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Chronology of Communications Between Barry
Adams RN & the Massachusetts Board of Registration In Nursing
(BORN)
October 15, 1996 - Complaints of "unprofessional
conduct," "unethical conduct," and "patient neglect" were filed
by Barry Adams RN against the Director of Nursing (DON) and the
Administrator (a registered nurse) of Youville Healthcare Center.
The complaints were filed on forms provided from the BORN. Reasons
given for the complaints were that neither of the administrative
RN’s took initiative to meet with the staff RN’s to investigate
their concerns related to patient care despite documentation that
supported the concern. Additionally, the DON was employing intimidation
tactics to silence some of the nurses.
Attached to the complaints was a letter to the BORN
asking for clarity on nursing practice issues. The Questions were:
1) "Given the current health care environment, is
the licensed nurse to assume she/he is still accountable even though
staffing patterns continue to be reduced by financial constraints
at the institutional management level?"
2) "In speaking with countless registered nurses
and licensed practical nurses, I have found the vast majority are
unaware of the wording of the Massachusetts Nurse Practice Act.
Although they feel the quality of care is poor and staffing is dangerously
low, they do not feel safe in addressing this with management and
administration. Could the citizens of the Commonwealth be better
protected if each licensed nurse is made aware of the purpose of
the Board of Registration and the responsibility under which the
licensed nurse is operating?"
3) "At what point does the registered nurse, whom
assumes the role of financial overseer for a fiscal budget, find
him/her-self not responsible for the safety of the care being delivered
under her/his direction or administration? Does the registered nurse
in such a role have accountability when overriding the assessments
of many registered and licensed practical nurses who actually provide
the direct care for patients on a twenty-four hour basis?"
BORN Response-On November 12, 1996 the Supervisor
of Healthcare Investigations replied in a letter; "the issues you
discussed in the narratives relate to administrative and personnel
policies of the facilities and do not appear to be ones over which
the Board of Registration in Nursing has jurisdiction." A referral
to the Massachusetts Department of Public Health was offered.
There was no response from the Board of Nursing
to the above questions.
October 18, 1996 - Adams is fired by the
DON. Within days two RN’s, whom also spoke up about poor patient
care, are issued disciplinary actions based on false allegations.
One is also accused of "patient abuse." The three RN’s file a complaint
with the National Labor Relations Board.
March 18, 1997 - The Massachusetts Department
of Public Health releases a report of investigation of Youville
Healthcare Center following the accidental overdose of a patient.
The facility is cited with eight deficiencies of patient care including;
two counts of "Patient care-neglect" and two counts of "Lack of
Professional & Technical Services" in the department of nursing.
The report also faulted administrators for failing to correct unsafe
practices identified by the DPH until further intervention by the
investigators. Within a year, the DPH investigates two more patient
incidents at the facility and issue more deficiencies.
May 21 and 22, 1997- A two day hearing is
held in Boston before federal Administrative Law Judge Arthur Amchan
for the National Labor Relations Board. Documentation is presented
to the judge. Two days of testimony is heard by the three staff
nurses and the Director of Nursing, as well as, the Human Resource
Director of the facility.
August 28, 1997 -The Director of Nursing
at Youville Health Care Center files a false, unsubstantiated complaint
of "unprofessional conduct" against Barry Adams’ nursing license
with the Massachusetts BORN.
*This complaint is filed ten months after he was
fired and four months after the NLRB hearing.
September 8, 1997 - Adams received a registered
letter (prepared by the BORN and assigned docket # RN 98-056) just
seven days after the complaint was written. It read; the BORN "is
in receipt of a complaint against your nursing license involving
unprofessional conduct..." He was requested to respond within thirty
days to the allegation and provide the following to the BORN:
1) Performance evaluations and or letters from employers
past and present.
2) Description of job at time of complaint.
3) Documentation of counseling/disciplinary action
for problems during employment past or present, including dismissals.
4) Letters from three (3) co-workers/supervisors
addressing professional practice on facility letter head.
(5) Copy of resume
(6) Documentation of CEU credits.
November 1997 - Judge Amchan issued a ruling
which states Adams’ firing was "illegal" and an "attempt to silence
and retaliate against him." He ruled the disciplinary actions issued
against Adams and two other RN’s were discriminatory, punitive,
and carried out with "animus" toward the three nurses. The Director
of Nursing’s testimony was unreliable, according to the judge. He
faulted her for offering "pretextual" and unsubstantiated motives
to silence the nurses. The nurses are ordered reinstated with all
back pay. All records of the punitive actions are ordered removed
and all past and present employees are to be notified of his decision.
Youville appeals his decision.
May 21, 1998 - Ten months after he is accused
of "unprofessional conduct" Adams is cleared of the charges. In
a letter to Adams, the BORN states; "the Board has voted to dismiss
the complaint because there is insufficient evidence to support
the allegation...and the file will be closed."
July 7, 1998 - Adams calls the Discipline
and Licensure Coordinator, a staff attorney for the BORN. He asks
what is the BORN’s definition of unprofessional conduct and unethical
conduct.
