Sample Letter on Statutory Definitions

DATE

Joelle Stein
Board Counsel
Board of Registration in Nursing
239 Causeway Street
Boston, Massachusetts  02114

Dear Ms. Stein:

As a practicing nurse in the Commonwealth, I am writing to express my comments and concerns regarding the most recent draft of the Board's proposed revised regulations dated June 1, 2000.

In particular, I would like to express my concern about the language used to define certain terms at 244 CMR 2.02, Standards of Conduct for Nurses/Definitions, that have been included in the current version of the regulations.   Specifically, I am concerned that these terms have existing statutory or other legal definitions that are commonly recognized and with which nurses are already familiar.  Consequently, the Board's efforts to assign meanings to these terms that are different from or inconsistent with common usage are not only confusing but also unnecessary.

I would urge the Board to adopt the existing statutory, regulatory, or other legal definitions for these terms as discussed below, or to revise the proposed definitions to ensure that they are complete. Although the references noted are not exhaustive, they illustrate that there is no need for the Board to create its own definitions.  Many of the definitions that are mentioned are more expansive and explanatory. At a minimum, the Board should merely indicate the appropriate citations to existing law.  Alternatively, the Board should expand its own definitions to include all of the terms found in these other sources.

(1) Abuse
Existing definitions of abuse can be found at the following sources:

• Massachusetts General Laws, Chapter 111, Section 72F (the Patient Abuse Statute definitions);
• Code of Massachusetts Regulations, Chapter 105, Section 155 (Department of Public Health, Patient Abuse and Prevention Reporting regulations);
• Massachusetts General Laws, Chapter 19A, Section 14 (Elder Abuse Prevention Statute);
• Code of Massachusetts Regulations, Chapter 651, Section 5 (Department of Elder Affairs, Elder Abuse Reporting and Protective Services Program regulations);
• Code of Massachusetts Regulations, Chapter 118, Section 2 (Disabled Persons Protection Commission regulations).

(2) Neglect
As above, existing definitions of neglect are found at the following sources:

• Code of Massachusetts Regulations, Chapter 651, Section 5 (Department of Elder Affairs, Elder Abuse Reporting and Protective Services Program regulations);
• Massachusetts General Laws, Chapter 111, Section 72F (the Patient Abuse Statute definitions);
• Code of Massachusetts Regulations, Chapter 105, Section 155 (Department of Public Health, Patient Abuse and Prevention Reporting regulations).

(3) Mistreatment
Similarly, mistreatment is defined at the following sources:

• Massachusetts General Laws, Chapter 111, Section 72F (the Patient Abuse Statute definitions);
• Code of Massachusetts Regulations, Chapter 105, Section 155 (Department of Public Health, Patient Abuse and Prevention Reporting regulations);
• Code of Massachusetts Regulations, Chapter 115, Section 5.05 (Department of Mental Retardation regulations).

(4) Harm
This term is also found in other regulatory sources:

• Code of Massachusetts Regulations, Chapter 105, Section 155 (Department of Public Health, Patient Abuse and Prevention Reporting regulations).

Although the term is not specifically defined in the Board's regulations, it is part of Standard #15 contained within the Standards of Conduct for Nurses. This is a very broad and subjective term that should either be given an appropriate definition or deleted from the regulations.

Finally, in addition to the terms noted in Paragraphs (1) through (4) above, there are other definitions that should be reviewed by the Board to determine whether their language should be added to the regulations or incorporated into one or more of the proposed definitions.  These include, for example:

• "Serious Physical Injury" and "Serious Emotional Injury" as contained in the regulations of the Disabled Persons Protection Commission (118 CMR 2.00);
• "Reportable Conditions" as contained in the regulations of both the Disabled Persons Protection Commission (118 CMR 2.00) and the Department of Elder Affairs (651 CMR 5.02);
• "Dangerous" and "Inhumane" as contained in the regulations of the Department of Mental Retardation (115 CMR 9.02). 

(5) Abandonment
The Board's definition of abandonment is generally consistent with the common legal meaning of the term, but it fails to adequately provide for the legitimate termination of the nurse/patient relationship at the end of the nurse's scheduled work period.  Therefore, it promotes the ability of employers to coerce nurses into mandatory overtime merely because the employer has failed to ensure sufficient or appropriate staffing to assume the patient's care.  It is critical that the board's definition of this term includes clear language that addresses such a situation and protects nurses from employment situations over which they have no control.

(6) Discrimination
Although the term is also not specifically defined in the Board's regulations, it is part of Standard #13 contained within the Standards of Conduct for Nurses. This term should be appropriately defined according to accepted legal standards to avoid confusion and to ensure that all required areas are addressed.

For example, the language of the Standard should indicate that a nurse will not discriminate in the provision of nursing services to patients on the basis of any status or condition which is specifically prohibited by any relevant federal or state law or regulation.  Such language encompasses an acknowledgement of existing anti-discrimination laws but still allows a nurse to refuse a patient care assignment based on his/her personally-held religious or moral beliefs.
 

Sincerely, 
 

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