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Reform of licensing boards coming in '09

The House Health Care Committee plans to introduce legislative concepts for the 2009 session later this year that could change the structure and oversight of the state’s health licensing boards, including citizen representation and how the recovery programs of clinicians with substance abuse problems are disclosed and monitored. The committee is specifically interested in the boards that oversee licensed health professionals rather than other state health boards that oversee barbers, aestheticians and other non-clinical providers that also hold licenses, according to committee chair, Rep Mitch Greenlick (D–Portland).

Although local and national media, the Governor’s office, legislators, consumer advocates and other stakeholders continue to closely scrutinize the State Board of Nursing, Greenlick said the changes in health licensing boards that he and his committee plan to propose are unrelated to scandals that have rocked Oregon’s nursing board for the past two years.

"We’re looking at the health professionals licensing boards. This is not driven by the nursing board [problems]," Greenlick said, referring to a series of charges against the nursing board including inadequate review of complaints, disciplinary measures and background checks of nurses with substance abuse problems and criminal histories, violations first reported in the Portland Tribune in 2006.

While it’s hard to talk about health licensing board reform without analyzing what went wrong at the nursing board, executive directors of other licensing boards are eager to move on. The problem is that some legislators, not necessarily represented on the House Health Committee, are worried.

"Some legislators are nervous. Some think, ‘If it happened with nursing, it could happen with other boards’," said Patrick Braatz, executive director of the Board of Dentistry. "But if there is that worry, then ask us [the boards] or audit us," he said.

This is the sort of recommendation that Braatz would like to share with multiple stakeholders including the Governor, legislators and other licensing board executive directors as the House Health Care Committee starts to craft its Legislative Concepts.

To that end, organized by Braatz, executive directors now have meetings once a month and have invited Greenlick and members of his committee to attend. "We need to do a better job of communicating with the Legislature," Braatz said. Lawyers from the state General Counsels office as well as Claudia Black, a senior health advisor to the Governor also attend these meetings.

The House Health Care Committee and the licensing board executive directors plan to address a range of issues that will drive reform of the arguably fractured health licensing boards.

For example, there is a common concern among many stakeholders including Greenlick, that the health licensing boards operate quite independently, each with its own statutes, review processes and strategies for disclosing disciplinary actions to the public including cases of substance abuse.

According to Amber Hollister, deputy general counsel in the Governor’s office, "oversight varies by board, sometimes members serve at the pleasure of the Governor, others do not. Some members can be dismissed for cause; others require due process. This system is too complex. We’re looking at ways to make it more efficient."

In spite of the Health Care Committee’s stated agenda and interest in moving beyond recent scandals, the nursing board’s new executive director, Holly Mercer, is determined to make the most of her visibility while also addressing ongoing problems with her board. And she has one idea in particular she hopes to introduce later this year.

"We need to simplify the issue, what our purpose is. Many boards have a similar mission: public safety," Mercer said.

She plans to adopt an approach introduced by the National Council of State Boards of Nursing called TERCAP, a database of nursing errors. TERCAP or Taxonomy of Error, Root Cause analysis allows state boards of nursing to share data on disciplinary actions and medical errors in order to help prevent future problems, not unlike the mission of the state’s Patient Safety Commission.

"My background is with the Occupational Health and Safety Administration. That approach is you can only get ahead of accidents if you find the root cause, by putting root cause analysis into practice," she said.

According to the National Council of State Boards of Nursing:

"there is much to learn from practice breakdown ... identifying, analyzing and tracking practice breakdown can identify generic patterns in error, risk factors, and system contributions identified to assist us in developing new approaches to prevent breakdown."

In addition to teaming with other licensing boards, Mercer hopes to collaborate with other groups focused on public safety such as the Patient Safety Commission to create centralized systems that would help health licensing boards, clinicians and health facilities learn from errors rather than focusing chiefly on disciplinary actions.

"We could input data from disciplinary cases, respecting confidentiality, and look at the root causes. With the history of cases we have we could do retrospective root cause analysis whether it’s fatigue, staffing levels, systems procedural or training issues – issues we can address with this data," Mercer said.

She said she plans to discuss these ideas with other licensing board executive directors but also with the Patient Safety Commission and members of the House Health Care Committee.

Greenlick expects that more than one bill will be introduced at the 2009 session, including an omnibus bill that would direct the licensing boards to include a certain number of citizen members or lay people and also a bill or bills that would allow for some standardization of policies and procedures also could centralize resources that might be shared by all boards.

For example, the so-called impaired professionals programs for each licensing board handles disclosure, discipline and monitoring of clinicians addicted to drugs and/or alcohol differently. For example, some boards are more transparent than others about publicly disclosing on their Web sites which licensees have substance abuse problems and the disciplinary action the board is taking. A quick comparison of the Medical, Dentistry and Nursing boards’ Web sites illustrate distinctly different approaches to disclosing and publicizing clinicians who have been subject to disciplinary actions and which have been suspended because of substance abuse, for example.

"It’s a question of what is disclosed to the public, what we tell citizens. The idea of these boards is to protect the public and improve the profession. How do we best structure these boards?," Greenlick said.

At the information hearings held about the licensing boards during the accelerated February session, Health Care Committee member Rep. Ron Maurer (R–Grants Pass) said "the dilemma we have is the protection of the public interest eliminating the perception that licensing boards are parochial and there to protect the interest of the profession." He added, "It’s clear we are stirring up a hornet’s nest."

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