He asks why he was investigated for unprofessional
conduct but the DON was not. He is told all complaints are investigated
and must be resolved, that they do not go away, and all parties
are notified of the outcome. He explained the letter he received
from the Supervisor of Healthcare Investigations. The attorney attempted
to access the computer to review the file. She stated there was
no file on a complaint issued by Adams in October of 1996. She advised
him to contact the Supervisor and inquire what happened to the complaint.
July 7, 1998 - He wrote to the Supervisor
that day and informed her of his conversation with the attorney
at the BORN. He asked what the BORN’s conclusions were regarding
the original complaints, and the definition of unprofessional and
unethical conduct.
No response received.
August 4, 1998 - A second letter was sent
to the Supervisor via certified mail. Copies of the original complaints,
the letter with 3 questions, and the July 7th, letter are enclosed.
August 6, 1998 - Two days later, Adams receives
a letter from the Supervisor of Healthcare Investigators. It reads:
"Any information that you seek from the Board of Registration in
Nursing regarding its policies or definitions should be requested
from the Board staff in room 1519 of this building." The letter
goes on, "there are no pending complaints filed by you." She now
states the issues addressed are under the jurisdiction of the Department
of Public Health.
August 8, 1998 - Adams responded saying the
forms provided to him by the BORN were clear in indicating they
were for complaints of unprofessional conduct. He reminded the Supervisor
that regulations for "standards of conduct" for nurses are within
the BORN’s jurisdiction and not the Department of Public Health
(Per Legislative Mandate of the BORN.) He questioned why he was
never referred to room 1519 before? He requested she review the
complaints again and respond. He asks if there is a time limitation
to refile the complaints and asks for two new complaint forms. No
Response. He does not receive the forms.
August 8, 1998 - Adams writes to the BORN
staff in room 1519. He asks the original questions of October 1996
regarding accountability for staff nurses and nurses in administration.
He requests a copy of BORN regulations in 244 CMR 7.00 regarding
Disciplinary Proceedings.
No Response.
August 25, 1998 - After obtaining the CMR’s
from the Internet, Adams again wrote to the Supervisor of Healthcare
Investigators. He asks if the DON or Administrator were notified
of his complaints in 1996 or of the BORN’s decision to dismiss them?
August 27, 1998 - Three judges for the National
Labor Relations Board issued a ruling on Youville Hospital’s appeal.
They upheld judge Amchan’s ruling that the actions against the three
staff RN’s were retaliatory in an attempt to silence them and were
illegal.
September 1, 1998 - Adams received a letter
from the Supervisor of Healthcare Investigations. She restated that
the issues of unprofessional conduct he referred to were "those
of administrative and personnel policies of the facility" and "You
were referred to the Department of Public Health...the agency most
appropriate to deal with your issues." She stated that the requests
of specific BORN policies have been forwarded to BORN executive
director, Theresa Bonanno.
No further response
September 7, 1998 - Adams writes to Theresa
Bonanno. He asked for advice on the appropriate channels to follow
to find out why his complaints were not investigated and his questions
on nursing practice were not answered. He noted that the BORN never
assigned a docket number to his complaint (per CMR 7.03 and 7.04).
He included copies of all communications between him and the BORN
over the last two years. He asked why the complaint against his
license was completely investigated (e.g., assigned a docket number)
and why complaints against the administrative RN’s were not.
No Response.
September 10, 1998 - With court documents,
reports from the Massachusetts Department of Public Health, and
the recent NLRB ruling offered as evidence, Adams refiled complaints
of "unprofessional conduct," "unethical conduct," and "patient neglect"
with the Division or Registration.s Office of Investigations against
the DON and Administrator. Attached to the complaint are: all written
communications between the staff nurses and the Nursing Administration,
Judge Arthur Amchan’s findings and ruling, the NLRB appeal ruling,
and investigative reports and conclusions of the Massachusetts Department
of Health.
The complaints were based in part on: the BORN’s
own CMR’s, the Mission Statement of the BORN, the American Nurses
Association Code For Nurses, and the absence of any language or
other differentiation in the above laws, regulations, and codes
that would absolve some licensed nurses in Massachusetts of expected
conduct that would serve the best interest of patients or the public
in general. Therefore, it seems a licensed registered nurse who
assumes a managerial or administrative position (or any role that
indirectly affects the care or safety of a patient) is also accountable
by the same laws, regulations, and professional codes to which all
other licensed nurses are held accountable. That is to say that
institutional policies of private businesses (hospitals, nursing
homes, prisons, schools, home care agencies, etc...) and job descriptions
of nurse executives, nurse managers and nursing supervisors can
not render a licensed registered nurse exempt from laws, and other
guidelines, which protect the patient and the essence of the profession
of nursing, or relieve him/her of expected professional ethical
standards.
No Response from the BORN was received. (The BORN
appears to be in violation of their own regulations CMR 7.03 and
7.04)
October 5, 1998 - Adams contacts the governors
office to ask whom to contact to look into the BORN’s silence regarding
his complaints and questions. This begins a series of calls and
letters between Adams, the Governors office, and the Office of Consumer
Affairs to whom he was referred.
