Nurse practitioners occupy an increasingly critical role in the nation's healthcare delivery system. With doctor and nurse shortages, nurse practitioners can bridge the boundaries between the two professions to provide prompt, integrated, efficient, competent, and lower-cost care both in the medical management and nursing care of patients. However, in their peculiar position, nurse practitioners can also get caught between a rock and a hard place, facing patient abandonment disciplinary charges before their state board of nursing. If you find yourself in that precarious position, retain the Lento Law Firm's premier Professional License Defense Team for your best outcome to those patient abandonment allegations. Don't ignore the disciplinary charge. Patient abandonment is a serious nurse practitioner issue. Call 888.535.3686 or complete this contact form now for the premier defense representation you need.
State Nursing Board Disciplinary Authority
To practice their valuable and rewarding profession, nurse practitioners must obtain and maintain their state nursing board license in good standing. You cannot practice as a nurse practitioner without your nursing license. Practicing without a license would subject you to further discipline and could subject you to civil injunction and even criminal charges, fines, and incarceration, depending on the state that has licensed you. Don't doubt the authority of your state board of nursing to discipline you for patient abandonment. Instead, get our skilled defense help.
The Arizona Nurse Practice Act is a good example. Arizona's Nurse Practice Act establishes the Arizona State Board of Nursing not only to license nurses for practice but also to regulate and discipline those licenses for nursing misconduct like patient abandonment. The Arizona Nurse Practice Act's Section 32-1663 authorizes nurse discipline, while Section 32-1666 makes it unlawful to practice without a current nursing license.
Alabama's Nurse Practice Act provides another apt example. Alabama's Nurse Practice Act authorizes the Alabama Board of Nursing to promulgate administrative regulations governing the practice of nurses licensed in the state. The Alabama Board of Nursing has accordingly adopted its Rule 610-X-8-.03 expressly prohibiting a nurse from “abandoning or neglecting patients,” among a long list of other grounds for license suspension, revocation, or other discipline.
State Nursing Board Disciplinary Procedures
Just because your state nursing board has charged you with patient abandonment does not mean that you will suffer disciplinary sanctions such as suspension or revocation of your nursing license. Charges are simply allegations. Your state nursing board's disciplinary officials may fully expect you to answer the charges with convincing evidence and explanations for your alleged patient abandonment. We can help you make that defense showing. Don't take the charges lightly. Patient abandonment is a serious charge because of its risk of patient harm. But also, don't assume you must suffer sanctions. Your state nursing board must provide you with procedural protections before depriving you of your constitutionally protected property and liberty interests in your nursing practice.
The Arizona Nurse Practice Act is once again a good example. The Arizona Nurse Practice Act's Section 32-1664 details the elaborate procedures that the Arizona State Board of Nursing's disciplinary officials must follow when seeking license suspension or revocation for nurse misconduct like patient abandonment. Those procedures include fair notice to the accused nurse of the alleged wrong, enough for the nurse's attorneys to prepare the nurse's defense. The procedures also guarantee a formal hearing before a qualified and impartial decision maker, the discovery of the nursing board's incriminating evidence, and the right to present and challenge witnesses at the hearing. Let us help you invoke your state nursing board's equivalent procedures for your best outcome to patient abandonment disciplinary charges.
State Nursing Board Disciplinary Sanctions
You should also not assume that your stakes in your disciplinary charges alleging patient abandonment are an all-or-nothing proposition, that you will either lose your license entirely and forever or keep your license unfettered. In fact, state nursing boards generally have broad discretion to impose a wider range of progressive sanctions. Those sanctions can be as little as a private reprimand, as draconian as a permanent license revocation, or several other things in between. The above Alabama Board of Nursing Rule 610-X-8-.03 is a good example, authorizing the Board to “deny, reprimand, fine, probate, suspend, revoke, and/or otherwise discipline” the accused nurse's license. Similar state nursing board provisions in other states indicate this fuller range of potential disciplinary sanctions:
- caution or warning;
- correction;
- private reprimand;
- public reprimand;
- probation;
- fine, restitution, and cost of the proceedings;
- remedial education and training;
- physical examination, diagnosis, and treatment;
- mental examination, diagnosis, and counseling;
- referral for substance abuse treatment;
- monitoring and reporting;
- license limitation or restriction;
- license suspension for definite or indefinite duration; and
- license revocation.
