The primary reason to belong to RN Guardian is to ensure, for a low monthly fee, that you have legal representation in case you are ever investigated by the California Board of Registered Nursing (BRN). Why is this important? What happens when BRN investigates RN’s? While the BRN investigation and enforcement process typically follows the same steps in each case, there are also differences in each case which makes it essential to be represented by an attorney experienced in defending RN’s in licensed matters if you are ever investigated by the BRN. The following is a summary of the various steps within the BRN investigation and enforcement process, and how representation by an RN Guardian attorney during such process can mean the difference between successfully defending your license and losing your license to practice as a registered nurse.
Who Does the BRN Investigate?
BRN investigations into RN’s are typically initiated when a complaint is filed against a RN with BRN. Anyone, including a patient or patient’s family member, a co-worker, a supervisor, or anyone with knowledge of the subject matter of the complaint. A compliant is filed about any particular RN with the BRN. Such complaint remains confidential within BRN and the person filing the complaint is typically not identified to the RN who will be investigated as a result of the complaint.
The two most common subjects of complaint filed with the BRN are alleged deficiencies in patient care and alleged chemical dependencies by the RN in question. Subjects which BRN does not have jurisdiction to investigate, but which sometimes are addressed in complaints filed with BRN include alleged wrongdoing in billing practices and personal conflicts.
What happens during the investigation?
First, BRN reviews the information contained in the complaint which was filed. If the complaint alleges any type of chemical dependency by an RN, the case can be referred to the BRN Diversion Program, an alternative process under which the RN is offered to participate in counseling while his or her license is suspended. If the complaint involves other alleged violations of the Nursing Practices Act, and if the complaint contains information substantiating the allegation, the RN typically transfers the case to the Department of Consumer Affairs, Division of Investigations for a comprehensive investigation (DOI). DOI conducts an investigation to gather all factual information relevant to the allegations contained in the complaint. Such investigation typically involves interviews of any relevant witnesses and usually involves (though not always) and interview with the RN accused in the complaint. It is prior to and at such interview that an RN belonging to RN Guardian will use an assigned attorney for representation.
When DOI has finished gathering facts related to the complaint in their investigation, they issue a report to BRN on their findings. BRN reviews the report and, if no violation can be substantiated, the matter is closed. If BRN concludes, however, that the DOI report shows the RN committed some wrongdoing, BRN takes one of the various disciplinary actions against the RN.
What happens after the investigation?
If BRN concludes from the DOI report that the RN has committed a minor violation, which does not call for formal disciplinary action, the case is handled through an informal process titled (The BRN Citation and Fine System) through an informal or formal appeal process. At this point, RN Guardian members again use their designated, experienced attorney to assist with deciding how to contest the fines and citations.
If BRN concludes from the DOI report that the RN has committed a violation of the Nursing Practice Act, a formal disciplinary action is warranted. The BRN sends the case to the Attorney General’s (AG) office. The AG then reviews the case and, if there is sufficient evidence, the AG issues a formal disciplinary charge against the RN, typically an “accusation.” The accusation, which lists the charges against the RN is then sent from the AG’s office to the RN. The RN then has the opportunity to appeal the charges at an administrative hearing. Of all the steps in the BRN investigation and disciplinary process, it is at this point that it is critical for an accused RN to be represented by an attorney experienced in the BRN license defense matters. RN Guardian members are represented by such attorneys.
The administrative hearing for the appeal by an RN to challenge an accusation is a formal process which very much resembles an actual trial. The hearing is heard by an Administrative Law Judge (ALJ) within the State of California’s Office of Administrative Hearings. Witnesses are presented by both the AG and by the accused RN at the hearing to testify under oath about the factual matters related to the disciplinary charges. Cross examination of each testifying witness is allowed and may be critical to the outcome of the case. Documents may also be presented as exhibits to establish the evidentiary record from which the ALJ will determine the case. After the hearing, the ALJ produces a written, proposed decision which either upholds the discipline, reverses the discipline, or presents or recommends some type of reduced discipline. The ALJ’s decision is then reviewed by a nine-member BRN panel for consideration. This BRN panel may accept the ALJ’s decision entirely, may reject the decision entirely, or may revise and adopt the ALJ’s decision. The BRN panel’s conclusion completes the administrative process for the appeal of the disciplinary charges.
It is important to note that either prior to the administrative hearing, during such hearing, or after such hearing (either before or after the ALJ has rendered his or her decision), the AG’s office and the accused RN may enter into a stipulated settlement of the matter. Here again, the experienced RN Guardian attorney representing the RN Guardian member is critical to possibly reaching a stipulation with the AG’s office which achieves the best overall result for the RN.
The ultimate outcome of a disciplinary accusation against an RN can vary from a citation and fine, an order placing the RN’s license on temporary probation, an order for the RN to surrender his or her license, or a suspension or revocation of the RN’s license. If the RN Guardian member is not satisfied with the ultimate outcome, the next legal step is to appeal the discipline issues by BRN to the local California Superior Court under an action called a Petition for Writ of Mandate. While all other representation for the RN Guardian member through the administrative process up to this point is covered under the members low monthly RN Guardian membership fee, moving forward with an appeal under a Petition for Writ of Mandate is done on a negotiated basis between the RN and RN Guardian and typically involves payment of an hourly rate for the continued representation (ARTICLE IV Section 1.c of the RN Guardian Plan Contract.)
Summary and Conclusion
From all the steps described above, it is clear the BRN investigation and discipline process involves multiple steps, can be somewhat complicated, would be extremely difficult for an RN to go through on his or her own without any legal representation. RN Guardian members enjoy being guaranteed an attorney experienced in BRN license defense for each step of the BRN investigation and disciplinary process.