The South Dakota Board of Nursing (BON) has implemented a Health Professionals Assistance Program (HPAP) that enables nurses with substance abuse issues to avoid professional discipline by enrolling in a supervised, monitored treatment program. The HPAP program is available to nurses on both a voluntary and a mandatory basis when the nurse has been directed to enroll by the BON. The program is not for everyone, and if you are considering enrolling in the HPAP, you should contact the Lento Law Firm Professional License Defense Team to learn more about what the requirements are and whether it is the best alternative for your particular situation. We have been reached by phone at 888.535.3686 or through our contact link on our website.
What is HPAP?
South Dakota's HPAP is authorized by South Dakota law. It's administered by a third-party provider that is responsible for managing enrollment and for administering the program. It is available to licensed nurses, those applying for a nursing license, and students enrolled in an accredited nursing program in South Dakota. The HPAP includes a number of different components, including regular monitoring and drug testing, group and individual counseling, and monitoring of the nurse's employment while they are enrolled in the program. The nurse's participation in HPAP is confidential, up to a point – those who are involved in the nurse's treatment, of course, know that the nurse is enrolled, as do the nurse's employer and supervisors.
HPAP is not an option for a nurse who
- diverted controlled substances for reasons other than their personal use
- has been accused of sexual misconduct
- has been terminated from South Dakota's HPAP or a similar program in another state for failing to comply with the program's requirements
If the nurse successfully completes the HPAP, any pending disciplinary matters related to the nurse's referral to HPAP will be dismissed. On the other hand, if the nurse is dismissed from HPAP for failing to comply with its requirements, the BON will be informed, and disciplinary proceedings against the nurse may resume.
Enrolling in HPAP
The process of enrolling in HPAP begins with the nurse contacting South Dakota's HPAP provider and completing and submitting a number of forms, including a detailed “Intake and History Form.” This form requires the nurse to disclose family information, marital history, parents' drug and alcohol use, educational background and licenses held, employment history, health history, prescribed and over-the-counter medications, counseling history, trauma history, anger and other emotional issues, previous substance abuse treatment received, arrests including DUI's, pending legal matters, religious affiliation, and areas in which the nurse is currently experiencing difficulty.
The nurse must also agree to accept financial responsibility for their treatment. There is a separate form that must be reviewed and signed that discloses the costs associated with participating in the HPAP. As of 2024, these are estimated to be at least $3000 per year and include an application fee of $200 and quarterly payments of $312.50 for those with an active South Dakota nursing license and $750 per quarter for those who do not have an active South Dakota nursing license.
The nurse's enrollment forms are submitted to an HPAP Evaluation Committee, which will review them and, if the nurse is approved for enrollment, will recommend terms for the nurse's Participation Agreement (PA). The PA will set forth in detail the Evaluation Committee's recommendations as to the nurse's treatment, ongoing care, support group requirements, toxicology screening obligations, restrictions on the work the nurse is allowed to do, how the nurse will be monitored at work, reports that need to be filed during the course of the nurse's participation in HPAP, and what the nurse must do to successfully complete their HPAP treatment.
Participating in the HPAP Program
The nurse is required to sign their Participation Agreement before they can begin their specific HPAP treatment. Once the nurse has done so, they'll be expected to follow their PA's requirements or face being expelled from the HPAP. These requirements must meet the requirements of South Dakota law and typically include:
- Random unscheduled drug screenings, with the minimum number per year defined by the nurse's PA
- Total abstinence from alcohol and certain drugs
- Required and regular participation in a peer support group
- Required and regular attendance at a certain number of 12-step support groups, with the help of a designated Sponsor, who will be expected to provide HPAP with quarterly reports about the nurse's participation in the 12-step program
- Medical treatment for substance abuse
- One-on-one psychological treatment for substance abuse
- Restrictions on employment, including designation of a work site monitor who is available to communicate with the HPAP staff and who will submit regular reports about the nurse's work performance
- Submission of Continuing Care reports by one or more designated professionals, which address the nurse's stability in the recovery process, the support systems that the nurse has in place, the nurse's judgment, and their cognitive functions
- Monthly submission by the nurse of self-reports that address any difficulties the nurse is experiencing that may affect the nurse's ability to participate in the HPAP or meet the terms of their PA, and that reflects on the nurse's progress
The Lento Law Firm Professional License Defense Team can help you evaluate whether the intense requirements of South Dakota's HPAP are best for you and your particular situation or whether there may be some other alternative that is likely to work better for you. Because of the multi-year nature of the HPAP commitment and the many obligations you'll be expected to meet as a participant, it's very important to be as sure as possible of your commitment to the HPAP and your PA requirements before you submit your enrollment materials. The reason for this is that, according to the HPAP Enrollment and Application Instructions, once you submit your application materials, “you agree to complete the SDBON HPAP enrollment process.”
