If you're a licensed certified registered nurse anesthetist (CRNA) in California, you've gone through quite a process just to get where you are. You've gone through years of education to obtain a bachelor's degree and a master's or doctorate, years of training in the field of nursing, specialized training in anesthesia, and perhaps many years of practice building your reputation in your field and the community. But that can all be jeopardized by a complaint lodged against you with the California Board of Registered Nursing (BRN).
The BRN takes professional misconduct allegations against CRNAs in California seriously, and you'll likely face a formal investigation and perhaps even a formal hearing and an appeal. If the BRN finds you responsible for the complaint, you could face a public reprimand, restrictions on your license and ability to practice, fines, or suspension or revocation. In some cases, you can even face criminal prosecution for allegations originally made to the California BRN. With such high stakes, you need the Lento Law Firm's experienced Professional License Defense Team to protect your rights and license from the beginning. Don't let the BRN steamroll you into a conviction. Call us at 888.535.3686 or contact us online to schedule a consultation as soon as possible.
Licensing for CRNAs in California
The California Board of Registered Nursing (BRN) is responsible for the licensing and professional standards for nurses in the state. Before becoming a CRNA in California, you must first be a registered nurse in California with an active and clear license. To become a registered nurse in California, “you must meet educational requirements, pass a criminal background check, and pass the national licensing examination.” To apply for licensing, you must:
- Apply online or with an application packet from the BRN,
- Send your application six to eight weeks before graduation,
- Have your school send your transcripts,
- Complete a fingerprint card and criminal background check, and
- Take the National Council License Exam (NCLEX).
You can meet the RN educational requirements in several ways in California, including:
- Obtain an associate degree in nursing,
- Complete a Bachelor of Science in Nursing,
- Complete an entry-level master's program in nursing,
- Complete 30 units of a program for Licensed Vocational Nurses, or
- Complete RN-level education and clinical experience as a military corpsman.
However, to be admitted to a CRNA program in California, you will also need:
- A Bachelor of Science in nursing or a similar field,
- At least one year of acute care nursing experience,
- A current license as a registered nurse in California, and
- Meet all the program-specific requirements, including class prerequisites.
To become a licensed CRNA in California, you must complete a master's or doctorate in an appropriate nursing program. There are eight accredited CRNA programs in California, including:
- University of Southern California,
- Loma Linda University,
- Kaiser Permanente School of Anesthesia,
- Samuel Merritt University,
- National University Fresno,
- Uniformed Services University of the Health Sciences,
- USUHS Detachment Naval Medical Center San Diego, and
- USUHS Detachment David Grant Medical Center Travis AFB.
According to the California Board of Registered Nursing regulations, “failure to report prior disciplinary action(s) and/or voluntary surrender(s) is considered falsification of application and is grounds for denial of licensure/certification or revocation of license/certificate.”
Professional Standards for CRNAs in California
In California, all nurses must comply with the state's Nursing Practice Act, which sets forth the responsibilities and scope of practice for RNs. The scope of practice for CRNAs in California is extensive and includes:
- Performing pre-anesthesia assessments and evaluations,
- Develop and implement an anesthesia plan,
- Performing general, regional, or local anesthesia with or without sedation,
- Performing regional anesthesia techniques,
- Applying appropriate invasive and non-invasive monitoring of a patient's physical status,
- Selecting and administering the appropriate anesthetics, accessory drugs, and fluids needed,
- Managing a patient's airway and pulmonary status,
- Discharging a patient from post-anesthesia care and providing follow-up care and evaluation, and
- Providing airway management, administering drugs and fluids, and using cardiac life support techniques in emergencies.
However, in California, CRNAs can administer anesthesia without a supervising physician. CRNAs and all RNs in California can face disciplinary proceedings for:
- Unprofessional Conduct: Unprofessional conduct in nursing includes:
- Failure to provide requested documents to the board,
- Failure to cooperate in board investigations, and
- Failure to report any felony or misdemeanor conviction to the board, including no contest pleas,
- Failure to report any disciplinary action by another licensing entity, the federal government, or the U.S. military, and
- Failure to comply with a court order.
- Gross Negligence: Gross negligence in nursing is “an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse.” This behavior includes “repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life.”
- Incompetence: Incompetence in nursing is “the lack of possession of or the failure to exercise that degree of learning, skill, care, and experience ordinarily possessed and exercised by a competent registered nurse….”
Some of the most common disciplinary actions for CRNAs in California arise from:
- Alcohol and drug abuse,
- Arrests like DUI,
- Gross negligence or incompetence that results in danger to a patient,
- Practicing without a license or exceeding the scope of a license,
- Fraud or theft,
- Violating probation conditions or restrictions on a nursing license,
- Mental impairment making it unsafe to practice,
- Patient neglect or abuse, and
- Criminal convictions related to the practice of nursing.
The Disciplinary Process for CRNAs in California
In California, the Board of Registered Nursing (BRN) is the first agency to handle complaints related to the state's Nursing Practice Act. Its regulations set forth the procedure for investigations and disciplinary actions for all of the state's registered nurses.
When the BRN receives a complaint from someone who believes a nurse has acted unprofessionally or unsafely, it will first review the allegations to determine the nature of the complaint. It will close the complaint if the allegations aren't related to the Nursing Practice Act. If the allegations are related to mental illness or a potential drug abuse problem, the CRNA will refer you to their intervention program. If the allegation in the complaint is related to the Nursing Practice Act, the CRNA will refer the case to investigators, law enforcement, or the California Department of Consumer Affairs Division of Investigation (DOI).
