Lately, the volume of complaints has been steadily increasing, a development that may be related to a law Texas passed in 2003 restricting lawsuits against medical providers. “Consumers who have been injured might not be able to get satisfaction from a malpractice lawsuit,” says Dusty Johnston, general counsel for the Board of Nursing. “It leads to complaining about the nurse to their nursing board. You have a shift of consumers seeking redress with the agency that licenses the health care providers.”
The board has developed a complex prioritization system for investigating complaints. Cases are evaluated based on the nurse’s likelihood of causing future harm to patients. A nurse accused of inflicting intentional harm or diverting drugs from patients is cause for immediate concern, while someone with a clean record who fails to properly document a procedure or neglects to report an old misdemeanor conviction is less likely to pose an immediate threat to patients. Cases deemed “low priority” can linger unresolved for a long, long time. Currently, there’s a backlog of 1,530 cases that are more than two years old.
This fall, the board launched an initiative called “Project Countdown.” The Board is hiring additional staff to help meet rising demand for investigations, and investigators have been asked to set aside a portion of their time to focus on eliminating the backlog of very old cases. Through that effort, the number of two years-or-older cases has been reduced from 2,227 on September 1 to the current 1,530.
Although that progress is encouraging, there’s a downside to prioritizing cases in this way. Some cases originally deemed low priority have turned out to be more severe than originally thought, says Anthony Diggs, director of enforcement for the Board of Nursing. Diggs would not reveal the details of individual cases, but says investigations sometimes unearth patterns of nurse behavior that might not be apparent from a single complaint over a minor issue. “There are certain investigations that start out as low priority that become higher priority,” Diggs says.
The complexity of nursing complaint cases has been increasing, as well. Many cases require lengthy administrative hearings that have taken on all the formality of district court proceedings. Some cases involve contact with as many as 30 or 40 patients, requiring investigators to conduct dozens of interviews and review extensive amounts of documentation. The older the case, the harder this process becomes, as the memories of the patients and nurses involved fades.
Delays on the docket
Increasingly, backlogs in one part of government are contributing to backlogs in another. That’s particularly true with agencies whose work intertwines with the criminal justice system, which may be the most chronically backlogged branch of government.
In California, for example, those wrestling with the backlog of investigations into teacher misconduct say their efforts are hampered by delays from the courts and law enforcement. When a teacher is arrested and identified by fingerprint, it can take a long time to get additional information investigators need to close a case. “All we know is there is an arrest,” says Nanette Rufo, general counsel for the Commission on Teacher Credentialing. “There are no facts. Some law enforcement agencies have said ‘Don’t even bother. We won’t have [a full report] for at least a month.’”
Some of the most serious state backlogs growing today are in the courts. Increasingly, docket delays are having real-world impacts, says Bill Robinson, president of the American Bar Association, which has been studying the effects of funding reductions for state courts. “We have had in states across the country cases where felons have been accused of serious crimes,” Robinson says, “and because of the Speedy Trial Act and inadequate funding that precluded the courts from complying, persons accused of these serious crimes have had to be released because the cases couldn’t be tried in time.”
One of the most severe state court backlogs is in Georgia. The state court system there has seen its funding drop by 25 percent over the past two fiscal years, leading some courts to shorten their operating hours and lay off employees. The result is that delays have become pervasive in both civil and criminal trials. Criminal trials now often take more than a year to complete, requiring the accused to stay warehoused in local jails at the expense of the cities and counties who run them.
One side effect, according to Georgia Chief Justice Carol Hunstein, is a dropoff in capital punishment cases: This is the first year in a long time that the Georgia Supreme Court hasn’t heard a direct appeal on a death penalty case. One jurisdiction has four pending death penalty cases, Hunstein says, “but the county couldn’t pay for the jurors or the courthouse.”
On the civil side, delays are even more widespread. One circuit has stopped hearing civil cases altogether so that it can focus on its backlog of criminal cases. But on the civil side, too, delays have real-world impact on people. Hunstein worries that delays in domestic violence-related proceedings could leave people in needless danger. And in divorce or custody-related proceedings, the welfare and proper support of children is at stake. Such situations are difficult enough for children and parents to handle without adding months-long delays to the mix. “It’s important for the citizens to know that their disputes will be resolved in a timely manner,” Hunstein says, “or they might take justice into their own hands.”
Stretched “to the limits”
Then there’s Hawaii, which has been experiencing backlogs practically across-the-board. State Ombudsman Robin Matsunaga has received a surge in complaints about slow response times from numerous state agencies, including those that provide public assistance, licensing, vital records, public safety and public health. “Based on the complaints we received, the staff reductions and furloughs that resulted from the budget cuts have created a significant delay in the provision of services by most of the agencies,” he told Stateline in an email. “In some agencies, the cuts have resulted in the total curtailment of certain services to the public.”
Delays in the Department of Human Services are among the most widespread. The department has seen approximately 492 positions eliminated since July 2009, a 17 percent overall staffing reduction. There are delays in responding to and investigating allegations abuse of children, the elderly and people with disabilities. There have been backlogs in processing requests for all manner of assistance, from food stamps to medical benefits and child care, as demand for those services has increased with the slow economy.
The agency is making a major effort to rebuild: Processing time for benefits have been improving as the agency has increased the use of overtime and reengineered its workflow. But fully overcoming its backlogs will take time. In a continuing tough budget environment, getting authorization for new positions so soon after the jobs were eliminated will be a tough sell. And it’s becoming apparent that some moves that were made to save money will likely have to be reversed.
For example, child protective services offices were centralized in order to create efficiencies by closing local offices. The resulting need for case workers to drive for up to four hours to investigate allegations of child abuse, and perform required monthly face-to face visits, has become untenable. Patricia McManaman, director of the Department of Human Services, says the agency is now rehiring frontline workers and moving back to a community-based system.
“It’s impacted the morale of our staff,” McManaman says. “It has stretched them to the limits.”
— Contact Melissa Maynard at mmaynard@stateline.org
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