The California Board of Registered Nursing (BRN) received a negative evaluation of its enforcement program in the most recent sunset review. The sunset review included a performance audit by the California State Auditor due to complaints received about the BRN’s enforcement process.

31 out of the 40 investigated consumer complaints between January 1, 2013 and June 30, 2016, were not resolved within the 18-month goal set by Consumer Affairs, potentially placing patients at additional risk. 15 of those 31 delinquent complaints took longer than 36 months to resolve. Seven of those 15 complaints took longer than 48 months to resolve, six of which included allegations of patient harm resulting from a nurse’s actions.The report also expresses concerns regarding inconsistent BRN enforcement, citing multi-year probation orders for both paperwork violations and patient deaths.

In particular, the report cites an egregious case of delinquent enforcement involving a nurse-midwife. The report states that the BRN adopted an ALJ decision which placed a nurse-midwife on probation and required her to get BRN approval of revised standardized procedures before resuming work. Less than two months following the adoption of the ALJ decision, the nurse-midwife submitted the standardized procedures to her practice monitor for approval. Receiving no response, the licensee was forced to file a writ of mandate to force the BRN to comply with the terms of its own enforcement decision. The BRN opposed the writ, arguing that relief is unavailable for lack of duty to approve the standardized procedures—an argument conflicting with the very statutes cited by the BRN.

After the court granted the nurse-midwife’s writ and ordered the BRN to approve the standardized procedures, the BRN appealed and lost, again. The superior court judge acknowledged that by delaying enforcement of its own decision, the BRN was actively destroying the nurse-midwife’s practice and devastating her personal finances.

To cure the enforcement defect made apparent by this case, the report recommends the BRN adopt a policy to respond to probationers within a reasonable period of time.