WYOMING STATE BOARD OF NURSING Discipline Decision Matrix ...

WYOMING STATE BOARD OF NURSINGDiscipline Decision Matrix (by Alphabetical Category)Wyoming State Board of Nursing (WSBN) Disciplinary Committee (DC) Decision Matrix has provided a mechanism for delegated Board staff theauthority to pursue summary suspension, dismiss a complaint, or issue a notice of warning or letter of reprimand to a licensee based upon certaincriteria. At any time, however, a particular complaint may be assigned to an appropriate DC consisting of one or more Board members if somepresenting aspects might not be viewed as appropriate for the matrix to apply or delegated Board staff determined that the matter should bereviewed by the DC. Any matters that may be processed under the matrix policy, which becomes disputed by the licensee, would automatically bereferred to a DC for resolution. For example, if the licensee or certificate holder does not agree with a Letter of Reprimand (LOR), the DC willconsider the matter independent of prior decision. The following represents another method of categorizing matters that could logically beprocessed under the matrix policy based upon historical experience in treatment of most disciplinary cases, as well as when a case should beoriginally assigned to an appropriate DC.CATEGORY BASIS FOR COMPLAINT DIS NOW LOR DCABANDONMENTABUSE OR NEGLECTAUDITNo violation of the NPAUnsubstantiated allegationsSubstantiated allegations but the evidence is less than clear and convincingSubstantiated allegations but patient(s) not harmedSubstantiated allegations but patient(s) minimally harmedSubstantiated allegations but patient(s) seriously harmedAll other substantiated allegations of abandonmentNo violation of the NPAXUnsubstantiated allegationsXSubstantiated allegations but the evidence is less than clear and convincing XSubstantiated allegations of isolated verbal abuse and no physical contactXSubstantiated allegations of abuse or neglect but minimal patient(s) involvement,unintended consequence of actionX XIntentional harmful act toward patient(s), minimal patient(s) consequenceXIntentional harmful act toward patient(s), serious patient(s) consequence 1 X*All other substantiated allegations of abuse or neglectXFailure to provide proof of CE credit or competency within last 24 months/orrenewal periodXXXXXXXX1This category represents a subject that also could form the basis for a summary suspension proceeding. In all categories not otherwise shaded in blue inwhich a matter would be referred to a DC the possible summary suspension is indicated in the DC column as “X*” – i.e., with an asterik.MATRIX – NONSERIOUS OR UNDISPUTED COMPLAINTS Page 1 of 7 MATRIX – SUMMARY SUSPENSION (July 2012)

CATEGORY BASIS FOR COMPLAINT DIS NOW LOR DCDRUG DEPENDENCY orSUBSTANCE USE DISORDERDRUG DIVERSIONFAILURE TO DISCLOSENo violation of the NPAXUnsubstantiated allegationsXSubstantiated allegations but the evidence is less than clear and convincing XSubstantiated allegations of isolated instance of alcohol abuse or criminalconviction for DUI AND no recommendations for treatment of Substance UseXDisorder (SUD)Substantiated allegations of isolated instance drug-related criminal convictionXAND no recommendations for treatment of SUDSubstantiated allegations of alcohol or chemical dependency, or SUD, withevaluation recommendations for treatment or restrictions to practice not disputedX 2by licensee and agreement for conditional/restricted licenseSubstantiated allegations of impairment in the workplace not disputed bylicensee and agreement for summary suspension pending further investigationAll other substantiated allegations of SUD, disputed by licensee X*No violation of the NPAXUnsubstantiated allegationsXSubstantiated allegations but the evidence is less than clear and convincing XSubstantiated allegations of drug diversion not disputed by licensee andagreement for summary suspensionAll other substantiated allegations of drug diversion disputed by licensee X*Licensee did not disclose information related to personal history questions onrenewal application, no evidence of intention to mislead/deceiveLicensee did not disclose information related to personal history questions onrenewal application, evidence of intention to mislead/deceive is less than clearand convincingLicensee failed to disclose information related to personal history questions onrenewal application, with clear and convincing evidence of intention tomislead/deceive, and licensee agreeable to reprimandLicensee failed to disclose information related to personal history questions onrenewal application, with clear and convincing evidence of intention tomislead/deceive, and licensee disputes reprimandXXXXX2This may initially be processed by matrix decision-making, as cases in this category typically result in a conditional license, with fairly common terms forprofessional monitoring, random drug testing, and restrictions in practice. A DC is assigned for consultation if necessary. If the licensee or certificate holderdisputes any recommended element of a conditional license, the matter is automatically referred to the DC.MATRIX – NONSERIOUS OR UNDISPUTED COMPLAINTS Page 3 of 7 MATRIX – SUMMARY SUSPENSION (July 2012)

