By TRACY WEBER AND CHARLES ORNSTEIN

Gov. Arnold Schwarzenegger replaced most members of the California
Board of Registered Nursing on  Monday, citing the unacceptable time it takes to discipline nurses accused of egregious
misconduct.

He fired three of six sitting board members – including President
Susanne Phillips  – in two-paragraph letters curtly thanking them for
their service. Another member resigned Sunday. Late Monday, the governor's
administration released a list of replacements.

The shake-up came a day after the Los Angeles Times and ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average
of three years and five months  to investigate and close complaints against
nurses.

During that time, nurses accused of wrongdoing are free to
practice – often with spotless records – and move from hospital to
hospital. Potential employers are unaware of the risks, and patients have been
harmed as a result.

Reporters found nurses who continued to work unrestricted for
years despite documented histories of incompetence, violence,
criminal convictions and drug theft or abuse. In dozens of cases, nurses
maintained clean records in California even though they had been suspended or
fired by employers, disciplined by another California licensing board or
restricted from practice by other states.

"It is absolutely unacceptable
that it takes years to investigate such outrageous allegations of misconduct
against licensed health professionals whom the public rely on for their health
and well-being," Schwarzenegger said
in a written statement.

Board member Andrea Guillen Dutton, in
a resignation letter Sunday said she was leaving in frustration. "Certain ‘bad
actors' are jeopardizing the reputation of the entire nursing profession," she
wrote. "This deeply saddens me."

"I have fought to defend the integrity of patient care throughout
the state by holding the negligent accountable," she wrote. "However, I have
grown increasingly frustrated by the board's lack of ability to achieve its
stated objectives in a timely and efficient manner."

Besides Phillips,
the other fired board members were vice president Elizabeth O. Dietz, a
professor of nursing at San Jose State, and Janice Glaab,
a public affairs consultant.

Schwarzenegger's action
Monday fills two of three vacancies on the board and replaces
four of the board's sitting members – all of whom
had been appointed by him. The two remaining members are Nancy L. Beecham,
appointed by the governor in 2006, and Dian Harrison, who was appointed last
year by Assembly speaker Karen Bass.

Beecham and Harrison
could not be reached late Monday, nor could any of the departing board members.

Schwarzenegger's
statement said his "administration
is dedicated to protecting public health and safety, and the new board will act
quickly and decisively to achieve that goal."

Fred Aguiar, secretary
of the State and Consumer Services Agency, said in an
interview that the new board would be asked immediately to come up with a plan
to eliminate the case backlog. "This plan needs to include how many more
investigators are needed, how much that will cost…I want to know now."

The governor's decision does
not directly affect the standing of Ruth Ann Terry, who has been the board's
executive officer for nearly 16 years and a staff member for 25. Only the board
has the power to hire and fire the executive.

Terry,
reached late Monday, hung up on a reporter, saying, "We don't have anything to
say."

But Aguiar suggested Monday that Terry
and other staffers could be vulnerable. The governor "supports the new board in
its commitment to protecting patients – and if that means cleaning house,
including board staff, so be it," he said. "The days of excuses and status quo
are over. It's broken and we're going to fix it."

The Times and ProPublica found that the board relied heavily on Terry and
her staff. At five public meetings attended by reporters since November 2007,
Terry never focused on the delays in disciplining errant nurses. Neither did
board members, even though they must vet all disciplinary actions.

In an interview last week, Terry acknowledged that the system
needed to be "streamlined" but blamed other parts of the state's bureaucracy
for delays.

Early Monday, Terry and her assistant executive officer, Heidi
Goodman, sent an e-mail to all board staff encouraging
them not to lose heart.

"Ruth and I are aware of the grim picture painted by this
article," they wrote, "however, the board members, managers and supervisors
know that you work very hard to carry out the mission of the board
to protect the healthcare consumers in California and we appreciate all that
you do."

Presented with the
investigation's findings Thursday, board
President Phillips, a family nurse practitioner and associate clinical
professor at UC Irvine, said she supported Terry "absolutely – without
question."

"The issue of
patient safety is of the utmost importance to this board," she said. "It's not
that we are ignoring a situation where there are delays. We absolutely are
not."

Questions about the board's leadership were first raised last
fall  when The Times and ProPublica reported that
nurses with serious or multiple criminal convictions kept their licenses for
years before the board acted against them. As a result, the board now requires
every nurse to submit fingerprints, which can be matched against arrest
records. Renewing nurses must also disclose any convictions or discipline by
other states.

In addition to the
governor's action, the state Senate Business and Professions Committee, which has
jurisdiction over the board, plans to hold a hearing next month to address the
issues raised in The Times' article.

The committee will look at introducing legislation that would
appoint an "enforcement monitor" to evaluate the board's discipline process and
make recommendations, said Bill Gage, the committee's chief consultant. Such a
monitor was appointed at one time to work with the Medical Board of California,
which regulates the state's doctors.

Consumer advocate Ken McEldowney said the board members need to do
more than just fill seats.

"The leadership is
key," said McEldowney, executive director of Consumer
Action, a San Francisco-based national consumer advocacy and education
membership organization. "It just appears to me that they don't care."

The six new board members are: Ann Boynton, 47, of Sacramento, a
former undersecretary for the Health and Human Services Agency; Judy Corless, 58, of Corona, a clinical nursing director at the
Corona Outpatient Surgical Center since April 2009; Jeannine Graves, 49, of
Sacramento, a staff nurse for the Capitol Surgical Associates and the Mercy San
Juan Medical Center; Richard Rice, 60, of Imperial Beach, a former chairman of
the Unemployment Insurance Appeals Board; Catherine Todero,
57, of La Mesa, director of the
school of nursing at San Diego State University and a professor there;
and Kathrine Ware, 50, of Davis, a nurse practitioner
for the Vascular Center Clinic at the University of California Davis.

These positions do not require Senate confirmation, and the
compensation is $100 per working day.

Tracy Weber and Charles Ornstein are reporters for the Propublica news service, which first published this post.

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