While this long list of potential sanctions surely looks concerning, the nursing board's discretion to choose among its many potential sanctions and the progressive nature of the sanctions gives our attorneys the opportunity to advocate for remedial measures. Your sanctions goals should include avoiding discipline that interrupts your nursing practice, affects your nursing employment, or reduces your professional support, security, and reputation. We can help you pursue and achieve those goals.
Nurse Practitioner License Reinstatement
All may not be lost if you have already suffered suspension or revocation of your nurse practitioner license. Some state nursing boards have state legislature authority to grant a nurse a new or reinstated license after a license suspension or revocation. In those cases, the nursing board typically has discretion whether to grant the reinstatement privilege. That discretion means that you would need to make a sound showing of the board's better interest in granting reinstatement, including that your resumed nurse practitioner services would subject no patient to risk of abandonment or other misconduct. You would have to make a convincing application and may have to appear at a board hearing. We can help you do so. Do not attempt license reinstatement without skilled attorneys services and, in doing so, lose your one good opportunity to resume nurse practitioner practice.
The Florida Nurse Practice Act provides a good example of reinstatement opportunities. The Act's Section 464.018 implies that the Florida Board of Nursing has license reinstatement authority by stating the conditions under which the Board must not reinstate a license previously revoked, such as after three or more drug convictions or when the candidate has not yet shown restored fitness for nursing practice. Alabama's Nurse Practice Act likewise authorizes the Alabama State Board of Nursing to reinstate a revoked license. The Alabama State Board of Nursing has exercised that legislative authority under its Rule 610-X-8-.03, barring resumed practice unless and until the Board offers license reinstatement. Let us investigate your case for reinstatement if you have already lost your license due to patient abandonment charges.
Defining Nurse Practitioner Patient Abandonment
How your state nursing board's disciplinary officials define a nurse practitioner's abandonment of a patient may go a long way toward determining the outcome of your disciplinary charges. State nurse practice acts and state nursing board administrative rules and regulations tend not to define patient abandonment, instead leaving the definition to nursing standards, practices, and customs. Generally, though, to abandon a patient means that the nurse practitioner terminated the patient relationship improperly, exposing the patient to preventable disease progression or other loss or injury. That definition states or implies these several separate elements, each of which your disciplinary officials may have to prove with credible evidence to establish their charge against you:
- you had a patient relationship with the involved patient or patients;
- you terminated that relationship;
- your termination of the patient relationship violated nursing practices, customs, and standards;
- your termination of the patient relationship occurred at a time when the patient had a critical or substantial need for nurse practitioner services that the patient could not meet through other readily available means;
- your termination of the patient relationship caused injury or other loss to the patient or exposed the patient to substantial risk of loss or injury;
- your termination of the patient relationship was otherwise preventable, including that you remained qualified, fit, and competent to provide the terminated nurse practitioner services.
