As a Certified Registered Nurse Anesthetist (CRNA) in Rhode Island, you understand first-hand how much time, study, and effort it takes to meet the education, experience, and certification requirements set by Rhode Island's Department of Health (DOH) and administered by the Board of Nurse Registration and Nursing Education (the Board). Your career, your livelihood, and your reputation depend on your CRNA license being in good standing.
That's why if you learn that you are under investigation or that a complaint has been filed against you for misconduct, you need the help of an experienced license defense attorney. The Lento Law Firm Professional License Defense Team is here to help you defend your rights in any DOH investigation or disciplinary proceeding. Call us today at 888.535.3686, or use our contact form to learn more about how we can help.
Ways the Rhode Island Department of Health Can Discipline CRNAs
The Rhode Island Department of Health reviews and will take action when complaints are filed against CRNAs by patients, family members, co-workers, supervisors, or anyone else alleging misconduct. While disciplinary action can follow when the complaint alleges that the CRNA committed any of a number of types of misconduct, the DOH won't pursue complaints based on “fee or billing disputes” or those “related to personality conflicts or poor customer service.”
Complaints must be filed “under penalty of perjury,” meaning that if someone knowingly files a false complaint against you, they could be subject to criminal penalties. The person filing the complaint may ask the DOH to keep their identity confidential, though doing so can make investigating the matter more difficult for the DOH; for example, if a patient is filing the complaint and asks the DOH to keep them anonymous, the DOH won't be able to request the medical records for that patient, since doing so will disclose their identity.
Following an investigation of the complaint – during which you, your colleagues and supervisors, your patient, and others may be contacted and questioned by the DOH investigator – the DOH will make a decision about what if any, further action to take. The investigation may exonerate you, in which case the matter will be closed.
If the allegations are substantiated, in whole or in part, the DOH may choose not to bring disciplinary proceedings against you but may issue you a “letter of concern,” which is the least severe form of discipline, though it may still appear on the DOH's public licensee directory in connection with your license information.
More serious sanctions may result if the DOH issues a complaint against you. In that case, whether as the result of a consent agreement or after a disciplinary hearing, the DOH can discipline in one of the following ways (assuming the allegations against you are substantiated):
- Letter of Reprimand. This doesn't affect your ability to practice but is made public and may direct you to take – or to stop taking – certain actions if you want to avoid further discipline.
- Probation. You'll typically be required to meet certain conditions for a period of time, such as to make regular reports to the DOH, in order to be able to continue to practice.
- Summary Suspension. This can happen almost immediately, without a hearing, if the DOH believes your actions constitute an “immediate danger to the public.” A hearing must then be held within 10 days of the suspension.
- Suspension. This can happen on consent, or after a hearing. A suspension is often limited in terms of time and typically will require you to take some kind of action, such as taking and passing courses, before your license will be reinstated.
- Revocation. The most severe penalty is when your CRNA license is revoked.
All of these disciplinary outcomes are public record. They will appear as part of your public license record when anyone conducts a license verification search and will also be available to the public via the DOH's Health Disciplinary Action Search site.
In some cases, typically those relating to alcohol or drug abuse, or where the CRNA holder is suffering from a diagnosed mental condition, the Board may elect to provide a “nondisciplinary alternative” instead of publicly disciplining the license holder. If that happens, the license holder must agree “to voluntarily participate in a program of treatment and rehabilitation.” The records relating to your participation in the non-disciplinary program will be kept confidential, except that your employer will be informed “to ensure adequate worksite monitoring and compliance.”
What Standards Does Rhode Island Expect CRNAs to Uphold?
CRNAs are considered “Advanced Practice Registered Nurses” (APRNs) by the Rhode Island DOH. To be licensed and entitled to designate yourself as both an APRN and a CRNA, you've already had to meet a number of strict requirements relating to education, training, and certification. In order to keep your license, you need to complete at least ten hours of approved continuing education hours relating to nursing practice.
