“We’ll do whatever is necessary to reconstitute the board, or revise its procedures or give them a very clear statement from both the executive and legislative branch that they need to set a much higher standard and enforce it,” he said.
“I’m just appalled,” said Vickie Halstead, a registered nurse in Minnesota who testifies as a medical expert in malpractice cases. She reviewed two dozen disciplinary cases for the Star Tribune. “It’s scary to think some of these nurses with these kinds of histories are taking care of patients.”
Shirley Brekken, the Nursing Board’s executive director, said the board’s priority in disciplining nurses is to protect the public. She said that can often be achieved by close supervision, mandatory training and other measures that allow these nurses to keep working.
Records show that nurses across the state have kept their licenses despite an array of harmful care: stealing narcotics from patients in pain, letting a patient fall so violently it caused a facial fracture and displaced an eyeball, neglecting a patient who was found caked in rodent feces. The board often views failures in patient care by nurses as a lapse in training, records show, not grounds for punishment or removal from the profession.
In one such case, Luvern Kraft died in a Waconia nursing home in April 2012 after her nurse failed to give her CPR or call 911 after she was found unconscious. The Minnesota Department of Health determined the nurse, Susan Walter, was responsible for the neglect of a vulnerable adult after telling an investigator she didn’t take emergency measures because she “was tired and was not thinking clearly,” according to the Health Department’s investigative report. The Nursing Board ordered Walter in August to take a CPR class and consult one on one with another nurse.
“I find it hard to believe they’re going to let people like that get their license back if they do that to other people, if you’re that careless,” said Kraft’s son, Steven. “It isn’t like making a bad hamburger at a restaurant … You’re dealing with somebody’s lives.”
Walter referred questions to her attorney, Craig Mertz, who said they have appealed the neglect finding. He said Walter didn’t start CPR because Kraft was already deceased when the nurse got to her.
Nurses who acknowledge misconduct, even severe transgressions, also can persuade the state board to let them keep practicing. That’s what helped Sean Dipasqua hold onto his license, despite a felony drug theft conviction in 2009 for stealing narcotics from Hennepin County Medical Center. He admitted to the Nursing Board that he practiced while impaired. In its disciplinary order, the board said it “acknowledges licensee’s candor and genuine remorse for his actions.” The board fined Dipasqua $3,000 and ordered him to undergo state monitoring to ensure his sobriety and notify his supervisor of the board order.
When the Nursing Board does take away a license, it often comes after years of criminal behavior, substance abuse or incompetent care. Cari Cady was allowed to keep practicing after she pleaded guilty in 2008 to stealing pain medications from a resident living at a Marshall, Minn., facility. She went through drug treatment and found a new job. But last year, she stole about 375 prescription painkillers from a Balaton, Minn., nursing home and replaced them with Tylenol and aspirin, an action that she knew would endanger patients. This time, the board suspended her license.
In a brief interview this summer, Cady was asked if she thought the state Nursing Board protects the public from dangerous nurses. Her answer: “Oh, God no.”
Protecting the public
The Minnesota Board of Nursing, the state’s largest health licensing board, receives an average of 1,600 complaints each year. It dismisses three-quarters of those complaints and hands down disciplinary and corrective action in one-fifth of them. About 140 nurses each year face the most severe consequence — loss of their license.
The 16-member nursing board includes 12 nurses. They are each appointed by the governor to oversee the licensing of more than 115,000 nurses, the vast majority of whom are “safe, competent and ethical practitioners,” Brekken said. The Star Tribune attempted to contact all current board members, four of whom referred questions to Brekken or the board chairwoman, while the rest did not return calls.
If a complaint against a nurse is proven, state law gives the board wide discretion to choose which disciplinary action to take. Board chairwoman Deborah Haagenson declined to talk about specific cases but said nurses facing action by the board have to demonstrate they are safe to practice.
“The law allows for remediation and recovery,” said Haagenson, a registered nurse and a vice president of a Park Rapids hospital. “If someone has demonstrated that they are safe to return to practice, the board would have no cause to prevent them from practicing.”
The board also has to balance its disciplinary role against the effect on a nurse’s livelihood, Brekken said. What it has to determine, she said, is “how intrusive does the action have to be [against the nurse] to protect the public?”