November 4, 1998 - The BORN proposes changes
in their regulations at CMR 244. Among the changes...
•Sections 7.03 and 7.04 are removed.- "Receipt of
all complaints will be acknowledged to the complainant" and "Each
complaint received shall be assigned a docket number and be filed
with the date received" •The new version states the purpose is to
"define the actions the Board may take following an investigation
of a complaint..." •The BORN approves new "Standards of Conduct
for Nurses." Standard of Conduct-#14-Collaboration with Health Care
Team is clarified to apply to nurses "when functioning as a member
of the healthcare team." •There is a new standard (#13) of conduct
which states licensed nurses "shall follow employer policies governing
nursing practice not in violation of, or inconsistent with accepted
standards of nursing practice."
•The new regulations include a separate section
addressing the responsibilities of nurses in a management role.
November 12, 1998 - Adams received a phone
call from Teresa Bonnano. He expressed his concern that she had
not responded to his letter of September 7th and that he had not
heard from the BORN regarding his questions of two years ago. He
stated he felt the BORN is inconsistent in the way in which they
address complaints. He questioned:
•Why the complaint he filed was dismissed without
investigation?
•Why the BORN had not answered his questions related
to nursing practice in Massachusetts?
•Why the BORN had not provided the definitions and
policies of unprofessional conduct and unethical conduct he had
requested?
•Why the BORN responded so quickly to the complaint
against his license but had never responded to his complaint against
nursing administration at the facility where the DPH found so many
violations?
•Why he never received complaint forms that he requested
from the office of investigations in August?
Teresa Bonanno stated the purpose of the BORN is
to regulate nursing practice according to Massachusetts General
Law Chapter 112; sections 74 through 81C. He told her he believed
the BORN was not in compliance with Massachusetts law 112; sec.
77 or CMR 7.03 and 7.04 when ignoring his complaint. She stated
she would review his letter of September 7 and the attached documentation
and get back to him. He never received another call.
December 3, 1998 - Adams wrote to the Office
of Consumer Affairs asking for assistance. He included all appropriate
documents to support his concerns with the BORN, including the complaints.
He noted the inconsistencies and the disparity in the way the BORN
addressed complaints and questions on nursing practice. He was referred
to Ann Collins, Deputy Director of the Division of Registration.
Later, a series of telephone communications began between Adams
and the Deputy Director.
January 7, 1999 - Adams wrote to Teresa Bonanno.
He referred to their conversation of November 12, 1999. He discussed
the judges findings and raised the issue of nurse executives "illegally"
firing and disciplining other registered nurses. He requested that
someone from the BORN contact him to acknowledge receipt of his
complaint filed in September of 1998. He cited CMR 7.03 and 7.04.
A copy is forwarded to the Office of Consumer Affairs.
He receives no response.
January 20, 1999 - At a town meeting held
at Newton-Wellesley Hospital Massachusetts nurses challenged the
BORN’s new proposed regulations. Expressing concern for the BORN’s
proposal for power to suspend a nurse’s license until an investigation
is complete, a nurse attorney noted the extreme length of time it
takes the BORN to conduct a hearing and complete an investigation.
Such a delay could leave a nurse with a suspended license with out
means to earn an income for months or years. In response, Marie
McCarthy (Chairwoman for the BORN) stood and stated that the BORN
had developed a new "streamlined" process to handle complaints in
a more expedient manner and that the back log of complaints had
been resolved. Adams challenged the statement stating he had tried
for two years to communicate with the BORN. He also noted five months
had passed since he filed his last complaint against administrative
nurses whom had illegally fired him to silence him. He had received
no notification of receipt of the complaint. There was no response.
January 21, 1999 - Adams writes to Marie
McCarthy at the BORN. He encloses copies of all correspondence with
the BORN over the previous two years and states he believes the
BORN chooses whose license they will discipline, and whose they
will not. He states he does not feel the DON or Administrator who
illegally fired him demonstrated "good moral character" or acted
in a way that "reflects positively on the profession of nursing."
No Response.
January 23, 1999 - Marie McCarthy, supporting
the BORN’s new proposed regulation that would allow the BORN to
suspend a nurse’s license before an investigation is completed,
refers to an actual case before the BORN of patient abuse by an
unidentified nurse. She is quoted in The Boston Globe as saying,
"But for the life of me, I cannot understand why any professional
organization would support allowing a nurse whose behavior has been
so egregious to continue practicing with a valid license for one,
two, or three years. I’ll never understand that, never."
February 23, 1999 - Six months after filing
the second complaint, Adams received a letter from the Division
of Registration Office of Investigations acknowledging receipt of
his complaint against the nurses who fired him. It is assigned docket
number RN-99-183 & 184. Seven months pass with no further word.
August 25, 1999 - Three weeks before the
BORN’s scheduled public hearings on "Standards of Conduct for Nurses",
Adams receives a certified letter from the BORN’s Discipline and
Licensure Coordinator. He is requested to attend an "Informal Conference"
to "discuss the complaint" on September 22, 1999. He is asked to
bring "any materials/witnesses that may assist the Board in this
matter." |
