As a Certified Registered Nurse Anesthetist (CRNA) in Oregon, you've earned the right to be listed among the ranks of Oregon's Advanced Practice Registered Nurses. You've met a rigorous set of education, testing, and licensing standards set by state law and administered by the Oregon State Board of Nursing. After working so hard to earn your CRNA license, you need to take it very seriously if your CRNA license is threatened by a misconduct complaint. The Lento Law Firm Professional License Defense Team understands how important your CRNA license is to you, and our experienced professional license defense attorneys are ready to help you protect it, along with your livelihood and your reputation. Call us today at 888.535.3686 or use our contact form to learn more about how we can help.
Nurses – including CRNAs – are licensed in Oregon by the Oregon State Board of Nursing (OSBN). The OSBN administers the Oregon Nurse Practice Act, which includes the laws and administrative rules that regulate CRNAs and other types of nurses in the state. The OSBN is also responsible for managing complaints filed against nurses, including investigations and disciplinary proceedings. It maintains an up-to-date public “verification portal” for every licensed nurse in the state, which discloses the type of license held by the nurse, the license status, any disciplinary actions taken against the nurse, and other information. In addition, the OSBN also regularly publishes a list of disciplinary actions taken against nurses, identifying the nurse by name and providing a short summary of the reasons for the discipline.
Ways the Oregon State Board of Nursing Can Discipline CRNAs
A complaint can be filed against a CRNA by practically anybody; the OSBN maintains a Complaint Portal that is available online. Typically, complaints are filed by patients, family members of patients, co-workers, and supervisors. According to the OSBN, information about who files the complaint, when it's made, what the allegations are, and who the complaint is filed against are kept confidential. If, after an OSBN investigation, the OSBN takes disciplinary action against a nurse and the nurse is found to have committed misconduct, the disciplinary action taken by the OSBN and the reasons for the discipline are made public.
The OSBN has a number of disciplinary tools at its disposal when a misconduct complaint against a CRNA has been substantiated, whether it's substantiated by the CRNA admitting to misconduct, or whether it's a determination made by an administrative law judge after a misconduct hearing. The types of discipline that can be imposed include:
- Reprimand. This is the lowest-level form of discipline. It notifies the CRNA that OSBN nursing “standards have been violated.” This does not affect the nurse's license, but it does become part of the CRNA's public record.
- Civil Penalty. Nurses, including CRNAs, found to have violated the OSBN's nursing standards can be fined up to $5000. A fine is often imposed in cases where a nurse has failed to renew their license on time and has continued working with an expired license or has continued working as a nurse even after their license was suspended or revoked.
- Probation. The CRNA is allowed to continue to practice but with certain conditions or restrictions on the type of work that they can do.
- Suspension. The CRNA is prohibited from working as a licensed nurse for a certain period of time. The nurse may also be required to take certain courses or other actions before the suspension will be lifted and their license reinstated.
- Revocation. The OSBN terminates the CRNA's license. In some cases, the OSBN may allow the nurse to reapply for a license, but only after a certain period of time (typically years) has passed.
In some cases, a nurse will voluntarily surrender their license rather than face serious discipline by the OSBN.
The OSBN does have an alternative to taking disciplinary action against a CRNA. In certain cases, the OSBN may refer a CRNA who is accused of misconduct to the Health Professional's Services Program (HPSP). This is typically done in cases where the nurse has been diagnosed with “a substance use disorder, mental disorder, or both types of disorders.” A nurse who has “successfully completed” a HPSP program and has “a reoccurrence of impairment” may be allowed one additional HPSP referral, but no more. HPSP referrals are not public, and the referral is not reflected on the CRNA's record.
What Standards Does the OSBN Expect CRNAs to Uphold?
