Imagine working a good portion of your life as a nurse practitioner. You’re settled into your own practice, established in life. You have the latest BMW SUV out there, a beautiful home, the best dogs ever….and loving parents who are bursting with pride every time you come up north to visit. You would think that graduation day was just yesterday by the way they beam at you over the dinner table during every Sunday dinner.
The seasons come and go in a small northern Arizona town. The leaves are boldly beautiful in the fall, the snow sparkles in the winter. As you sit in a cozy living room having coffee and homemade cookies with your parents over a holiday weekend its hard not to breathe it all in…..this is your reality, your life. Everything is preciously simple, predictable…. and yet so peacefully, unbreakably, enduring. You take pride in the fact you can care for them, oversee things to make sure they are well provided for. There is nothing in this world you can’t give back to them after all they have done to help you through school.
Life. Is. Great.
Until it isn’t.
Until it won’t be anymore.
Until all that remains of your life are just fleeting embers floating away in the wind……
Such is the story of one nurse practitioner I began corresponding with in 2013. He had been following my case for quite some time and was frustrated with his counsel. It seemed to him that his attorney was more interested in placating the Arizona Board of Nursing than representing his interests. A short time later he would take his defense into his own hands by doing all the legal work himself in order to ensure that his own bests interests were being kept front and center.
He stayed up many days and nights at a time doing legal research, studying other nurse’s cases, emailing back and forth with me. The following are highlights of this nurse practitioner’s journey battling the Arizona Board of Nursing.
As most nurses know, it’s easy for virtually anyone to file a complaint against one’s license. In Nathan’s case this was no different. In August of 2011, a patient who became angered by a question Nathan had asked him during a psychiatric assessment, filed a complaint against his license. The patient would later contact the board to “quash” the complaint, advising the Board of Nursing that he did not want Nathan to be disciplined for no reason. Nathan recalls “The guy filed a rambling similar complaint on a NP co-worker at the same time. Hers disappeared… mine didn’t. The only difference I could see was an ASU connection. She was a grad and a preceptor and had good connections there.”
The complainant’s request fell on deaf ears…the Board of Nursing would continue their hunt into Nathan’s past…and into every private aspect of his life. Instead of dismissing the complaint against Nathan, they came up with 12 “Factual Allegations” UNRELATED TO THE INITIAL COMPLAINT to potentially charge him with.
For a period of 13 months Nathan’s case sat on a desk and was passed off from investigator to investigator until it landed on the desk of University of Phoenix Assistant Dean of Nursing and 2014 RN.com “Giving Excellence Meaning” Award Nominee—a Nurse Practitioner herself, Janeen Dahn. From the point she picked it up, Nathan recalls, everything went to hell—AND FAST.
As per usual for most nursing board investigations, (depending on who you know) the state uses all its time, technological, and financial resources to delve into the life of a nurse. Nathan’s case was one that required the “special knowledge and tactics” of Valerie Smith—the on again off again retired consultant that me and others believe is “brought out of retirement” for the more “problematic cases” such as Nathan’s and mine. The AZBON’s hired gun, Valerie Smith has a background primarily in psychiatric nursing (no general med surg. just psych.) and is notorious for “diagnosing on the spot.” (She did as much on the stand during my administrative hearing when I cross examined her)
The common denominator among nurses who come to me with their stories is their interaction with Valerie Smith. Nathan and I were similar in the sense that we fought the charges and sought to secure our constitutional and/or Civil Rights during a process that ceremoniously strips them away from a nurse. HIPPA does not apply to ANY NURSE under investigation. The Arizona Board of Nursing has within its grasp the ability to subpoena any and all legal, medical, and psychiatric/pharmacy records. They can, and will, use what they find within those records against a nurse whether it is relevant to a case or not.
