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.
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.
California takes far longer to discipline registered nurses than many other large states, according to a review by the Los Angeles Times and ProPublica. Click graphic to see the full details.
"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, who 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.
Later, the state Department of Consumer Affairs, which oversees the board, sent reporters a three-page list of "process improvements." Many were mundane or incremental adjustments – such as revising disciplinary guidelines or planning expert witness training. Others seemed more directly aimed at reducing delays: adding staff, meeting with investigators about stalled cases and using computer systems to better track complaints.
Patricia Harris, acting chief deputy director of the department, stood behind the board. "I think they do a good job," she said.
It’s impossible to measure the number of nurses whose conduct endangers patients, but it is presumed to be a small fraction. The board disciplines several hundred a year.
Even a small number of troubled nurses can have wide impact, however. Registered nurses are required to perform or oversee complex treatment, and each can see dozens of patients a week.
Patients generally don’t have a choice in which nurse they get. Most trust that, at minimum, the government wouldn’t allow a nurse with known problems at their bedside.
In California, the board’s vigilance is especially important. The state has among the fewest registered nurses per capita of any state, with an estimated 654 working nurses for every 100,000 residents, compared with 836 nationwide.
Putting even greater strain on the nursing supply is a unique state law that limits how many patients each hospital nurse can treat at one time.
With demand outstripping supply, nurses have readily jumped from one hospital to another, and employers have relied heavily on the board to screen out poor performers.
Despite its critical mission, the board faces little outside scrutiny or pressure to change its ways. Public board meetings, held five times a year, are filled with praise for staffers’ efforts. During five meetings attended by reporters since November 2007, Terry never focused on the delays in discipline.
Susanne Phillips, president of the California Board of Registered Nursing, at a June 2008 board meeting. Click to view biographies of the board members.
And board members – including both nurses and public appointees – never publicly challenged staffers or urged quicker action even though they review every disciplinary action. (Board President Susanne Phillips said such questions are often raised with staff privately.)
While the board tarries, nurses like Owen Jay Murphy Jr. keep working.
In 2006, more than a year after Kaiser warned the board about him, Murphy was employed at Riverside Community Hospital. There, according to a criminal investigator’s affidavit, he forcibly grabbed the face of a patient whose arms were tied down.
"I was helpless," said Christy Ledebur, now 50. "Why would they have someone like that working in an emergency room?"
Ten days later, Murphy punched and elbowed another restrained patient in the face, the investigator’s statement said.
"I don’t even recall the first two hits," said Murphy, 41, adding that his stress and anger at the time clouded his memory. "They said I hit ’em three times."
Riverside Community fired him in July 2006 and immediately alerted the nursing board, a hospital official said. He later pleaded no contest to misdemeanor charges in both incidents.
A month later, a patient at Arrowhead Regional Medical Center in Colton complained that Murphy had put her in a headlock and shoved her against the wall, leaving clumps of hair on the bed and floor, according to hospital officials and board records.
The board took its first public action in June 2007, filing a formal accusation detailing the administrative charges against Murphy.
The former Army medic said in an interview that he had been provoked in some cases by aggressive or mentally impaired patients. But he said he was a good nurse and confident that court-ordered anger management classes had taught him self-control.
Still awaiting his first board hearing, he works in the emergency room of Parkview Community Hospital in Riverside with an unrestricted license.
Racking up accusations
The Times and ProPublica found more than 60 nurses disciplined since 2002 who – like Murphy – were accused of committing serious misconduct or mistakes in at least three health facilities before the board took action.
From 1995 to 2002, California’s nursing board received complaints about Carolyn Fay Thomas. But the board didn’t revoke her license until August 2005. Click to see an interactive graphic. (Liz O. Baylen / Los Angeles Times)
At least five employers reported Los Angeles nurse Carolyn Fay Thomas to the board for allegedly making medication errors and falsifying charts to hide her drug thefts.
And John Michael Jones racked up complaints from at least three hospitals for stealing and using drugs during work. Yet the board waited five years to revoke his license, even after he allegedly dozed off while performing CPR on a dying patient in 2002.
"I was high some of the times that I was working. Yes, I was," Jones, who denies falling asleep during CPR, said in an interview.
Several hospital administrators expressed shock when reporters told them that nurses they had turned in for dangerous failings went on to work at other facilities. No one tracks these nurses, who typically aren’t required to tell the board where – or even if – they are working.
"There’s got to be a better system than now to protect our patients and their safety," said Deborah Hankins, chief nursing officer at Bakersfield’s San Joaquin Community Hospital, one of the hospitals that complained about Jones.
As it stands, complaints often take a circuitous route through several clogged bureaucracies: from the nursing board for initial assessment to the Department of Consumer Affairs for investigation, to the California attorney general’s office for case filing and the state Office of Administrative Hearings for trial. Then the case goes back to the board for a final decision.
Other California health licensing boards are also hampered by delays – but the registered nursing board stands out because of the sheer volume of licensees it regulates.
The biggest bottleneck occurs at the investigation stage, as Consumer Affairs staffers struggle to handle complaints against nurses as well as those against cosmetologists, acupuncturists and others. The nu