You are also required by Rhode Island law to follow certain standards for CRNA practices, specifically those issued by the American Association of Nurse Anesthesiology. These cover topics such as patient's rights; procedures to follow before a patient is anesthetized; securing patient consent for anesthesia procedures; properly documenting the anesthesia procedure and care; correct use of anesthesia equipment; monitoring the patient during and after the anesthesia is administered, and responding properly to alarms; preventing infections; transferring care of the patient post-procedure; and other areas relating to patient care and safety.
Grounds for CRNA Discipline in Rhode Island
- a CRNA licensed to practice in Rhode Island, you can be disciplined for a number of different types of misconduct. These include:
- Submitting fraudulent or deceitful information in connection with your license application;
- Alcohol or drug abuse, in particular being “Habitually intemperate” or “addicted to the use of habit-forming drugs;”
- Being diagnosed as “mentally incompetent;”
- Abandoning a patient;
- “Making and filing” false reports or records in connection with your practice;
- Disregarding “standards of nursing practice;”
- Failing to provide “succeeding nurses” with “appropriate details” relating to a patient's nursing needs;
- Being found guilty of “a crime of gross immorality.”
When a complaint is filed against you, the DOH will investigate it and will confirm whether or not it is the type of complaint that the DOH acts on. If so, and if the complaint appears to make credible allegations of misconduct against you, the DOH will conduct an investigation. If you receive a notice that the DOH is conducting an investigation of a complaint made against you, the notice should also identify what the claim is alleging. This is when you should seek help.
Retaining an experienced attorney from the Lento Law Firm Professional License Defense Team early on means we can help you respond to information and interview requests from DOH investigators, be with you during any DOH investigator interview to make sure you only answer clear questions that you understand, and in some cases, conduct our own investigation to uncover helpful facts or evidence that the DOH may miss. Our professional license defense attorneys know the laws, rules, and procedures that apply when the Rhode Island DOH investigates and begins disciplinary proceedings against a CRNA. We can help alleviate much of the stress and uncertainty that comes with being under investigation or being the target of a disciplinary proceeding.
Don't Assume the Truth Will Protect You From CRNA License Sanctions in Rhode Island
One very natural reaction to learning that the DOH is investigating you for alleged misconduct is to want to contact the investigator to try to “clear things up” because “it's all just a misunderstanding.” Unfortunately, this approach rarely works and, in some cases, can even backfire. The DOH has a legal obligation to conduct a full investigation of relevant complaints against CRNA license holders, and once that process starts, it will continue until the DOH has fulfilled its duty. Reaching out to a DOH investigator to try to put a quick stop to the process almost never works and could result in you providing the investigator with confusing or misleading information that might be used against you.
What can be very helpful is to retain an experienced professional license defense attorney who can help you understand the investigation and disciplinary process and, where appropriate, contact the DOH on your behalf. The Lento Law Firm Professional License Defense Team has helped nursing license holders all over the US, including in Rhode Island, deal with the stress and uncertainty of misconduct investigations and disciplinary proceedings. We can help from the early stages.
If you're going to be interviewed by an investigator, we can help you prepare for what can sometimes be a stressful meeting. If the investigator asks you an unclear question, or a question you don't understand, we can help correct the situation. Nobody benefits if you respond to a question that's not clear, particularly if your response doesn't really answer the question or includes information that wasn't asked for. Having one of our attorneys by your side will help you only answer clear questions that you understand – resulting in a higher quality interview.
The Process After Someone Files a Complaint Against You
The first thing that happens when someone files a complaint against a CRNA is that the DOH will review it to make sure it is the type of matter they can discipline for – as noted above, billing disputes, customer service issues, or complaints about personality clashes are not ones they regulate. Assuming it is the kind of matter that falls within the DOH's disciplinary authority, they'll open an investigation and assign it to one or more DOH investigators.
You may be contacted and asked to provide a written response to the allegations, and you may also be interviewed by a DOH investigator. The DOH may get copies of the health care records that relate to the matter and may even interview your co-workers, supervisors, or others who may have been present at the time the events described in the complaint occurred. This process can stretch on for weeks or even months.
Once the investigators have completed their work, the DOH will review their findings and decide whether to file formal charges against you. If they decide not to proceed, the matter will be closed, and no further action will be taken by the DOH in connection with the complaint. In other cases, the DOH may issue you a letter of concern. In more serious cases, the DOH will bring a formal complaint against you.
