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Medical oversight fines often go unpaid

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California dental regulators have collected only about 20 percent of the fines they have levied against dentists in the last four years, a far weaker record than licensing authorities that oversee registered and vocational nurses and psychiatric technicians.

That record, revealed in a recent legislative report, emerged as the Legislature is taking a close look at several medical oversight boards whose regulatory powers are set to expire under the law.

According to the report, the Dental Board of California collected a high of 37 percent of fines in 2007 and a low of 9 percent in the fiscal year ending in 2010. Since 2006, the board has assessed about $125,000 in fines and collected about $24,000.

In contrast, the board that licenses vocational nurses and psychiatric technicians has in recent years collected about 80 percent of the fines it levies.

The Board of Registered Nursing [PDF] had a collection rate of 14 to 30 percent in recent years, until the board made a concerted effort to rake in fines and brought in a record amount in 2010. The effort brought that board's four-year collection average to 54 percent.

Julie D’Angelo Fellmeth, administrative director of the University of San Diego's Center for Public Interest Law, who tracks the activity of California licensing boards, said the fines are not considered formal discipline but still are important to enforce.

“What good does it do to investigate a matter and issue a fine if you’re just going to let them blow off the fine?” she said.

Here are summaries of what type of conduct the boards cite and why some say they have had a hard time collecting fines:

Dental Board of California

Richard DeCuir, executive officer of the dental board, said most fines are levied when inspectors find unsanitary conditions in dental offices.

The dental board also is increasingly using citations and fines to go after dentists who don’t comply with requests for patient records during an investigation.

DeCuir said the fine payment rate lags behinds because dentists repeatedly appeal citations; if citations are finalized, they appear on the dentist’s license status for decades. In contrast, citations for nurses and pharmacists are taken off a licensee’s public website profile after three or five years.

DeCuir said his board has asked for a limit on citation disclosure as part of the law to continue the dental board's authority. That amendment has not yet been added to the pending legislation, SB 540.

He said the board was told that a bill would be put together next year to address multiple enforcement issues for licensing boards. DeCuir also said licensees are required to pay outstanding fines before they’re allowed to renew their license.

Records show that the board is owed $101,000 in unpaid fines over the last four years.

Board of Registered Nursing

The board that oversees registered nursing has a track record of collecting as little as 14 percent of the fines it issued in recent years, records show.

Russ Heimerich, spokesman for the Department of Consumer Affairs, which oversees many licensing boards, said the board lacked the staff to aggressively go after the fines.

He said that after articles by ProPublica exposed problems with board enforcement, the agency brought in staff from other boards in 2009 to help clear the backlog of uncollected fines.

In 2010, the board [PDF] issued $229,000 in fines and collected $224,000, some from prior years.

Some nursing board fines penalize people posing as nurses without a valid license. In one such case, a nurse who lost her license in 2009 [PDF] for caring for patients while under the influence of Vicodin was cited in 2010 for practicing with no license.

The board also cites and fines nurses for violations that harm a person’s health or safety or show a willful disregard for the law.

In coming months, Heimerich said, the board will be issuing a spate of fines to nurses who’ve been convicted of drunken driving.

“A DUI doesn’t often rise to level of taking action against a license,” he said. “But the board does have a vested interest in changing that behavior.”

Like the dental board, there is no central repository of information on the board’s website about who was fined, why and whether the fine has been paid. Currently, $235,000 in outstanding fines are owed to the board.

Board of Vocational Nursing & Psychiatric Technicians

The board that oversees vocational nurses and psychiatric technicians has been the most consistent in collecting a majority of the fines it issues. Over four years, it has collected about 80 percent of the issued fines.

According to that board’s sunset report, citations can be issued for the following reasons:

  • Up to $10,000 against employers of these workers if they fail to report a suspension or termination “for cause” of a worker
  • Up to $2,500 against licensees who commit violations that cause patient harm, such as abandoning a patient, falsifying notes or borrowing money from a patient
  • Up to $1,000 for technical violations, such as working on an expired license or failing to disclose a criminal conviction

The board says the majority of fines are for unprofessional conduct, including failure to perform prescribed care. The board says it will not renew licenses until fines are paid. Also, it uses the Franchise Tax Board's intercept program to draw outstanding payments from licensee tax returns.

Currently, the board's vocational nursing program is owed about $64,000, and the psychiatric technician program is owed about $11,600.

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