It’s well known by now that a nurse’s personal life, their entire career, their physical and mental health history are all fair game. In many instances, the Board of Nursing pads its investigative reports with defamatory false “statements” from “coworkers” to further their case against a nurse. Sometimes—they go too far in their attempts to inflict harm–Most recently they made the mistake of publishing a nurse’s personal address, her email address, her social security number and date of birth on a public site. There is no maneuver that escapes them when they are in pursuit of a nurse’s livelihood. However, it should be noted once more–they apply the shock and awe approach to specific cases, and not all cases.
During the course of his investigation Nathan was shocked to learn that his medical records had been subpoenaed by and reviewed by Investigator Dahn. During a meeting with her, Dahn (allegedly) quizzed him about his sexual preference and his sexual practices as per what was written in his primary care physician’s progress notes. The words “high risk behaviors” were (allegedly) used by Dahn. He described to me the “three religious medals she wore” on her clothing as she interrogated him and how he found it ridiculous.
You see, Nathan is gay. “I outed in the 80’s…” he recalls.
Within all the medical records reviewed, Investigator Dahn (allegedly) included in the investigative report a one page progress note from his physician that discussed his gay status and his negative HIV status as well as other personal particulars irrelevant to the initial complaint lodged against his license:
“She (Investigator Dahn) (allegedly) made a big deal out of a few things: that I graduated from a diploma RN program. That my medical record said ‘high risk behaviors’. The investigative interview was a sham, she wasn’t even listening to me…conclusions were drawn. It’s a kangaroo system with zero objectivity. I was sure I had the justification, the rational data, and expert emails to justify my actions in the complaint. Then she (Investigator Dahn) hits me: “Why did you quit this job without notice? Why were you given a written warning at ___________? (I’m an NP) Why did you write yourself 2 separate anti-biotics in 2011? And a few more totally unrelated to the initial complaint. The board meeting was last Monday. Four days before that, my lawyer called to say the original complaint had not even mentioned that there were 12 items stating unprofessional conduct and failing to maintain minimum standards. I was like WHAT? I didn’t even get to answer to them. I still don’t know what they all are-I have an idea. They are now trying to railroad me into a 12 month probation… I’m not sure I even want to remain in the profession-I’ve been in clinical practice for 15 years.”
Nathan felt strongly that they were using his sexual orientation as a basis to establish that he wasn’t a safe practitioner, that somehow his sexual orientation would translate to him providing unsafe care to patients. Over the past few years, Nathan has had to go back and forth with the Board. It was his full time work searching for jobs, strategizing and reading up on the law in order to find ways to secure his constitutional rights throughout the process. It hasn’t been easy to do, as there are blocks to Constitutional Rights when you are a nurse under investigation in Arizona:
“It’s in the 4th amendment to the Constitution, due process, searches of private matters, probable cause , double jeopardy all to protect our liberty=right to practice chosen profession from government action=AZBON. They claim they have to balance with public safety -no member of the public was at risk even if the crap they are claiming against me was true. There are checks in place so government or government agencies can’t make up things against you, to take your protected health information, to delve into personal private areas of your life. I was born and raised in Boston where all these crazy ideas began… it’s in my blood. I think around here people like to feel they can make up their own rules. I beg to differ, we’ll see. Odds are against me but I love a good fight.”
When Nathan requested discovery of all evidence the Board of Nursing had against him, they denied his requests. One would think that a nurse can appeal to other government agencies for another set of eyes, an impartial party—to take another look. In Arizona such an agency does not exist. Nurses, patients, and other attorneys have appealed to the State Ombudsmen’s office numerous times (without response or resolution), the Auditor General’s office, the State Attorney General’s office, and state legislators themselves. The media itself—will not investigate the Board of Nursing’s actions against licensed professionals. They will however—investigate the Medical Board and the Dental Board. Go figure.