Employment While Participating in the HPAP Program
In almost every case, enrollment in South Dakota's HPAP will mean that you will not be able to work until approved to do so by HPAP staff. When you are allowed to return to work, there are likely to be a number of specific restrictions placed on what kind of work you can do, how many hours per week you can work, what shifts you'll be allowed to work, and what medications, if any, you can access and dispense. In addition, the employer will have to designate a workplace monitor who will be responsible for supervising you and preparing and filing periodic reports on your work with HPAP.
The immediate loss of employment when enrolling in HPAP can be a significant challenge for a nurse who, at the same time, is agreeing to take on the added financial responsibility of participating in that program. This is another reason why it's important to review your options carefully and to make sure you understand the consequences before you apply to South Dakota's HPAP. The experienced attorneys at the Lento Law Firm Professional License Defense Team can help you review your options and understand what will be involved with any treatment program you are considering before you take the important step of enrolling.
The Employment Process While Participating in HPAP
As you move forward with your treatment, following the requirements of your PA, there will come a point where HPAP will clear you to return to work as a nurse. That return will have some conditions attached to it, as noted above. Your employer will need to have a copy of your PA before you begin work and will be required to assign a workplace monitor. The monitor must meet a number of requirements before your employment will be approved by HPAP.
- The monitor must be someone you report to and are accountable to
- In most cases, the monitor should be working at the same place and times when you are working
- Your monitor can't be someone who reports to you
- The monitor must agree to act as your monitor and supervise your job performance
- The monitor must agree to communicate with HPAP staff about your work performance and to submit periodic written reports to HPAP about you
In addition to monitoring requirements, your employer will be expected to permit you to work according to any ongoing practice restrictions that your PA or HPAP staff impose on your return to work.
The process of finding employment once you've enrolled in HPAP is obviously more complicated than the usual job search process. The fact that your employer will need to know about your enrollment, appoint a specific person to act as your workplace monitor, and agree to limit your work as required by any HPAP practice restrictions that may be in place means that it is likely to be more difficult to find employment while enrolled in HPAP than it would if you were not. While that is certainly not a reason to avoid receiving treatment for a substance abuse issue you may have, it is another reason to carefully consider what kind of program you enroll in. The Lento Law Firm Professional License Defense Team can help you evaluate your options and choose the path forward that makes the most sense for your particular situation.
Travel While Participating in HPAP
Because you will need to be available on a daily basis to provide drug tests as part of your PA requirements, travel away from home can be a challenge. In the usual case, once you are notified that you must provide a sample, you'll have eight hours to submit the specimen. If you are unable to submit a sample within that time frame because you are away from home and are not close to an approved testing center, you risk being considered in violation of the terms of your PA and the requirements of the HPAP. As noted in South Dakota's administrative rules, “Failure by a participant to submit specimens as required . . . may result in the participant being reported to the board.”
This means that if you plan to travel during your participation in HPAP, you should discuss it with HPAP staff well before committing to any travel plans. You may need to identify acceptable drug testing sites near your travel destination and secure advance approval if you will be away from any approved testing sites during your travels. In addition, you will need to address being absent from regularly scheduled group meetings and counseling sessions. In some cases, you may not be able to make the trips you would like to be able to take. In others, you may be required to submit to enhanced drug testing when you return from your approved trip.
As part of enrolling in HPAP, nurses are required to provide detailed information about their current medical status, including any serious injuries and recurring pain. All current doctors must be disclosed, as well as all prescribed and regularly-taken over-the-counter medications.
If you are enrolled in HPAP and need a medical procedure that will require you to receive any prescription drugs, you will need to have your doctor contact HPAP in advance of the procedure to discuss what drugs you are likely to receive and whether there are any more suitable alternatives. Your progress towards completing your assigned PA requirements may be postponed for the period of time when you are unable to comply with all of the terms of your HPAP program.
The HPAP regulations do allow for participants to take an approved leave of absence; one reason for requesting a leave would be in a situation where extended medical procedures or treatments would make it difficult or impossible to comply with the terms of your PA.
Because of the strict nature of the HPAP program – it is an abstinence program that forbids the use of alcohol and a wide range of prescription and non-prescription drugs and substances – you will need to secure approval for any prescription medications that you are required to take. Your prescribing physician will need to submit a Medication Report form to HPAP that will include information about the medication, the prescribed dose, and the reason it's being subscribed.
