing his or her license to complete at least 30 hours of CE by pursuing a course in the RN field or relevant to the practice of the licensee.
- States that CE courses may be from a continuing education provider (CEP) either approved by the BRN before January 1, 2018, or approved by accrediting agencies or associations as the BRN deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, American Association of Nurse Anesthetists, American Nurses Credentialing Center, and the National Association for Practical Nurse Education.
- Requires the BRN to promulgate emergency regulations to establish a list of approved entities based on the entities’ history of sanctioning learning opportunities appropriate to the practice of registered nursing.
- Requires the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving CE opportunities by January 1, 2019.
- Prohibits the BRN from renewing existing CEPs or approving individual CEPs or CEs.
- Requires that CEs be related to evidence-based scientific knowledge.
- Makes technical changes.
FISCAL EFFECT:
Unknown. This bill is keyed “fiscal” by the Legislative Counsel.
COMMENTS:
- Purpose. This bill is sponsored by the Author. This bill is one of four “sunset review bills” the Author is sponsoring this session. According to the Author, this bill is necessary to implement changes to the Nursing Practice Act and update sunset dates for the BRN in order to ensure oversight over the registered nursing profession. The health, safety, and welfare of consumers are protected by a well-regulated nursing profession. The BRN has recently shown a strong commitment to improve its overall efficiency and effectiveness and has worked cooperatively with the Legislature and this policy committee to bring about necessary changes.
- Oversight Hearings and Sunset Review of Licensing Boards and Programs. Beginning in 2017, the Senate Business and Professions Committee and the Assembly Business and Professions Committee (Committees) conducted joint oversight hearings to review 14 regulatory entities: DCA, Chiropractic Board, Physical Therapy Board, Optometry and Registered Dispensing Optician’s Board, Medical Board of California, Osteopathic Medical Board of California, Board of Guide Dogs for the Blind, Naturopathic Committee, Respiratory Care Board, Board of Registered Nurses, Speech Language, Audiology & Hearing Aid Dispensers Board, Occupational Therapy Board, Board of Vocational Nurses and Psychiatric Technicians, and the California Council for Interior Design Certification.
The Committees conducted three hearings in March. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees and which are reflected in the background papers prepared by Committee staff for each agency and program reviewed this year.
- BRN Background. The BRN regulates the practice of RNs in California. BRN implements and enforces the Nursing Practice Act, the laws and regulations related to nursing education, licensure, practice, and discipline.
BRN regulates over 500,000 licensees in California. In addition to licensing RNs, BRN issues permits for pending licensees and certificates to the following advanced practice registered nurses (APRN): nurse practitioners (NPs), nurse anesthetists, nurse midwives (NMs), and clinical nurse specialists (CNSs). BRN also issues furnishing numbers to NPs and NMs with furnishing authority, maintains a list of psychiatric/mental health nurse specialists, issues certificates to public health nurses, and approves continuing education providers (CEPs).
BRN is responsible for setting educational standards for RN, NP, and NM programs, approving such programs, approving continuing education providers, evaluating and licensing RN and APRN applicants, administering discipline, managing a Intervention Program for licensees with substance use disorders or mental illness, and providing stakeholder information and outreach.
The BRN is a self-supporting, special fund agency that obtains its revenues from licensing fees. The primary source of revenues is renewal fees.
- Review of the BRN – Issues Identified and Review of the BRN – Recommended Statutory Changes. The following are some of the major issues pertaining to the BRN along with background information concerning the particular issue. Recommendations were made by Committee staff regarding the particular issue areas which needed to be addressed.
- Issue: Employer Reporting.
Background: SB 466 (Hill, Chapter 489, Statutes of 2015), required the California State Auditor (Auditor) to conduct an audit of the BRN’s enforcement program, among other directives. The Auditor found fault with BRN’s complaint processing, data collection and use, complaint referrals, and investigator training.
The Auditor also noted that state law does not require RN employers to report complaints or discipline to BRN, as employers must do for licensed vocational nurses and hospitals/medical staff must do for physicians. The report indicated that “the assistant executive officer stated that she does not know why BRN was excluded from this law, but she believes BRN would benefit greatly if employers were required to report to it nurses who violate the Nursing Act.”
Recommendation and Proposed Statutory Change: To ensure that BRN receives timely and consistent notification of nurses’ alleged violations of the Nursing Act, the Legislature should require the employers of registered nurses to report to BRN the suspension, termination, or resignation of any registered nurse due to alleged violations of the Nursing Act.
This bill will requires a RN to report to the BRN in writing if another person has committed any act that is grounds for discipline under the Act or would warrant a denial of application. This bill would also require an employer of a RN to report to the BRN the suspension or termination for cause, or resignation for cause, of any RN in its employ.
