Matthew H. Mead Governor Wyoming STATE BOARD OF NURSING Cynthia LaBonde MN, RN Executive Director COMPLIANCE & DISCIPLINE REPORT October, 5 Prepared by Laura C. Rowe, J.D. I. st Quarter 6 Fiscal Year Case Closures by MATRIX/DC Decision and License Type June, 5 to September 4, 5 77 cases resolved in st Fiscal Quarter 6 License Type Matrix DC Total % of Closed Cases, 4th Qtr. CNAs 7 36% LPNs 9 3 6% RNs 5 9 34 44% APRNs 3 4% Total 47 3 77 % 5 5 Matrix DC 5 CNAs LPNs RNs APRNs Page of
A. Matrix Decisions by License Type and Discipline MTX- Dismissal N.O.W. L.O.R. Inactive Conditional Revocation Summary Suspension Voluntary RSTMT. Suspension Surrender CNAs 6 6 LPNs 3 4 9 RNs 7 3 3 5 APRNs Totals 4 47 MTX- ILA TOTAL 9 7 6 5 4 3 Dismissal N.O.W. L.O.R. Inactive Conditional Revocation Summary Suspension Suspension Voluntary Surrender ILA Reinstatement CNAs LPNs RNs APRNs Matrix summary suspension for impairment concern of nurse while nurse was on-call Page of
B. DC Decisions by License Type and Discipline DC - DC - DC - DC - DC - Cond. DC - Rev. DC - S.S. DC - Susp. DC - V.S. DC - DC - Dismissal N.O.W. L.O.R. Inactive ILA¹ Reinstatement TOTAL CNAs 7 LPNs 3 RNs 7 3 3 9 APRNs Totals 3 9 3 5 3 3 Though an ILA is signed, it does not necessarily mean the case is closed or the investigation is complete. 7 6 5 4 3 CNAs LPNs RNs APRNs DC - Dismissal DC - N.O.W. DC - L.O.R. DC - Inactive DC -Conditional DC - Revocation DC - Summary Suspension DC - Suspension DC - Voluntary Surrender DC - ILA DC - Reinstatement Now including data on Interim Letter Agreements (ILA) that are entered into during the fiscal quarter Kira Davis, CNA was issued a DC NOW after she was originally placed on summary suspension for misappropriation. She was required to complete training courses before the NOW was issued. The DC reinstatement was issued to RN after she completed NMP monitoring DC summary suspension is a drug diversion case, assigned to DC because Executive Director was out of office for extended period of time Page 3 of
C. Summary Comparison to Prior Fiscal Quarters of Number of Cases Closed Matrix Cases DC Cases Total 3 nd Fiscal Qtr. [Oct. - Dec. 3] 4 7 57 3 3rd Fiscal Qtr. [Jan. - Mar. 3] 7 4 94 3 4th Fiscal Qtr. [April - June 3] 64 3 94 4 st Fiscal Qtr. [July - Sept. 5] 44 5 69 4 nd Fiscal Qtr [Oct - Dec. 3] 44 6 6 4 3rd Fiscal Qtr. [Jan., '4 - Mar. 4, '4] 6 9 45 4 4th Fiscal Qtr. [Mar. 5, '4 - June 7, '4] 5 7 5 5 st Fiscal Qtr. [July, '4 - Sept., '4] 4 6 66 5 nd Fiscal Qtr [Sept. 3, '4 - Dec., '4] 3 5 55 5 3rd Fiscal Qtr [Dec. 9, '4 - Mar., '5] 4 96 5 4th Fiscal Qtr [Mar. 9, '5 - June 7, '5] 5 7 5 6 st Fiscal Qtr [June 7, '5 - Sept. 4, '5] 47 3 77 II. st Quarter Fiscal Year 6 Cases Opened by Complaint Type June 7 September 4, 5 54 Cases Opened 7 of the abuse cases allege verbal abuse (yelling, inappropriate language) 5 of the neglect cases stem from a single patient episode at the Wyoming State Hospital of the drug diversion cases resulted in summary suspension Page 4 of
Complaint Type CNA LPN RN APRN Total Abandonment Abuse (Verbal & Physical) Board Discipline - Other State Boundary Violation ᵃ Criminal Conviction Drug Diversion 3 Failure to Comply / Disclose Failure to Report Violation Fraud and Deceit 3 Impairment ᵇ Inappropriate Delegation 3 Medication Error Misappropriation Neglect 4 4 9 Practicing Beyond Scope 4 Practicing without License 4 Privacy Violation Sale, Unauthorized Use of C.S. 4 Substance Abuse/Dependency Unprofessional Conduct ᶜ Unsafe Practice ᵈ 3 4 7 Unsafe Rx Practice Totals 4 6 4 54 % of new cases opened, st Qtr 45% % 43% % % ᵃ Boundary violations include financial and sexual boundaries ᵇ Impairment includes both mental and physical impairment. ᶜ Unprofessional conduct includes inappropriate demeanor and language with a resident or patient (not including cursing), hiding phone from resident ᵈ Unsafe practice allegations include failure to properly monitor a patient, leaving a patient on : observation; failing to take and document vitals during emergency transport, not following MD request to check on patient, punching hole in wall in front of patient Page 5 of
9 7 6 5 4 3 CNA LPN RN APRN A. Summary Comparison to Prior Fiscal Quarters of Cases Opened Fiscal Quarter Cases Opened 4 st Fiscal Qtr. [July - Sept. 5, 3] 45 4 nd Fiscal Qtr. [Oct - Dec. 3, 3] 36 4 3rd Fiscal Qtr [Jan. - Mar. 4, 4] 55 4 4th Fiscal Qtr [Mar. 5 - Jun. 7, 4] Total 4 Fiscal Year 64 5 st Fiscal Qtr [Jun. - Sept. ] 4 5 nd Fiscal Qtr. [Sept. 3-Dec. ] 7 5 3rd Fiscal Qtr [ Dec. 9 - Mar. ] 5 4th Fiscal Qtr [Mar. 9 - June 7] 54 Total to date Fiscal Year 5 6 st Fiscal Qtr [June - Sept. 4] 54 Page 6 of