As the years go on and Joey Ridenour continues her “Command” role over Arizona’s version of “B613″– the Arizona Board of Nursing soldiers on in its effort to impede upon the basic Civil Rights of nurses. In my case—freedom of speech (my social media accounts are still monitored by the state) and in Nathan’s case—his status as a gay man who happens to be a nurse practitioner. Other cases involve nurses who are older in age. Yet, nurses with multiple DUI’s or multiple drug offenses are gently set free from the proverbial investigative web of wonder to resume their careers unscathed. Their records fiercely protected from the public’s eyes like the B613 files in Scandal. At one point, Nathan took note of several cases against ASU nurses that were dismissed by AZBON officials, but he and I were too busy to investigate further. The question still lingers.
Nathan has experienced other challenges on his road to justice. He lost his home. He lost his vehicle. He was unable to secure a job, but was finally able to get Circle K to hire him. He had to quit after a short while due to his declining health. His health status has taken a significant hit throughout this process. He has also watched his parents’ health decline these past few years as a result of the ordeal that has impacted not just him—but all of his loved ones and friends who have been on this road with him.
…..Just one day prior to his hearing before the Arizona Board of Nursing his father suffered a stroke and Nathan was unable to be with him because he was scheduled to do his own defense the following morning……
During the years we corresponded back and forth, supporting each other in the middle of the night as we struggled to put together our own cases and cope with our losses, he shared with me how he felt on one occasion he had gone out of state to visit his parents: “When I went back to MA for a job interview I saw my parents for the first time in 18 months and I couldn’t believe my eyes… they don’t even look the same. I think this has had an effect on them. They are both in their 80s. The last time I saw them they were vibrant and active, now they appear withdrawn, almost defeated.”
There is a lifelong guilt, the responsibility one bears upon their shoulders, when they choose to battle against the Board of Nursing’s injustice. It’s no longer about just you, everyone around you becomes a part of things. Everyone around you suffers with every hit you take. Your family, your friends, your significant others. In some way or another, to some degree….they are affected by the point of impact.
I have not yet heard back from Nathan about the outcome of his case. My guess is he is in MA caring for his ailing father and supporting his mother. I hope he triumphed. I hope he is able to recover what is left of his practice… more than that—I hope he is able to get back to living his life, one with peace and the self-realization that he is bigger, bolder and better than the process that has not just engulfed him spiritually, physically, and mentally—but has taken a good portion of his hard earned life from him.
I don’t know what I would have done without those emails back and forth in the middle of the night the past few years…..our experiences and feelings mirrored each other’s in so many ways. I consider him my friend, my colleague, and a brother in all this….and I am proud to finally tell his story. Because he was and is so brave where others are not. Because he chose to keep getting up no matter how many times he was knocked down. Because he wanted to set an example and establish a precedent for all gay nurses.
I believe Nathan has an important message to get out there—BEING GAY DOES NOT EQUATE WITH BEING A DANGEROUS NURSE. BEING GAY DOES NOT MEAN YOU ARE ANY LESS OF A GOOD SOLID PRACTITIONER THAN THE NEXT NURSE. BEING GAY CANNOT BE USED AS A PREDICTOR OF FUTURE BEHAVIORS AS A NURSE PRACTITIONER, OR A NURSE FOR THAT MATTER. BEING GAY SHOULD NOT BE A PRECURSOR FOR LOSING ONES HARD EARNED NURSING LICENSE. BEING GAY DOES NOT GIVE THE STATE OF ARIZONA THE RIGHT TO USE THAT STATUS TO TAKE AWAY THE LIVLIHOOD AND STABILITY OF ANYONE. BEING GAY IS NOT A VIOLATION OF THE NURSE PRACTICE ACT.
THE DEFINITION OF A NURSE…..should not EXCLUDE people on the basis of race, gender, ethnicity, religion, socioeconomic status, or sexual preference. The question is, just how far will state lawmakers allow ANY STATE to go when it comes to persecuting nurses on the basis of these very factors? More importantly—how low will the profession allow itself to be taken down before making a stand that supports acceptance, tolerance, and the high standards we’re expected to uphold as touted within the Code of Ethics for Nurses?
Maybe—this case is a sign that our profession has arrived at a point in time that The Code, The Oath, and the very tenets that Nursing was built upon no longer matter…