You'll be notified of the formal complaint, of course. The DOH may also provide a suggested resolution of the charges, which, if accepted, would quickly end the matter – but would likely result in the suggested resolution (such as a reprimand, probation, or suspension) appearing against your public license record. If you've retained one of the experienced attorneys from the Lento Law Firm Professional License Defense Team, your attorney will help you decide whether to accept the resolution proposed by the DOH or whether to contest the matter further.
It may make sense, depending on the situation, to meet with a representative from the DOH to discuss alternative ways to resolve the disciplinary matter. Here too, you'll benefit by having the advice of one of the Lento Law Firm Professional License Defense Team's experienced attorneys. We have helped others in your shoes and can propose ways to resolve disciplinary disputes that can protect your license and your livelihood. Or, again, with our experienced advice, you may decide to contest the charges and continue to the hearing stage.
If the matter moves to the hearing stage, the process will be governed by procedures described in Rhode Island law. These include a pre-hearing conference, which will be before the Administrative Hearing Officer (AHO) assigned to the matter and which may cover a variety of issues, such as what is in dispute, what the schedule will be, how long the hearing is likely to take, whether there are any points of agreement between you and the DOH, and other types of so-called housekeeping matters.
It may also be a chance for you, your attorney, and the DOH representative to discuss possible settlement scenarios again. Contrary to what many people think, proposing or discussing a settlement isn't a sign of weakness; a good attorney will always seek to find the best result for their client, and in many cases, the best result comes from a settlement. In other cases, particularly where the evidence against the DOH's allegations is strong, it may make more sense to defend against the charges.
There may be a period of discovery where both sides exchange information relevant to the dispute. You or the DOH may also file a motion with the AHO, typically seeking to remove or resolve certain issues before the hearing.
The hearing will proceed as many court cases do: the DOH will go first, and your attorney will be able to cross-examine their witnesses and, where appropriate, argue against their proposed written or documentary evidence. Then, your side will present your defense, which can include witness testimony and your own documents. Closing arguments may follow at the hearing, or the AHO may ask that they be submitted in writing by a certain date.
The AHO will issue a written decision. It will include the facts that the AHO is relying on, the law that the AHO is applying to those facts, and the resulting conclusions. Note that until that decision is issued, it is still possible to enter into a “consent order” with the DOH that will resolve the matter based on a set of agreed facts set forth in the order. The AHO will review any proposed consent order and may accept it or reject it.
Depending on the outcome, either side has the right to appeal the AHO's decision to the Rhode Island Superior Court in Providence. Appeals need to be filed within 30 days of when the AHO issues the decision. Our experienced attorneys understand the appeal process and are available to discuss it with you and advise you of your options at this stage as well.
What Happens if You're Disciplined by the Rhode Island Department of Health?
As noted above, disciplinary rulings against you become part of your state license record, and anyone conducting a search of your license record or of disciplinary matters on the DOH website will see that you've been disciplined, what the discipline is, and in most cases a summary of why the discipline happened (though in many consent cases, the information may be limited to a notice that you and the DOH have consented to some particular form of discipline).
How the Lento Law Firm Professional License Defense Team Can Help
Whether you work in the Providence area or another part of Rhode Island such as Woonsocket, Burrillville, Newport, or Westerly, the Lento Law Firm Professional License Defense Team can help you if your CRNA license is in jeopardy as the result of a misconduct complaint filed against you. Whether you've just been notified about the complaint, or formal charges have been filed against you, or even if a decision has been rendered against you and you're considering an appeal, we can help. Our experienced attorneys understand the CRNA licensing laws in Rhode Island, the DOH disciplinary procedures and standards, and the Rhode Island court procedures applying to appeals of disciplinary decisions.
We'll work with you to help you understand what's going on and will take much of the day-to-day burden of dealing with the process off of your hands. If your CRNA license is in jeopardy, call us today at 888.535.3686 or use our contact form to set up a confidential consultation. You have a right to a strong defense when misconduct allegations are made against you; let the Lento Law Firm Professional License Defense Team help you protect your license, your livelihood, and your reputation.