In addition to maintaining practice standards for nurses and APRNs, the OSBN has a separate set of practice standards for CRNAs. These focus on practices that are specific to CRNAs, including:
- Defining what the “scope of practice” applicable to CRNAs is
- Having an “anesthesia plan” for each patient and adjusting the plan as necessary depending on the patient's status
- Using “advanced monitoring or other diagnostic technology” in connection with anesthesia and verifying that equipment is “maintained to current health care standards,” including having backup equipment available
- Providing proper “post-anesthesia care”
- Requiring the CRNA to comply with state and federal rules and regulations relating to their practice
- Making sure there are emergency supplies available
- Professionally monitoring patient status during a procedure where anesthesia is being administered
- Maintaining proper client records
Grounds for CRNA Discipline in Oregon
As noted, CRNAs are a specific type of APRN in Oregon. As a CRNA, you are licensed to perform anesthesia and have the authority to prescribe medication. Because of the additional practice scope, you can be disciplined for a wide range of alleged misconduct. This includes violations of your “authority to write prescriptions,” in particular by:
- Prescribing drugs that are not FDA-approved
- Prescribing for purposes other than “therapeutic or prophylactic” ones
- Writing a prescription for someone who is not your patient
- Prescribing drugs for your own personal use
- Administering or prescribing drugs in an unsafe manner
- Selling, buying, or trading drug samples
Of course, you can also be disciplined for misconduct that is not directly related to your prescription-writing authority. There is a wide range of misconduct that the OSBN considers to be “Derogatory to the Standards of Nursing,” and that can result in misconduct proceedings being instituted against you. Examples of misconduct include:
- “Violent, abusive, intimidating, neglectful or reckless behavior” towards patients
- “Dishonesty, misrepresentation, or fraud”
- Failing to meet “essential standards of acceptable and prevailing nursing practice”
- Actions that jeopardize patient safety
- Failing to put in place or appropriately modifying a patient “plan of care”
- Not respecting patient dignity in a wide range of areas – including age, race, gender, gender identity, sexual orientation, and others
- Engaging in “sexual misconduct” or “sexual abuse” involving a patient or failing to report the same when committed by someone else
- Disclosing personal patient information in violation of their privacy rights
- Failing to keep or update patient records, destroying patient records, or falsifying information in patient records
- Practicing when impaired by alcohol or drugs
- Developing an improper relationship with a patient or taking improper advantage of the nurse-patient relationship
- Providing false information to the OSBN in connection with your license application
These and other types of misconduct can result in a disciplinary investigation and proceedings being filed against you by the OSBN. If you learn that you're the subject of any kind of misconduct complaint, the Lento Law Firm Professional License Defense Team can help you understand the allegations against you and protect your rights during the investigation and disciplinary process.
Don't Assume the Truth Will Protect You from CRNA License Sanctions in Oregon
It's very natural when you learn that a misconduct complaint has been filed against you to think that you might be able to put a stop to everything by reaching out to OSBN and explaining your side of things. Unfortunately, that rarely works. OSBN has a legal obligation to investigate misconduct complaints and, where they appear to be substantiated, bring disciplinary proceedings or agree to a HPSP referral. If you contact them and make any statements about the allegations against you, that information may end up being used against you, especially if it happens to be inaccurate or is misunderstood by the OSBN official you're speaking with.
That's why it's generally much better to be working with – and through – an experienced license defense attorney whenever you have contact with the OSBN about a disciplinary matter. At the Lento Law Firm Professional License Defense Team, we understand when it is helpful to reach out and when it is not. We also know how to provide information in a way that minimizes the chances that it will contain inadvertent errors or that it will be misconstrued by the OSBN.
We'll also help you in situations where you may have to interact directly with an OSBN investigator, such as if you're interviewed about the alleged misconduct. By preparing you for the type of questions to expect, we'll help you understand what you're likely to be asked before the interview happens. We can also help make sure you only answer clear questions that you understand, and where the question (or your answer) isn't clear, we'll help correct those problems as well.
The Process After Someone Files a Complaint Against You
The OSBN has a process it follows when someone files a complaint against a CRNA or other type of nurse. The first step is to review the complaint to make sure it's about something that the OSBN regulates. For example, billing disputes or complaints about personality conflicts may not qualify as the type of issues that the OSBN regulates. If, after an initial review, the OSBN believes the matter is something it has disciplinary jurisdiction over, the following steps are what you can expect to happen:
- Investigation. The OSBN will assign the complaint to one or more investigators. The investigator will review the allegations and will conduct interviews and collect information from you, your employer, and possibly the patient and others about the matters raised in the complaint. If there appears to be enough information to support a disciplinary proceeding, the investigator is likely to meet with you to review the findings. It can be extremely helpful to be working with an experienced license defense attorney during this investigation stage, to help you understand the allegations against you and the potential sanctions that could occur, to help act as your interface when communicating with the OSBN, and where appropriate to help you negotiate with the OSBN.