- Issue: BRN Investigations of RNs in the Intervention Program.
Background: As reported by the Auditor, state law requires the BRN to close the investigation of certain types of complaints against a RN if the RN is determined to be eligible for, and chooses to participate in, the BRN’s voluntary intervention. The investigation remains closed unless the RN exits the program early or he or she fails to successfully complete it.
If the nurse chooses not to participate in the intervention program or fails to successfully complete it, BRN refers the complaint to the appropriate unit for investigation and possible disciplinary action. However, an investigation may not occur or be completed until several years after BRN receives the complaint, due to the RN’s participation in the intervention program, restricting BRN’s ability to access evidence and potentially impose discipline when warranted.
To the extent BRN finds that evidence is no longer available, it will close the complaint without taking action against the nurse’s license. If state law required BRN to conduct investigations of all complaints against nurses while they participate in the intervention program, it would increase the likelihood that investigators have access to the necessary evidence. Therefore, if a nurse fails to successfully complete the program, BRN would already have collected the necessary evidence to pursue disciplinary action. This approach would also allow BRN to defer any disciplinary decision until it knows whether the nurse successfully completed the program. Essentially, this means that as long as the nurse participates in the program and successfully completes it, BRN would not pursue any disciplinary action related to the original complaint.
Recommendation and Proposed Statutory Change: State law should be amended to require BRN to conduct investigations of complaints alleging substance abuse or mental illness against nurses who choose to enter the intervention program.
This bill will require the BRN to investigate all complaints against RNs participating in the intervention program.
- Issue: Mandatory Judgment and Settlement Reporting.
Background: Current law requires RNs to report any judgment or settlement requiring the licensee or his or her insurer to pay anything above $3,000. BRN is currently collecting data to determine whether this is an appropriate amount. The $3,000 figure was set in 1975, and BRN gets many low-dollar reports that do not represent sufficiently egregious violations to warrant investigation.
BRN indicates that 199 cases were reported from January 1, 2014 through October 24, 2016. Of those, 39 were between $3,000 and $29,999, and 150 were between $30,000 and $6,000,000, with the average being $345,908.
Recommendation and Proposed Statutory Change: The BRN should continue to investigate what monetary threshold would best capture the information necessary to warrant the investigation of the nurse practitioner. BRN should indicate what types of cases it would not receive if it were to raise the cap.
This bill will require BRN liability insurance providers to report incidents over $10,000.
- Issue: Continuing Education Providers.
Background: All licensees are required by statute to complete 30 hours of CE during each two year renewal cycle to ensure continued competence. Statute requires that the BRN establish regulations ensuring that CE courses are either related to the scientific knowledge or technical skills required for the practice of nursing, or to direct or indirect patient care. The BRN promulgated regulations further specifying appropriate coursework, including the requirement that all content be relevant to the practice of nursing. CEPs are approved by BRN based on the evaluation of a single course, and then are on their honor to ensure the balance of their offerings meet established criteria. The BRN is the sole agency tasked with defining and interpreting the practice of nursing and is required to exercise their discretion to “withhold or rescind approval from any [CE] provider that is in violation of the regulatory requirements.”
Prior to 2002, the BRN conducted random audits of RNs CE and CEPs, averaging 2,700 RNs CE and 282 CEPs per year. The BRN has not completed any CEP audits since 2001, citing lack of staff and “the current structure of the CRNE [continuing registered nursing education] laws and regulations on its inability to do its job. This is particularly concerning because the BRN acknowledges that CE compliance is “essential to ensure public safety and protection.” It is unclear why BRN feels that current law does not facilitate the exercise of their enforcement obligations, because the plain reading of statute gives them authority to approve and disapprove CEPs based on multiple CE content criteria.
BRN continues to be lax in its approval standards for CEPs as well, approving courses with dubious scientific merit and not directly relating to patient care.
Recommendation and Proposed Statutory Change. The BRN should cease CE approval and renewals for two years. In the interim, the BRN should accept CE only from existing providers and those approved by specified accrediting entities. The Board should withdraw approval for CE providers that do not meet statutory and regulatory standards.
By March 1, 2019, the BRN should deliver a report to the appropriate Legislative policy committees with a comprehensive plan for approving and disapproving CE providers and courses, which shall include a cost-benefit analysis comparing the cost of doing this work entirely within the Board or relying on outside accreditors. The Board should consider additional staff and staff time necessary and compare costs for both licensees and CE providers for each option.
This bill will make the following changes to the BRN’s CE Program:
Specify that CE may be from a CEP who is either approved by the BRN before January 1, 2018, or approved by accrediting agencies or associations as the BRN deems appropriate, which shall include, but not be limited to, the following: American Association of Nurse Practitioners, American Association of Critical-Care Nurses, American Association of Nurse Anesthetists, American Nurses Credentialing Center, and the National Association for Practical Nurse Education.
