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Loose Reins on Nurses in Drug Abuse Program

California's drug diversion program for nurses is seriously troubled.

| Mon Jul. 27, 2009 5:45 PM EDT

This story first appeared on the ProPublica website.

The morning of her second day at Starpoint Surgery Center in Studio City, nurse Melony Currier was found in the parking lot, passed out in her car.

Once roused, she was escorted to a drug-testing facility to provide a urine sample. In the restroom, she injected an anesthetic she had stolen from the surgery center, according to state records and a Starpoint official.

Currier, a participant in the state's confidential recovery program for impaired nurses, had failed repeatedly—and spectacularly—at rehabilitation, the records show.

Over 4 1/2 years, she'd been discovered high in her car at a Hollywood hospital, stolen anesthetics at a San Gabriel Valley hospital, been convicted of burglary after taking more drugs from the same hospital and flunked a drug test.

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Melony Currier was convicted of stealing drugs from the health facilities she worked at.Yet it wasn't until Currier shot up at the drug-testing facility in September 2006 that she was kicked out of the recovery program. Though her evaluators labeled her a "public risk," the California Board of Registered Nursing didn't impose discipline until 1 1/2 years later, leaving her free her to work without restriction in the interim, the documents show.

As the state begins overhauling regulation of California's 350,000 registered nurses, one of the board's most touted programs stands out as seriously troubled: drug diversion.

For years, nursing board officials have described diversion as a haven where good nurses can kick bad habits—without losing their licenses or their reputations.

But an investigation by ProPublica and the Los Angeles Times found participants who practiced while intoxicated, stole drugs from the bedridden and falsified records to cover their tracks.

Since its inception in 1985, more than half the nurses who have entered the program haven't completed it. Some who fail at diversion are deemed so incorrigible that the board labels them "public safety threats" (sometimes referred to as "public risks").

Based on a review of all nurses who faced disciplinary action since 2002, The Times and ProPublica identified more than 80 such nurses.

Dire as they sound, the labels do not trigger immediate action or public disclosure. Some nurses that the board considers dangerous continue to treat patients.

"These healthcare professionals may be in the operating room. They may be serving you when you're sick," said George A. Kenna, an addiction researcher at Brown University. "You just don't want that sort of person who's impaired" at the bedside.

Earlier this month, Gov. Arnold Schwarzenegger replaced most of the nursing board and demanded wholesale reform after The Times and ProPublica reported that it took more than three years on average to investigate and discipline nurses. The newly appointed board meets for the first time Sunday and Monday.

Confronted with reporters' findings on the diversion program this week, State and Consumer Services Secretary Fred Aguiar answered nearly every question by saying the program was part of a "broken system." Aguiar, whose agency oversees professional licensing, promised it would be on the new board's agenda.

In a separate interview, Carol Stanford, who has directed the diversion program since 2006, vigorously defended it. She said reporters were focusing too heavily on nurses who failed and not enough on those "saved" by diversion.

"You can pick apart any program," she said. "But what about the good? What about the other side of that story?"

Stanford said the program, which nearly 1,400 nurses have completed since 1985, had a graduation rate of 59% last year.

"Of course, nothing's perfect," she said. "We're working on whatever issues might be going on."

Diversion, embraced in various forms by many regulators, is intended to protect both professionals and the public.

See the Los Angeles Times and ProPublica database of more than 2,000 sanctioned nurses

Nurses enroll voluntarily, sometimes after a complaint, sometimes before they land in trouble. They agree to a host of conditions, such as submitting to random drug tests, seeking treatment and pledging not to work without permission.

In return, the board suspends the disciplinary process, keeping secret the nurses' participation in the program. With an annual diversion budget of nearly $3 million, it relies on an outside contractor to run the program day to day.

Because the program is confidential, it is impossible to know how many enrollees relapse or harm patients. But a review of court and regulatory records filed since 2002, as well as interviews with diversion participants, regulators and experts, suggests that dozens of nurses haven't upheld their end of the bargain. And oversight is broadly lacking.

Nurses must promise they won't work until they're sober, yet the board doesn't confiscate their licenses, nor does it ensure that addicts have kept their word.

Some covertly get jobs and steal drugs. The board typically doesn't find out until the nurse gets in trouble again.

Even after the program expels nurses and labels them public safety threats, the board takes a median 15 months to file a public accusation—the first warning to potential employers and patients of a nurse's troubles. It takes 10 more months to impose discipline, based on the Times/ProPublica review of disciplinary records filed since 2002.

After being kicked out of the diversion program, Tiffany Fahrni logged at least two drug-related arrests before the board filed an accusation against her.

Labor and delivery nurse Tiffany Fahrni, who originally enrolled in the program after stealing and using painkillers, said she was kicked out and labeled a "public risk" in December 2005 because she had worked without permission. But the board didn't file an accusation against her until January 2009.

During that time Fahrni logged at least two arrests on drug-related charges, though she says she did not work as a nurse.

"They terminate you. They say you're a danger to public society . . . then it takes three more years for them to do anything," she said.

The nursing board "should have been all over me like a hawk," Fahrni said. "An addict—you got to watch them like a baby."

Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego, said every "public risk" case should be pursued within five days.

Nurses "treat how many dozens of patients?" she said. With such delays, "the chance for harm to a patient is exponentially multiplied."

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