Problem nurses stay on the job as patients suffer

Problem nurses stay on the job as patients suffer

By Charles Ornstein, Tracy Weber and Maloy Moore
July 12, 2009


Nurse Owen Jay Murphy Jr. twisted the jaw of one patient until he screamed.

He picked up another one -- an elderly, frail man -- by the shoulders, slammed him against a mattress and barked, "I said, 'Stay in bed.' "

He ignored the alarms on vital-sign monitors in the emergency room, shouted at co-workers and once hurled a thirsty patient's water jug against the wall, yelling, "How do you like your water now?" according to state records.

Murphy's fellow nurses at Kaiser Permanente Riverside Medical Center finally pleaded with their bosses for help. "They were afraid of him," a hospital spokesman said.

Under pressure, Murphy resigned in May 2005. Within days, Kaiser alerted California's Board of Registered Nursing: This nurse is dangerous.

Tracy Weber and Charles Ornstein, both former Los Angeles Times staff writers, did significant reporting for this article before leaving The Times last year and have continued to cover the issue for ProPublica.

Maloy Moore is a Times researcher. Doug Smith, The Times’ director of database reporting, contributed to this report.
But the board didn't stop Murphy from working elsewhere, nor did it take steps over the next two years to warn potential employers of the complaints against him. In the meantime, Murphy was accused of assaulting patients at two nearby hospitals, leading to convictions for battery and inflicting pain, board and court records show.

Even Murphy, who has since taken classes to curb his anger, was surprised the board didn't step in earlier.

"The nursing board is there to protect the public from me," he said in an interview.

The board charged with overseeing California's 350,000 registered nurses often takes years to act on complaints of egregious misconduct, leaving nurses accused of wrongdoing free to practice without restrictions, an investigation by The Times and the nonprofit news organization ProPublica found.

It's a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

Reporters examined the case of every nurse who faced disciplinary action from 2002 to 2008 -- more than 2,000 cases in all -- as well as hundreds of pages of court, personnel and regulatory reports. They interviewed scores of nurses, patients, families, hospital officials, regulators and experts.

Among the findings:

* The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics. In at least six other large states, the process typically takes a year or less.

"It's really discouraging that when you do report people . . . they don't take action," said Joan Jessop, a retired chief nursing officer in Los Angeles who filed multiple complaints with the board during her 43-year career. "What is so frightening to me is that these people will go on and do it to somebody else."

* The board failed to act against nurses whose misconduct already had been thoroughly documented and sanctioned by others. Reporters identified more than 120 nurses who were suspended or fired by employers , disciplined by another California licensing board or restricted from practice by other states -- yet have blemish-free records with the nursing board.

* The board gave probation to hundreds of nurses -- ordering monitoring and work restrictions -- then failed to crack down as many landed in trouble again and again. One nurse given probation in 2005 missed 38 drug screens, tested positive for alcohol five times and was fired from a job before the board revoked his probation three years later.

* The board failed to use its authority to immediately stop potentially dangerous nurses from practicing. It obtained emergency suspensions of nurses' licenses just 29 times from 2002 to 2007. In contrast, Florida's nursing regulators, which oversee 40% fewer nurses, take such action more than 70 times each year.

In interviews last week, the board's leaders and other state officials defended its record. "We take what we do -- protecting the public -- very, very seriously," said Executive Officer Ruth Ann Terry.

Terry, at the helm for nearly 16 years and on staff for 25, acknowledged that the pace of the disciplinary process has "always been unacceptable" and said the system was being streamlined. But she blamed other parts of the state bureaucracy for delays and was vague about what changes would be made...

This report, one in a series of occasional articles about oversight of nurses, was prepared in collaboration with ProPublica, an independent investigative newsroom in New York.