The demand for health care continues to rise in this country and the Commonwealth of Kentucky is no different. This demand requires more medical professionals, especially nurse practitioners. These unique professionals have a greater scope of practice compared to registered nurses. But this greater possibility comes with a greater chance of a complaint for professional misconduct, whether from a patient or colleague.
If you're a nurse practitioner in Lexington, Louisville, Paducah, or any other part of the state facing disciplinary action, don't handle this yourself. Contact the Lento Law Firm to talk to its Professional License Defense Team. We can help assess your case and develop a defense strategy that ensures the best outcome for your situation. You can call us at 888-535-3686 or use our online contact form to schedule a consultation.
The Kentucky Board of Nursing's Jurisdiction
The Kentucky Board of Nursing (KBN) regulates most nurses in Kentucky, including nurse practitioners. This means enforcing Kentucky's Nurse Practice Act (NPA), which outlines:
- Scope of nursing practice
- Qualifications for licensure as a nurse practitioner
- Nursing titles that may be used
- Punishments for violating nursing law
While the KBN may spend much of its time handling the renewals and initial granting of nurse licenses, part of its duties extend to investigating possible misconduct and handing down discipline if a nurse practitioner violates the NPA.
Because Kentucky is a mandatory reporting state, anyone with knowledge about possible violations of the NPA has a legal duty to report it to the KBN. This includes your employer, fellow nurses, and other colleagues and peers. As a result, if you make a mistake on the job that violates the NPA, there's a fair chance that someone is aware of what you did and may report it to the KBN. If this happens, an investigation may begin, and depending on what's found, you could be subject to one or more forms of disciplinary action.
The Disciplinary Process for Nurse Practitioners in Kentucky
They might sometimes seem harsh, but the reason nurse practitioners in Kentucky face potential punishment for violating the NPA is twofold. First, it's to protect the public. The sanction may remove the nurse practitioner from practice and, therefore, make it less likely they will do something that hurts a patient or other member of the public.
Second, it's to maintain the integrity of the profession. Even if the misconduct doesn't directly harm anyone else, it can lower the standing of nurses within the public eye. A loss of trust in nurse practitioners can undermine their mission and make it harder for them to provide care to their patients.
Whether it's to protect the public or the profession itself, the disciplinary process for nurse practitioners in Kentucky usually starts when someone files a complaint.
The Complaint
After someone files a complaint, the KBN will review it and confirm that it falls under the KBN's jurisdiction. If the KBN has jurisdiction, it will see if there's enough evidence to warrant an investigation. The types of conduct that could result in a complaint and investigation are numerous but can include things like:
- Violating patient confidentiality.
- Failing to properly renew or otherwise maintain a valid nursing license.
- Having an inappropriate relationship with a patient.
- Engaging in unethical conduct.
- Not completing the necessary continuing education requirements.
- Behaving in a way that constitutes unprofessional or unethical conduct.
- Providing substandard care to patients.
- Falsifying patient records or other medical records
- Committing any crime that adversely affects the nurse practitioner's ability to safely treat patients.
- Abusing drugs or other substances that negatively affect the nurse practitioner's ability to safely and effectively treat patients.
- Suffering from physical or mental health issues that affect the nurse practitioner's ability to safely and effectively treat patients.
To help decide if there's enough evidence to justify further investigation, the KBN will send a letter to the nurse practitioner notifying them of the complaint. Included in this letter is a copy of the complaint and an Official Response Form. This is the nurse practitioner's opportunity to give their side of the story, and it must be sent to the KBN within 30 days of receiving a copy of the complaint.
The Investigation
If the KBN concludes an investigation is needed, in addition to asking for the nurse practitioner's version of the facts, the KBN might also request an informal meeting. The nurse practitioner may attend alone, but it's strongly recommended they have an attorney present during this meeting.
The KBN may also review medical records and other documentation, as well as interview anyone else who has knowledge about what allegedly occurred. In most cases, the nurse practitioner can continue working while the KBN investigates a complaint. Two exceptions to this are if the nurse practitioner doesn't have a valid license or if the allegations create a concern that the nurse practitioner may be a threat to the public. In this rare situation, the KBN may temporarily suspend the nurse practitioner even though the investigation isn't complete.
Immediate Temporary Suspensions
A nurse practitioner may temporarily have their license suspended if the KBN believes there's an urgent need to protect the safety of the public. An immediate temporary suspension may also occur if the nurse practitioner fails to pay a license fee, fails to pay court-ordered child support, or fails to complete an evaluation ordered by the KBN. This can include a psychosocial, psychosexual, substance abuse, physical, or neuropsychological evaluation.
The nurse practitioner has the burden to choose and pay for the evaluator. The KBN may order this evaluation if there's “reasonable cause” to believe the nurse practitioner can't practice with reasonable skill or safety or if the nurse practitioner is abusing drugs or alcohol.
Immediate temporary suspensions are scary because they can occur through unilateral action by the KBN. In other words, the nurse practitioner never gets a chance to defend themselves before they have their license suspended.
How Complaints Resolve After the Investigation
After the Kentucky Board of Nursing finishes the investigation, there are four possible outcomes for the complaint. First, the complaint is closed because there's no basis for the allegation, and therefore, the KBN concludes that the claim is unsubstantiated.