Defenses to Nurse Practitioner Patient Abandonment
Remember, just because you face state nursing board disciplinary charges for patient abandonment does not mean that you must suffer discipline. The disciplinary officials charging you with patient abandonment may not have substantial credible evidence of the alleged wrong. They may even lack admissible evidence and doubt their own allegations, instead hoping that you ignore and default on the charges or admit to the charges. They may alternatively expect you to retain us to present clear evidence that you committed no wrong. Disciplinary officials can, at times, be arbitrary and capricious, but to the contrary, they are often reasonably understanding and even compassionate. Your disciplinary officials may highly value your nurse practitioner services and hope to preserve them for the benefit of the patient and the public. They simply have a duty to ensure patient safety. We can help you make that showing of your safety and fitness for nurse practitioner practice, asserting whichever of the following defenses your evidence and circumstances may support:
- that you were not the complaining or involved patient's nurse practitioner;
- that the patient or other reporting or complaining witness misidentified another nurse practitioner or physician as you, and that any abandonment was the fault of that other practitioner, not your fault;
- unexpected personal or professional circumstances suddenly disqualified you from continuing to serve as the patient's nurse practitioner, such that you could not lawfully continue to serve through no fault of your own;
- your employer or supervisor, the facility manager, or another administrator or healthcare professional had the responsibility to inform the patient of your withdrawal and arrange for substitute services but carelessly failed to do so;
- that the involved patient had no emergent or critical medical need, such that your termination of the relationship had other grounds and does not constitute abandonment;
- you followed proper practices when terminating the patient relationship such that the termination was not improper;
- the patient suffered no harm, loss, or injury from your withdrawal, nor any risk of harm, loss, or injury;
- you simply did not abandon the patient but instead remained available and willing to serve, but the patient or another authorized patient representative refused services and terminated the relationship;
- changes in the patient's medical conditions made you no longer qualified to continue with your nurse practitioner care such that you had to terminate the relationship;
- your employer terminated your employment or the facility terminated your practice privileges such that you were barred from continuing the patient relationship.
Examples of Nurse Practitioner Patient Abandonment
The particular circumstances surrounding your conduct, giving rise to the state nursing board's allegations that you abandoned a patient or patients, are very likely to influence the outcome of your disciplinary charges and whether the board imposes a sanction. Nurse practitioners can abandon patients or face accusations of abandonment under several different circumstances, each with their own special considerations. The following examples of nurse practitioner patient abandonment may help you appreciate the investigation our attorneys will take and the strategic approaches to your defense that they may pursue:
- the nurse practitioner suffers the serious illness, severe injury, or death of a close family member for whom the practitioner has care responsibilities, suddenly distracting and disabling the practitioner from continued practice;
- the nurse practitioner suffers the practitioner's own serious illness, severe injury, or other disabling or impairing event, suddenly preventing the practitioner from continued practice;
- the nurse practitioner suffers separation, divorce, child custody dispute, home fire or flood and destruction, or other sudden, overwhelming personal event distracting the practitioner from patient responsibilities;
- the nurse practitioner takes a vacation or other extended break from practice, failing to notify patients and arrange for substitute nurse practitioner coverage;
- the nurse practitioner had a workplace personality conflict or other workplace or management dispute that discouraged the practitioner from fulfilling work assignments and schedules, leaving patients unattended, or
- the nurse practitioner had a disagreement with the involved patient and decided to forgo continued care out of hard feelings from that disagreement.
Other Factors Affecting Nurse Practitioner Patient Abandonment
State nursing board disciplinary officials have some discretion in whom they charge with patient abandonment and under what circumstances. The above examples suggest some of the relevant charging factors. Charging criteria can be numerous and subtle. They can also be influential not only in which nurse practitioners get charged but also in the outcome of those charges. We can help you evaluate charging factors and make your best case on the available defense evidence to defeat those charges. Consider these potential aggravating and mitigating factors:
- the particular treatable disease or condition from which your patients suffered at the time you allegedly abandoned them;
- the extent to which your alleged abandonment accelerated the course of that treatable disease or condition;
- the extent to which your continued nurse practitioner services could have slowed, reversed, or healed the patient's treatable condition or disease;
- the particular reason or motivation you had for terminating the patient relationship;
- whether your reason or motivation for terminating the patient relationship was something you brought on yourself or was instead imposed by events and conditions beyond your control;
- how many patients have you allegedly abandoned;
- whether you had previous incidents of patient abandonment or other misconduct;
- whether your alleged patient abandonment adversely affected the facility in which you practiced;
- whether your alleged patient abandonment adversely affected your employer;
- whether your alleged patient abandonment subjects you, colleagues, the facility, or your employer to civil liability;
- whether you admitted, reported, and sought to correct your patient abandonment or, conversely, falsely denied it or attempted to conceal it;
- whether your continued nurse practitioner services to the involved patient or patients would have provided fit, competent, and qualified services or, conversely, would have been unlawful; and
- whether your alleged patient abandonment subjected the medical profession to public ridicule, contempt, or scorn due to public disclosure of the incident.