- Stipulated Agreement. You are likely to be given an opportunity to agree to a certain set of facts and to accept some form of discipline offered by the OSBN. You don't have to accept what's offered, however. Depending on your situation, it may make sense for you to refuse the offer from the OSBN and to contest the charges. Working with one of the attorneys from the Lento Law Firm Professional License Defense Team can help you immensely when it comes to making these kinds of difficult choices.
- Notice. If you don't reach a stipulated agreement with the OSBN, the OSBN is likely to serve you with a notice that describes the misconduct you're accused of committing and the sanction that the OSBN is seeking to impose on you. It will also give you a timeframe for a hearing on the matter, which you must request or lose the right to have the misconduct case heard. That request must be received by the OSBN within 20 days of when its notice was mailed to you, so it's important not to ignore the notice or to wait too long to request your hearing.
- Hearing. Hearings take place before an Administrative Law Judge (ALJ) who is likely to hold one or more conferences before the hearing to set schedules and deal with requests for information from either side. Either side may also bring motions designed to reduce the issues to be considered at the hearing, which the ALJ may decide before the hearing or may choose to leave unresolved. At the hearing itself, the OSBN will have the chance to bring witnesses to testify against you and may also seek to introduce documentary evidence against you as well. Your attorney will be able to cross-examine the OSBN's witnesses and can argue against the OSBN's proposed evidence. You'll then have a chance to bring your own witnesses to testify and to introduce evidence on your behalf.
- Proposed and Final Orders. After the hearing is finished, the ALJ will issue a proposed order. The OSBN may adopt the proposed order or may reject it. Its decision will be issued as a Final Order.
- Appeals. If the Final Order is against you, you may appeal it to the Oregon Court of Appeals. If the Court of Appels does not agree with your appeal, you can appeal further to the Oregon Supreme Court.
The experienced attorneys from the Lento Law Firm Professional License Defense Team can help you at every step of the disciplinary process – from investigation, to negotiation with the OSBN, to a contested hearing, and to an appeal. While we strongly recommend retaining us early on, we've been able to help clients who tried defending themselves and were not successful and who turned to us for help with their appeals.
What Happens if You're Disciplined by the Oregon State Board of Nursing?
Depending on the type of discipline that the OSBN imposes on you, your life may change very little, or may change considerably. If you're reprimanded, your CRNA license remains in effect, and you should, in theory, be able to continue to work as a CRNA unless your employer elects to take action against you using the disciplinary sanction as an excuse. The reprimand, as with other OSBN penalties, will become part of your public license record.
The other types of OSBN penalties can result in more immediate problems. Probation can result in you having to modify your work to accommodate the conditions of the probation period. A suspension can leave you unable to practice as a CRNA until it's lifted. And if your license is revoked, you'll be unable to practice at all unless you successfully apply for reinstatement or a new license, typically only after several years. In addition, because state nursing boards communicate with one another, if you're disciplined in Oregon, almost every other state you may want to practice in will be aware of the discipline and may impose similar restrictions on your ability to practice there.
How the Lento Law Firm Professional License Defense Team Can Help
Our attorneys regularly represent nursing license holders in Oregon and other states in disciplinary proceedings. Whether you work in Portland, Salem, Corvalis, Eugene, Bend, Medford, or another city or town, our experienced license defense attorneys can help you protect your CRNA license. We will act as your interface with the OSBN investigator and officials; conduct our own investigation of the allegations, where that may be helpful; negotiate on your behalf with the OSBN; represent you and protect your rights at any hearing that takes place; and where necessary, draft and file appeals.
In almost every case, we find that the sooner our client contacts us, the better we're able to help them protect their license, their livelihood, and their reputation. Call us today at 888.535.3686 or use our contact form to set up a confidential consultation. We understand how much effort you've put into your CRNA license and career, and we're here to listen and help!
