This story is part of a MedPage Today series on alternative-to-discipline nurse rehabilitation programs.
Type the words “nurse alternative discipline program” in Google and depending on the state, up will pop the websites of several law firms specializing in defending nurses facing complaints of substance abuse.
The nurse may have been arrested for driving while impaired or accused by an employer or co-worker of stealing drugs from the workplace, working under the influence, or forging a prescription for a controlled substance.
In all but a handful of states, the nurse may be eligible for an alternative-to-discipline (ATD) program authorized by the state’s nurse licensing agency. Under certain circumstances, a nurse — perhaps a first-time offender — may enroll in a years-long rehabilitation program to avoid discipline and any public notice that would destroy a career.
MedPage Today‘s investigation into these state programs found that enrollment is low, and explored the trends contributing to the low numbers. One reason, some experts speculated, is that many lawyers’ websites warn nurses not to enroll in such programs — at least not before hiring counsel to discuss the accusation and perhaps fight the charge instead.
ATD programs are appropriate for some nurses, but they’re not in the best interest of many others, these advertisements stated.
Attorneys contacted about their messages said that all too often, the duration, amount of monitoring, and time commitments these programs require — not to mention their high costs — are overkill and disproportionate to the offense, especially if the incident, such as a first-time DUI, did not put any patients at risk.
If the nurse believes the accusation is false, an attorney’s legal skills can refute it, the lawyers said.
IPN “does have some advantages for the truly impaired nurse,” the website says. But, “In many cases, the nurse who is the victim of a termination action by an employer or a complaint against his or her nursing license involving allegations of drug abuse, alcohol abuse, or impairment may view IPN as an easy way to avoid discipline. This is a complete fallacy. Such an apparent easy way out should be avoided at all costs.”
The website for attorney Lucy S. McAllister in San Jose warns nurses that if they enroll in the California Board of Registered Nursing’s Intervention Program, a nurse’s “license is immediately deactivated” for an average 12 to 18 months to 3 years, “without exception.” There are restrictions on their practice, such as no night work, no home health, and no practicing alone, limits on hours, and a work-site monitor may be put in place, the website claims.
The program, her website says, is “for-profit” and “is costly,” and has an onerous regimen with daily meetings for 90 days. And while confidentiality is supposed to be a program benefit, workplace co-workers “clearly become aware of nurse’s participation in the program.”
‘Not Your Friend’
In San Antonio, Texas, attorney Alejandro Mora’s website tersely tells potential clients: “The Board Is Not Your Friend. We Are.”
The website for Philadelphia attorney Brian Quinn notes that, “While the creation of PNAP [Pennsylvania Nurse Peer Assistance Program] is certainly a good step towards protecting the livelihoods of nurses dealing with substance abuse, it is important to still seek the guidance of an attorney whenever a nursing license is at risk.” It adds, “A knowledgeable attorney can help explain your options, including whether participation in state-sponsored programs are in your best interests.”
The website of another Texas attorney, Bridget Eyler in Irving, says this: “Nurses often get scared and feel that they have no option but to sign up for TPAPN [the Texas Peer Assistance Program for Nurses] but this is not true. Just remember that if you admit to having a drug/substance abuse problem just to go along because it seems ‘easier’ than fighting the system, it will be very difficult to go back later and argue that you did not have a problem.”
Several attorneys who responded to requests for comment said that in general it’s often worth it for a nurse to legally challenge the complaint, especially if the nurse doesn’t think he or she has a problem.
George Indest III, lead attorney for the Health Law Firm, said the intended effect of his website’s language is to get the nurse to consult with an experienced health law attorney first.
If there’s a disciplinary matter pending, or something that may not result in discipline, “don’t just in a knee-jerk fashion decide to go into IPN. You’re in an IPN for the next 5 years,” Indest told MedPage Today.
Often, when appropriate, he encourages nurses to enter the program. It’s “on an individual basis by the facts of that case.”
McAllister said in an email that her website uses such negative language about the California program because it’s run as if “one size fits all, and with substance use that is generally not the case.”
Just One Slip-Up
Mora said in an interview he’s advised many nurses to participate in the Texas TPAPN program. “What I find too often is that there is some allegation of either a mental health issue or substance abuse,” but the actual complaint is vague or “innocuous as, ‘the nurse was acting impaired,’ ‘her eyes were dilated,’ and ‘she seemed kind of out of it.'”
He added that an employer may say, “‘this nurse is acting strange, acting impaired.’ We’ve actually represented many, many, many nurses,” asking why the employer thought that. “We’ve been able to look at the evidence and help the board understand that there really is no substance abuse problem” and that TPAPN was not appropriate for that nurse.
Additionally, he said, if the nurse does accept TPAPN, she’s stuck with it. If you back out, “all of a sudden that gives the board authority to sanction you, and I think that they typically take more aggressive actions.”
Eyler said that for certain nurses, TPAPN is the right approach. But she noted that all too often these cases involve a nurse who slipped up just one time. “She tried some gummy bears [laced with THC] or got caught. They get scared, enroll in TPAPN, (the Texas program) and find out ‘Wow it’s a really tough, strenuous program’ and they feel like criminals.”
Eyler added, “I’ve had several disgruntled ex-spouses get mad [at a nurse] and send a complaint to the nursing board. They made stuff up.” When nurses call her first, she can use legal means to gather the facts and prevent that nurse from going through the ordeal.
Last Updated August 03, 2021