Types of Patient Harm from Nurse Practitioner Abandonment
The type of harm, loss, or injury that the patient or patients allegedly suffer from your patient abandonment may likewise go a long way toward influencing the disciplinary charge, disciplinary proceeding, and disciplinary sanction. Once again, our attorneys can investigate the evidence of patient harm, loss, or injury to help you make your best defense of the disciplinary charges. It may be the case that the patients in your matter suffered no harm, loss, or injury and no substantial risk of harm, loss, or injury, which would be the best defense relative to this issue. Nurse practitioners may, though, cause these kinds of patient harm, loss, or injury when abandoning a patient or patients:
- patients suffering unnecessarily from disease or injury without available analgesic relief;
- patients worsening in their diseased or injured condition for lack of prompt and continuous examination, diagnosis, and treatment;
- patients failing to promptly recover from their diseased or injured condition when healing and recovery were possible from continued nurse practitioner services;
- patients failing to obtain or continue preventative medications for lack of nurse practitioner examinations, diagnosis, and prescription, leading to the contracting or worsening of disease;
- patients failing to promptly obtain necessary or helpful admission to other facilities for special treatment and care, for lack of nurse practitioner evaluation, documentation, communication, and recommendation;
- patients failing to promptly obtain necessary or helpful assistive devices or equipment due to lack of nurse practitioner evaluation, documentation, communication, and recommendation;
- patients failing to obtain prompt hospital or facility discharge for lack of nurse practitioner evaluation, documentation, communication, and approval, leading to increased costs of stay; and
- sudden and irreversible onset of serious medical events such as strokes, seizures, and heart attacks due to the interruption of nurse practitioner services and medical care.
The Role of the Defense Attorney
The above discussion should already have shown you that our attorneys play a critical role in your strategic and effective nurse practitioner license defense. Do not proceed on your own or with unqualified criminal defense attorney representation. Instead, trust our highly skilled and experienced attorneys to make the right investigation, advocacy, negotiation, and other actions for your best outcome to patient abandonment charges. We may take any or all of the following actions in your defense, depending on the nature, circumstances, and status of your case:
- obtain a more detailed specification of the alleged charges so that we can help you prepare an effective defense;
- identify, acquire, organize, and present your best defense evidence;
- invoke early informal resolution conferences and conciliation conferences to obtain voluntary charge dismissal;
- propose and negotiate remedial measures that you have already completed or can readily complete in lieu of punitive sanctions;
- if disciplinary officials insist on proceeding with formal charges, then invoke your administrative hearing;
- present your defense testimony, witnesses, and other evidence at the formal hearing;
- cross-examine adverse witnesses and challenge other incriminating evidence at the formal hearing;
- obtain, evaluate, and advise you on the hearing decision, including whether it leaves a record of discipline affecting your employment and future;
- communicate, advocate, and negotiate with your nurse practitioner employer to preserve your employment before, during, and after the disciplinary proceeding;
- if you have already lost your hearing, then prepare and pursue available appeals and
- if you have already lost your appeals, then seek available civil court review and reversal.
Premier Nurse Practitioner License Defense
If you are a nurse practitioner facing patient abandonment disciplinary charges, retain the Lento Law Firm's premier Professional License Defense Team for your best achievable outcome. Our highly skilled and experienced attorneys know the administrative law, rules, customs, and procedures that apply in professional license proceedings, which differ from court rules, conventions, customs, expectations, and procedures. We know how to prepare and present your best administrative license defense, protecting and preserving your nurse practitioner license, employment, and career. Call 888.535.3686 or complete this contact form now for our premier license defense services.