Second, the complaint results in a Letter of Concern. Here, the KBN finds there's a basis for the allegations in the complaint, but it doesn't rise to the level of sanctions, such as a reprimand, license suspension, civil penalty, or license revocation. A letter of concern is not a form of discipline against the nurse practitioner.
Third, the KBN enters a Consent Decree if they find that the violation was accidental or minor. In this case, the nurse practitioner waives their right to a formal administrative hearing and agrees to pay a civil penalty. The KBN might also order the nurse practitioner to take continuing education classes in addition to paying the civil penalty.
Fourth, the KBN and nurse practitioner can negotiate a settlement. If this happens, the KBN enters an Agreed Order, which occurs if the nurse practitioner admits to the violation but agrees with the KBN as to the penalty they must face. A nurse practitioner who consents to an Agree Order will waive their right to a formal administrative hearing.
If the KBN orders the nurse practitioner to pay a civil penalty, the amount could be as much as $10,000.00.
Types of Sanctions Possible Against a Kentucky Nurse Practitioner
Here is a list of potential sanctions a nurse practitioner could face if they're found to have violated the NPA:
- Reprimand: This is the lowest form of punishment because it doesn't affect a nurse practitioner's ability to practice and only results in a monetary civil penalty. Depending on the case, it could require a nurse practitioner to complete drug screenings or complete additional continuing education courses.
- Probation: The nurse practitioner may continue to practice, but while doing so, they must meet certain conditions for a set amount of time. These conditions can include meeting with KBN officials, completing drug screenings, obtaining necessary treatments, or satisfactorily meeting professional duties and requirements, as evidenced by employer reports.
- Limitation: The KBN may allow the nurse practitioner to continue working but may restrict what they can do. These limitations can include limiting where the nurse practitioner can work, limiting the nurse practitioner's access to certain medications, or ordering that the nurse practitioner work under the supervision of an appropriate health care professional.
- Voluntary surrender of license: The nurse practitioner agrees to give up their license for a set period of time or until certain conditions are met. In some cases, a permanent surrender of a nursing license is possible.
- Suspension: The KBN requires that the nurse practitioner have no right to practice nursing for a set period of time. In addition to establishing a time frame, the KBN may also impose certain conditions before the nursing license is reinstated. Conditions might include completing a mental health evaluation, obtaining a letter of recommendation, or passing drug screenings.
- Licensure denial: The KBN declines to grant an applicant a license to practice nursing in the Commonwealth of Kentucky.
- Reinstatement denial: The KBN may refuse to reinstate a lapsed or suspended license.
- License revocation: This is the most serious sanction as the nurse practitioner loses the right to practice nursing in Kentucky. In some cases, this revocation is temporary in that the former nurse practitioner may reapply for a license after a certain amount of time and retake and pass necessary exams. In other cases, the revocation is permanent.
The Formal Administrative Hearing
Most complaints that lead to disciplinary action don't result in a formal administrative hearing. This is because most nurse practitioners respond to the complaint when they first learn about it, and if they don't, they accept the proposed settlement from the KBN.
The formal administrative process begins when the KBN issues a Notice of Hearing and Statement of Charges. This is a formal declaration that the KBN is bringing charges against the nurse practitioner. This notice will list the charges, the laws allegedly violated, and information about the hearing (when and where it'll be held). Upon receipt of this notice, the nurse practitioner has 20 days to respond. If they don't, the lack of response will be deemed to be an admission of the allegations. Note that a failure to respond because the notice was sent to the wrong address is not a defense as long as the KBN sent the notice to the address of record.
Before the formal hearing, there will be a pre-hearing. The nurse practitioner's attorney (if applicable), the nurse practitioner, the investigator, the prosecuting attorney, and the Hearing Officer will be present. The purpose of the pre-hearing is to discuss preliminary matters before the actual hearing, such as issuing subpoenas for witnesses needed to testify.
The formal hearing will be before the Hearing Panel and is open to the public. During the hearing (or at the pre-hearing), the nurse practitioner may represent themselves or hire an attorney to represent them instead. Each side presents its evidence, and the two KBN Members serving on the hearing panel will make a decision. If there's a tie, the Hearing Officer (who acts like a judge during the hearing) will provide the tiebreaking vote.
After the formal hearing, the Hearing Panel issues its decision. This decision is a “recommended order” because it must first be reviewed by the KBN during its next Board meeting. If the nurse practitioner disagrees with the recommended order, they have 15 days to file “exceptions” to it.
After receiving the recommended order and any exceptions, the KBN has 90 days to issue a Final Order. If the nurse practitioner disagrees with the Final Order, they have 30 days to file an appeal to the Jefferson County Circuit Court.
Get Legal Help When Facing Potential Discipline From the KBN
You've worked hard to become a nurse practitioner in Kentucky. The last thing you want is to lose your livelihood because you didn't take a complaint against you seriously. This is a mistake you must avoid because when the KBN decides to take action against you, the odds aren't in your favor.
Not only is the burden effectively on you to prove your innocence, but understand that you're not going up against the individual who submitted the complaint. Instead, you're going up against the Kentucky Board of Nursing, which almost assuredly has more resources than you do to litigate the case. The moment you find out someone filed a complaint with the Kentucky Board of Nursing, you need to contact the Professional License Defense Team at the Lento Law Firm. Our attorneys have years of experience defending hundreds of licensed professionals such as yourself. Set up a consultation online or call us at 888-535-3686.