Some serious allegations are more likely to be referred to the DOI, such as:
- Serious patient harm, injury, or death,
- Mental or physical impairment of a nurse that could potentially harm the public,
- Sexual misconduct with a patient,
- Practicing under the influence of drugs or alcohol,
- Gross negligence,
- Unlicensed practice,
- Aiding and abetting unlicensed practice,
- Criminal violations, including fraud, financial abuse, possession of narcotics, and other serious crimes, and
- Compromising an exam.
BRN Intervention Program
The BRN intervention program handles complaints against nurses that involve mental illness or drug abuse. If you complete an intervention program, the BRN will close the complaint and not take additional disciplinary action against you. However, if you fail to complete the program, the intervention program may refer the complaint back to its investigators to complete the disciplinary process.
BRN Investigations of California Nurses
When a BRN investigator receives the complaint, they will first determine whether the complaint, if true, merits discipline. If not, they will close the case. If the complaint is minor, the investigator may issue a citation and a fine to the nurse and then close the complaint. This may happen if there is insufficient evidence, or the supporting evidence doesn't rise to the level of disciplinary action against your license.
If the investigator does decide to proceed with the investigation and the complaint is related to patient care, an expert witness will review the complaint and any related evidence. Sometimes, they may ask for an extended investigation to collect additional evidence. The expert will then decide whether you deviated from the accepted standard of care as a CRNA or if your actions involved gross negligence. After the expert witness review, the BRN will review the opinion and determine whether the board should close the case for insufficient evidence or forward the case to the California Attorney General's office.
Disciplinary Hearings for CRNAs in California
When the Attorney General's office receives the case against a CRNA, it can proceed in several ways:
- Dismiss the case for lack of evidence,
- Request a supplemental investigation to gather additional evidence regarding the complaint allegations, or
- Move forward and prepare an accusation against you that describes the charges against you.
If the Attorney General's office moves forward, you will receive written notice and have the opportunity to provide a Notice of Defense within 15 days. The case will then proceed to a hearing before the Office of Administrative Hearings, or you can negotiate a settlement agreement with the BRN. If you fail to provide a Notice of Defense or appear at the hearing, the BRN can revoke your license in a default judgment against you.
At the administrative hearing, the Attorney General's office will present the BRN's case against you, including witnesses and evidence gathered in the investigation. You and your attorney will be able to present a defense, including cross-examining witnesses, challenging evidence, and presenting your own evidence. The administrative law judge will prepare a written report with findings of fact and conclusions of law, making recommendations to the BRN. The parties can also come to a “stipulated agreement,” a consent agreement with both parties agreeing to the terms of discipline that the BRN will take against your license.
California Board of Registered Nursing Decision
After the administrative hearing, the BRN will review the administrative law judge's decision and vote to adopt, amend, or reject the decision or the parties' stipulated agreement. The board will also vote on the sanctions to impose against you, including a public reprimand, probation, suspension, or revocation of your license. In deciding whether to revoke or suspend your license, the BRN will consider:
- The nature of your alleged complaint and how serious it was,
- Whether there was any harm or potential harm to the public,
- Whether you harmed or could have harmed a patient,
- Whether you have prior disciplinary actions,
- Any evidence of mitigation,
- Any evidence of rehabilitation,
- If you have a criminal conviction, whether you've complied with the sentence and probation terms,
- Your criminal record,
- How long it's been since the office occurred, and
- Whether you've had the offense expunged.
In issuing its final decision, the BRN will release an order with the agency's conclusions of facts and law and the actions the agency is taking against your license. You can petition the agency for a reduction in your penalty or reinstatement of your license one year after the decision date.
Stipulated Settlement Agreements in California
The BRN may offer you a stipulated settlement agreement or consent agreement as an alternative to proceeding to a hearing. A stipulated agreement will contain an agreement by both you and the BRN concerning your punishment. It can contain agreements for fines, suspension, probation, restrictions on your license, supervised practice, or even surrendering your license in lieu of revocation. You should never sign a stipulated or consent agreement without the review of the Professional License Defense Team at the Lento Law Firm.
Appealing a CRNA License Disciplinary Action in California
After a formal hearing before an administrative law judge and a final disciplinary decision by the BRN, you still have the right to appeal to the courts under California law. The California Administrative Procedures Act allows judicial review of a final agency action after you've exhausted your administrative remedies.
You will begin the appeal process by filing a writ of administrative mandamus in the California Superior Court, asking the court to review the BRN's conclusions of fact and law. You must file this petition within 90 days of the BRN's final order.
It's important to understand that the California Superior Court will not review your case de novo. Rather, they will solely look at the record established in the hearing below. The court will consider:
- Whether there was a prejudicial abuse of discretion,
- Whether the agency exceeded its jurisdiction,
- Whether there was a fair trial, and
- Whether the evidence supports the findings.
The court will apply an “abuse of discretion” standard in its review. The court can order the case remanded to the BRN in these limited situations.
You Need Experienced License Defense on Your Side
The recommended default disciplinary action for all offenses in California is suspension or revocation of your license. So, if you're a CRNA facing a BRN investigation or hearing, you must take the allegations seriously. The consequences of failing to respond and vigorously defend yourself can be serious. That's why you need the Lento Law Firm's skilled Professional License Defense Team to protect your rights during the investigation, hearing, and appeals process. The Lento Law Firm Team has been helping licensed professionals like you nationwide for years. Call 888.535.3686 or contact us online to schedule your consultation.