TPAPN, the BON and the future

The BON is meeting July 17-18, 2008. One of the agenda items involves the Board's Legislative Appropriations Request. This is how the Board asks for money from the state to fund their activities. There were several issues brought up by the Board that I found interesting (and that also confirm what I have been telling nurses):

1. More nurses are finding themselves before the Board. The number of complaints is increasing and the Board expects 9200 complaints this year. Just two years ago in 2006 there were approximately 5185 complaints and two years before that in 2004, there were approximately 3690 complaints.

2. More nurses are choosing to fight the Board in front of a judge.

3. The cases that are going before a Judge are more complex. This means that there are more nurses challenging the Board rather than choosing not to show up at a hearing and losing by default.

4. More nurses are hiring attorneys to represent them before the Board. After hearing from prior employees of the Board that nurses should never represent themselves before the Board, I am glad to see that more nurses are seeking help when dealing with the Board.

5. The Board is getting tougher on nurses and nursing licensure applicants.

As part of the request, the Board is asking for funding for 3 attorneys, 2 legal assistants and 4 investigators. Below is part of this draft document involving the need for more money to hire more staff:


New Personnel Needed for Enforcement, Legal and Operation Processes -
The agency’s enforcement workload and expenses for its contested cases have steadily and rapidly increased and must be addressed in order for the Board to maintain its mission to protect the public and timely resolve its complaints. The Board needs appropriations to cover the increase in litigation related costs for its expert fees and witness fees. Additionally, the Board will need approximately eleven (11) additional FTEs for FY 2010 and FY 2011 for its Enforcement, Legal and Operation Departments in order to meet the growing demands. Six (6) FTEs are needed for an increased workload due to growing complaints and litigation. This number would include two (2) investigators; two (2) litigation attorneys; one (1)legal assistant; and one (1) administrative assistant. The agency will begin to process criminal background checks for students. The Board will need an additional five (5) FTEs, including one (1) administrative assistant, two (2) investigators, one (1) Attorney and one (1) legal assistant. Although this number appears to be significant, the rise in the number of investigations, plus the complexity of the Board’s disciplinary cases, supports the need to add enforcement, legal and operation staff in order to meet the agency’s mission and timely resolve cases. The Board in FY 2008 will likely receive 9,200 complaints leading to 2,400 disciplinary actions. By comparison, the Texas Department of Licensing and Regulation (TDLR) will have approximately 8,000 complaints in FY 2008 and will likely take approximately 1,240 disciplinary actions (TDLR Statistical Questionnaire, May 2008). TDLR employs thirty-five (35)investigators and ten (10) prosecuting attorneys. Other than the increase in volume of complaints, there are several other reasons why the Board’s enforcement cases will require more resources for the agency to meet its mission effectively and timely:

1. Complaints are increasing by approximately 15% annually;
2. Formal charges statistics and unresolved complaints statistics are increasing;
3. The Board’s policies have tightened with regard to enforcement and
eligibility;
4. Attorney representation has increased significantly; and
5. Proceedings before the State Office of Administrative Hearings (SOAH)
have become more complex.

We project that cost of adding eleven FTEs as follows: four (4) Investigator
IIIs - $167,576; three (3) attorney IIIs - $189,291; two (2) legal assistants -
$88,962; and two (2) administrative assistants - $62,156. Costs of computer
hardware (one time only) - $11,000. Costs of telephones (one time only) $2,750. Costs of Remodeling (one time only) - $11,000. Costs of Furniture (one-time only) $5,500. Costs of annual phone and internet connections - $1,100. Litigation and expert witness fees - $25,000. This will impact the Enforcement and Licensing Strategies.