CATEGORY BASIS FOR COMPLAINT DIS NOW LOR DCMISAPPROPRIATIONNONCOMPLIANCE -- NMPPRACTICE BEYOND SCOPEUnsubstantiated allegationsXSubstantiated allegations but the evidence is less than clear and convincing XSubstantiated allegations but no patient/client harmXSubstantiated allegations of misappropriation but harm to patient/client is lessthan $100X XSubstantiated allegations of misappropriation AND serious patient/client harm X*All other substantiated allegations of misappropriationXFirst failure to comply with Settlement Agreement orders – administrative noncomplianceSecond failure to comply with Settlement Agreement orders – administrativenon-compliance (missed or diluted drug testing)Failure to comply with Settlement Agreement orders – positive drug screenadmitted by licensee and agreement for suspension from practiceFailure to comply with Settlement Agreement orders – positive drug screendisputed by licensee and/or agreement for suspension from practiceAll other substantiated allegations of failure to comply with SettlementAgreement orders – failure to comply with NMPNo violation of the NPAXUnsubstantiated allegationsXSubstantiated allegations but the evidence is less than clear and convincing XSubstantiated allegations of practice beyond scope but no patient harm X XSubstantiated allegations of practice beyond scope but minimal harm to patientSubstantiated allegations of practice beyond scope and patient seriously harmedAll other instances of substantiated practice beyond scopeXXXXXXXXUNSAFE PRACTICE /SUBSTANDARD CARESubstantiated allegations of unlicensed practice, < 30 days + renewal XSubstantiated allegations of unlicensed practice, >31 days + renewalXUnsubstantiated allegationsXSubstantiated allegations of unsafe practice/substandard care, but the evidenceis less than clear and convincingXSubstantiated allegations of unsafe practice/substandard care, no patient harm X X3All other cases involving unlicensed practice are handled by the Board’s advisory attorney and are not a license discipline matter.MATRIX – NONSERIOUS OR UNDISPUTED COMPLAINTS Page 5 of 7 MATRIX – SUMMARY SUSPENSION (July 2012)

CATEGORY BASIS FOR COMPLAINT DIS NOW LOR DCUNSAFE PRACTICE /SUBSTANDARD CARE(continued)VIOLATION OF BOARDORDERSUMMARY SUSPENSIONSubstantiated allegations of unsafe practice/substandard care, minimal patientharm or long term consequenceSubstantiated allegations of failure to follow standards of nursing care, seriouspatient harm or long term consequenceAll other instances of substantiated unsafe practice/substandard careUnsubstantiated allegationsXSubstantiated allegations of violation of Board Order but the evidence is lessthan clear and convincingXSubstantiated allegations of violation of Board Order but no patient/client harm X XSubstantiated allegations of violation of Board Order but minimal harm topatient/clientAll other substantiated violations of Board Order and disputed by licenseeSubstantiated allegations of impairment in the workplace not disputed bylicensee and agreement for summary suspension pending further investigationSubstantiated allegations of drug diversion not disputed by licensee andagreement for summary suspensionFailure to comply with Settlement Agreement orders – positive drug screenadmitted by licensee and agreement for summary suspensionSummary suspension order from another jurisdiction or Board, not disputed bylicensee and agreement for summary suspensionSubstantiated allegations of impairment in the workplace AND disputed byX*licenseeSubstantiated allegations of drug diversion AND disputed by licensee X*Substantiated allegations of SUD, with evaluation diagnosis indicating licenseeis unsafe to or should be immediately removed from practice andX*recommendations for treatment AND disputed by licenseeFailure to comply with Settlement Agreement orders – positive drug screen ANDX*disputed by licenseeSubstantiated allegations of inappropriate sexual/personal relationship withpatient/client AND disputed by licenseeSubstantiated allegations of physical and/or mental impairment or lack ofX*competency AND serious patient/client harmSubstantiated allegations of intentional harmful act toward patient(s), seriousX*patient(s) consequenceXXXXXMATRIX – NONSERIOUS OR UNDISPUTED COMPLAINTS Page 6 of 7 MATRIX – SUMMARY SUSPENSION (July 2012)

CATEGORY BASIS FOR COMPLAINT DIS NOW LOR DCSUMMARY SUSPENSION(continued)Substantiated allegations of misappropriation AND patient/client(s) seriouslyX*harmedCriminal arrest for prescription fraud, theft/burglary from patient/client, providingillicit substances to other persons, not disputed by licensee and agreement forX*summary suspensionSubstantiated allegations of multiple drug-related or felony criminal conviction X*(Feb. 2013)MATRIX – NONSERIOUS OR UNDISPUTED COMPLAINTS Page 7 of 7 MATRIX – SUMMARY SUSPENSION (July 2012)