Nursing & Healthcare News

BRN Scandal

California state auditor investigation finds gross misconduct

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The Board of Registered Nursing is responsible for investigating nurses accused of misconduct, but a recent investigation by California State Auditor Elaine M. Howle, CPA, concluded that three BRN executives committed gross misconduct — ironically, by falsifying a report about the BRN’s enforcement efforts.

BRN Enforcement Audit

Here’s the background: Following a December 2016 audit report on the large number of complaints awaiting investigation by the BRN, the state auditor’s office made a number of recommendations for reducing the BRN enforcement program’s case backlog.

The audit team later determined that the BRN’s initial attempts to address these recommendations had increased investigators’ average caseloads to what auditors considered excessive levels, which “had simply shifted — not eliminated — its backlog of complaints.” The auditors advised the BRN that to fully implement the audit recommendations, caseloads should not exceed 20 cases per investigator.

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In November 2018, the BRN submitted information showing that average enforcement caseloads had indeed been reduced to fewer than 20 cases per investigator.  Satisfied, the state auditor indicated in a January 2019 report to the Legislature that the BRN had implemented the audit recommendations.

Whistleblower Report

A whistleblower subsequently warned the state auditor’s office that the BRN’s November 2018 report had been deliberately falsified. The state auditor investigated and found that three BRN executives had concocted an elaborate scheme to deceive auditors about investigators’ current caseloads.

Those executives allegedly ordered managers to temporarily reassign some outstanding cases to an investigator who was then out on long-term leave and to a manager who doesn’t normally investigate cases directly. This shift nominally reduced the investigator’s average caseload by about 20 percent.

Nursing Education

Just days after submitting the new caseload numbers to the audit team, managers reassigned those cases to their original investigators, immediately undoing the supposed reductions.

During the state auditor’s investigation, two of the three BRN executives (who are not named in the investigative report) admitted their involvement in this deception, although they said the scheme was conceived by a third executive who’s no longer with the BRN.

Damaged Trust

Howle has asked the BRN to take disciplinary action against all three executives. Each may also face fines of up to $5,000 for violating state laws against obstructing an official audit “with intent to deceive or defraud.”

In a letter to the governor and the Legislature on June 30, Howle said the executives’ actions “also undermined the trust that our office had with BRN.” One consequence is that auditors are now taking extra steps to verify the reliability of information the BRN submits on other matters.

ANAC Executive Director Marketa Houskova, RN, DNP, MAIA, says this scandal is a reminder that California needs to “bring nursing to the 21st century by streamlining operations of a woefully understaffed BRN; continued oversight of proposed solutions; and, most importantly, hold accountable current leadership.”

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