B. Cases Opened by County in st Quarter Fiscal Year 6 With 4 & 5 Totals 6 5 4 Total Column3 6 5 43 Total3 Column5 6 3 5 4 Total Albany 5 6 Hot Springs 5 3 Sheridan Big Horn 4 4 6 Johnson Sublette Campbell 3 7 Laramie 3 4 3 6 Sweetwater 4 4 Carbon 3 4 3 Lincoln 3 5 Teton 6 Converse 5 6 Natrona 6 33 5 64 Uinta 3 9 67 Crook 6 Niobrara 3 4 Washakie 4 5 Fremont 4 9 5 Park 3 7 Weston 4 5 Goshen 7 9 Platte TOTAL 54 6 63 477 Total Cases Opened By County: 4, 5, 6 Albany Campbell Big Horn Carbon 7 6 5 4 3 6 7 6 5 6 64 4 67 5 9 Converse Fremont Hot Springs Laramie Natrona Park Sheridan Sweetwater Uinta Crook Goshen Johnson Lincoln Niobrara Platte Sublette Teton Washakie Weston The total number of cases opened by county will not match the total number of cases opened because some cases do not originate within Wyoming, such as other board discipline or criminal convictions out of state. Page 7 of
C. Fiscal Year 6 Cases Opened by Facility Type st Quarter With 4, 5 Totals Facility Type Ambulatory Surgical Center Assisted Living Facility Clinic / Doctor Office Community Mental Health Center Correctional Facility/Re-Entry Center Critical Access Hosptial Federally Qualified Health Center Home Health Agency Hospice Program Hospital Intermediate Care Facilty for Mentally Handicapped Nursing Care Facility (Nursing Home) Psychiatric Hospital Psychiatric Residential Treatment Facility Rehabilitation Facility Rehabilitation Hospital Rural Health Care School Other Not Applicable Total 6 5 4 Total 3 3 6 7 7 4 3 4 3 3 3 6 6 3 5 44 7 9 64 7 63 44 4 5 43 3 3 3 4 3 6 95 7 54 79 7 54 Facility types are only designated if the complaint originates from conduct occurring at a type of listed facility. If the licensee/certificate holder is being investigated for conduct occurring outside of a facility (i.e. criminal conviction, self-report arrest, other Board discipline) no facility type will be designated and not applicable will be entered. Other facilities can include private care, data centers and air transport. Page of
Cases Opened by Facility Type: 4, 5, 6 Ambulatory Surgical Center Assisted Living Facility 4 4 Clinic / Dr. Office Community Mental Health Center Correctional Facility Critical Access Hospital 6 4 4 3 44 64 43 Federally Qualified Health Center Home Health Agency Hospice Program Hospital 3 6 3 4 Intermediate Care Facility for Mentally Handicapped Nursing Care Facility (Nursing Home) Psychiatric Hospital (State Hospital) Psychiatric Residential Treatment Facility Rehabilitation Facility Rehabilitation Hospital Rural Health Care School Other Not Applicable Page 9 of
III. Compliance & Discipline Updates A. Reporting Inactive Status of nurses/cnas on a discipline track Recently the National Practitioner Data Bank (NPDB) provided a directive that those nurses/cnas that choose to place their license/certificate on inactive status while an investigation is open and before a final Disciplinary Committee decision is entered should be reported to NPDB (or NURSYS when applicable). When a licensee/cna opts to go inactive during an investigation, a settlement agreement for inactive status is proposed for Board approval and an order approving the inactive status. Previously, this action and order were not reported to NURSYS (for nurses) or NPDB (for CNAs) because it was not considered discipline. Going forward, WSBN will report these actions as required and will post the approved inactive settlement agreement to the WSBN verification page. In addition, an internal decision was made after discussion between the Executive Director, C&D Manager and Prosecuting Senior Attorney General that licensees/cnas with Board orders for conditional licenses/certificates or with practice review requirements under a letter of reprimand who choose to go on inactive status before full completion of monitoring or review requirements will also be reported to NURSYS/NPDB, with a copy of any inactive settlement agreement being posted to the verification page. B. Denials Process Investigators will now be drafting preliminary denial letters for Application Review Committee matters. Previously, licensing staff drafted preliminary denial letters using templates from KNURSE. Investigators will draft letters using a template form provided by the Prosecuting Senior Assistant Attorney General. Once an ARC decision is issued to deny an application the case file will be forwarded to C&D for processing from licensing staff. Having C&D staff draft preliminary denials is conducive to the current process of needing final approval/ratification of preliminary denials by the Board which is already processed by C&D. C. November, 5 Hearings Currently there are matters set for hearing on Tuesday November, 5 starting at 9:3 am. All matters are anticipated to be default hearings except possibly one matter. Page of