Exiting the HPAP Program
The HPAP staff will evaluate your progress throughout your participation in the HPAP and will determine when you are ready to be discharged from the program. The evaluation is based on a number of criteria, including your compliance with your PA's terms and conditions. You will also need to provide the following:
- A written plan for your continued wellness or recovery
- Recommendations from:
- Your worksite monitor or employer
- Your approved treatment provider
- The HPAP Evaluation Committee
- A designated period of negative drug test results, typically defined in your PA
If you leave the program voluntarily without meeting the exit criteria, or if you are removed from the HPAP for repeated failures to live up to the terms of your PA, your departure will be reported to the BON, and any pending disciplinary investigations or actions against you may be resumed.
Challenges of the HPAP Program
As you can see, the HPAP is a challenging program with many requirements. Because substance abuse disorders can be so challenging to overcome, it should not be a surprise that South Dakota's HPAP is so rigorous. But it's important that you understand the challenges you'll face – in addition to overcoming any substance abuse issues you may have – if you enroll in HPAP. Some of these include:
- Cost. Drug testing, one-on-one therapy, support group fees, and HPAP quarterly charges can easily add up to thousands of dollars per year.
- Employment challenges. You'll likely be required to stop working as you begin your HPAP treatment, and once approved for work, you will need to find an employer willing to hire someone who is being monitored by HPAP and who may be subject to practice restrictions.
- Time challenges. Traveling to and from counseling sessions, group meetings, and drug testing appointments can take a substantial amount of time, particularly if you live far from where any of these are located.
- Travel restrictions. Securing advance permission for travel can be difficult, and in some cases, you may not be able to take the trips you would like to take.
While the challenges may seem daunting, if the HPAP program is your best option when it comes to receiving effective treatment for a substance abuse issue, dealing with the challenges may be well worth it. The Lento Law Firm Professional License Defense Team can help you evaluate what your options are if you believe or have been told that you have a substance abuse problem, particularly in a situation where you may also be facing a disciplinary investigation or proceeding that can negatively affect your license and your career.
Reasons to Enroll in HPAP
The HPAP can be an effective program for nurses who are dealing with substance abuse problems. It provides a detailed, comprehensive monitoring and treatment plan that includes more than one type of support mechanism for helping nurses learn about their abuse disorders and learn strategies to help them prevent substance abuse from happening in the future. In situations where there is a strong possibility of serious disciplinary action as a result of substance abuse issues, HPAP may be the best alternative for treatment since it also means that if you successfully complete the program, you will avoid being disciplined for those issues.
Alternatives to HPAP
That said, there are many treatment alternatives to HPAP, though none that will postpone disciplinary proceedings while you are enrolled. Many employers provide access to confidential substance abuse treatment programs, and there are numerous healthcare providers and some not-for-profit groups that also have treatment options available. While you may face pressure to enroll in HPAP from the BON or your employer, what makes sense is to explore what your options are and pick the program that you believe will provide you with the best chance of recovery.
The Lento Law Firm Professional License Defense Team can help you with this decision. Particularly where you may be facing a disciplinary investigation or proceedings, our experienced attorneys can review your situation and your options with you to help you determine whether it may make more sense to contest the disciplinary matter and enroll in a program other than HPAP or take some other approach. What's important is that you explore what your choices are so that you can make an informed choice.
How the Lento Law Firm Professional License Defense Team Can Help
The Lento Law Firm Professional License Defense Team has years of experience helping nurses all over the US – including in South Dakota – face serious disciplinary situations as a result of substance abuse allegations, as well as a wide range of other types of misconduct. Our experienced attorneys understand the disciplinary process for nurses and can help you at whatever stage you may find yourself in.
If you've been accused of misconduct and an investigation is beginning or underway, we will help you understand what the allegations against you are and what that could mean to your license. We will represent you in meetings with BON investigators and will help make sure that the questions you're asked are clear and fair and that you are able to provide clear and accurate responses. In some cases, we can also conduct our own investigations on your behalf and can help gather evidence that may be used in your defense.
In many cases, we will be able to discuss your situation with the BON and can negotiate acceptable outcomes on your behalf. And where negotiation isn't fruitful, we will aggressively protect your rights and defend you in any disciplinary proceeding that may result.
Even if you've reached the point where you've been disciplined, the Lento Law Firm Professional License Defense Team may be able to help you appeal the decision – so in most cases, it's never too late to contact us to learn how we can help.
If you are a nurse facing any type of disciplinary allegation in South Dakota, including allegations related to substance abuse, contact the Lento Law Firm Professional License Defense Team today at 888.535.3686 or use our contact link to set up a confidential consultation. We understand how important your nursing license is to you, your career, and your reputation, and we are ready to listen and to help.