Require the BRN to promulgate emergency regulations to establish a list of approved entities based on the entities’ history of sanctioning learning opportunities appropriate to the practice of registered nursing.
Require the BRN to deliver a report to the appropriate legislative policy committees detailing a comprehensive plan for approving and disapproving continuing education opportunities.
Specify that the BRN shall not renew or approve existing CEPs or CEs until such time as it has prepared a plan and secured funding to execute it.
- Issue: BRN Sunset Extension.
Background: Current law sunsets the BRN on January 1, 2018. The BRN and its current membership should continue to license and regulate the nursing profession. However, the BRN faces serious problems in managing its licensing and enforcement program as indicated by the Auditor. It is also evident that BRN needs to develop a plan to manage its CE and CEP responsibilities properly, examine its Advanced Practice Registered Nurse regulations, and address other issues as identified in this Background Paper.
Recommendation and Proposed Statutory Changes: The BRN has made substantial changes since the appointment of its new Executive Officer and has satisfied the Auditor’s immediate concerns about its enforcement program. It is recommended that the BRN be extended for four years, with periodic check-ins with the Legislature to ensure it is meeting its objectives.
This bill would extend the BRN’s sunset date until January 1, 2022.
- Related Legislation. SB 796 (Hill, 2016) adds a four year sunset date to the Naturopathic Medicine Committee and Respiratory Care Board of California and makes statutory changes to improve the effectiveness of these regulatory entities. (Status: This bill is currently set to be heard in front of this policy committee on April 24, 2017.)
SB 797 (Hill, 2016) permits the Board of Vocational Nursing and Psychiatric Technicians to delegate to its executive officer the authority to adopt a decision entered by default and a stipulation for surrender of a license. (Status: This bill is currently set to be heard in front of this policy committee on April 24, 2017.)
SB 798 (Hill, 2016) extends the sunset date for the Medical Board of California and Osteopathic Medical Board of California until January 1, 2022 and makes statutory changes to improve the effectiveness of these regulatory entities. (Status: This bill is currently set to be heard in front of this policy committee on April 24, 2017.)
SB 798 (Hill, 2016) extends the operation of the Medical Board of California until 2022, subjects the Osteopathic Medical Board of California to review by the appropriate policy committees of the Legislature as if the OMBC were scheduled to be repealed in 2022, and makes various changes to the MBC Act and OMBC Act intended to improve oversight of physicians and surgeons and osteopathic physicians and surgeons. (Status: This bill is currently set to be heard in front of this policy committee on April 24, 2017.)
- Prior Related Legislation. SB 466 (Hill) extended the BRN’s sunset date until January 1, 2018, required the California State Auditor’s Office to conduct an audit of the BRN’s enforcement program, required BRN to promulgate regulations to ensure that schools grant credit for military education and experience, and made technical changes.
- Arguments in Support. The American Nurses Association\California and their coalition partners, the California Nurse-Midwives Association, the California Association of Colleges of Nursing, and the California Association of Nurse Anesthetists write in support, “Thanks to the recent success of Dr. Joseph Morris, Executive Officer of BRN, in making improvements in technological use of cloud IT that streamlined license application processing, we are pleased to support BRN in its continuing quest for improved customer protection. SB 799 would also authorize the Board to revise continuing education provisions that are required for each registered nurse renewing her/his license as it requires the Board to adopt a set of new regulations establishing standards of continuing education. These standards shall take cognizance of specialized areas of practice, the content must be relevant to nursing practice and be evidence-based in scientific knowledge or technical skills that are related to direct or indirect patient/client care.”
- Arguments in Opposition. The California Nurses Association (CNA) opposes the bill’s CE and CEP provisions, stating that the prohibition renewing on existing CEPs is “impractical” and may result in RNs being out of compliance with CE requirements. CNA is also opposed to approval by specified third-party accrediting agencies or associations because they believe they do not do any better job of vetting CEPs than the BRN does. CNA also opposes the criteria that certain courses be based in evidence because it could lead to “dehumanizing care.”
SUPPORT AND OPPOSITION:
Support:
American Nurses Association\California
California Nurse-Midwives Association
California Association of Colleges of Nursing
California Association of Nurse Anesthetists
Opposition:
California Nurses Association
-- END --
Discussed in Hearing
2MIN
Senate Floor
1MIN
Assembly Floor
1H
Assembly Standing Committee on Appropriations
28MIN
Assembly Standing Committee on Business and Professions
1MIN
Senate Floor
48MIN
Senate Standing Committee on Appropriations
11MIN
Senate Standing Committee on Business, Professions and Economic Development
Bill Author
Bill Co-Author(s):