When Caregivers Harm: Learning from the ProPublica-Los Angeles Times Nurse Investigation

By the time you read about the case of 9-year-old Caitlin Greenwell, unable to talk because her brain was starved of oxygen during a botched birth, you are convinced: the oversight of nurses in California is abysmal.

Her story is deep inside "When Caregivers Harm," an investigative collaboration between ProPublica and the Los Angeles Times published Sunday.

Then you find out that the nurse accused of botching that birth thinks that oversight is abysmal, too. "What they're doing is torturing us," Candyce Warren told reporters. Six years after a complaint against her was filed with the Board of Registered Nursing, Warren's case is still in limbo.

Every time you think that Charles Ornstein and Tracy Weber of ProPublica, and Maloy Moore of the Times, have exhausted all possible angles, sources or ways of nailing this story, they come up with a new one. I wanted to highlight a few of the many things they did right in this investigation and show some of the places they went to get information.

1. They put their findings in the right context. "The board failed to use its authority to immediately stop potentially dangerous nurses from practicing. It obtained emergency suspensions of nurses' licenses just 29 times from 2002 to 2007. In contrast, Florida's nursing regulators, which oversee 40% fewer nurses, take such action more than 70 times each year." Information about nurses and other health professionals in Florida can be found here.

2. They called it like they saw it. Often when reporters investigate a subject, the subject says, "We're fixing that problem." The reporters here looked at the fixes and drew a conclusion: "Many were mundane or incremental adjustments..." Throughout the story, they make similar authoritative assessments. They also showed how these promises had been made before. They found a board report to the Legislature from 2002 that exposed some of the same problems and called for changes. Legislative reports can be a great resource for reporters. These agencies are often forced to justify their very existence, providing detailed accounts of their work.

3. They explained why this all matters, showing how the state has fewer working nurses per capita and how each nurse can play a role in dozens of cases every day. They also talked about how "the delays make the pursuit of cases more difficult: Witnesses die. Records are purged. And former co-workers cannot be found."

4. They documented the problems with multiple public record sources. In the case of Abbie Dickerson, for example, a nurse at Olive View-UCLA Medical Center in Sylmar, they used Los Angeles County Civil Service Commission records to find that she had "been written up four times for medication errors," before she incorrectly connected a patient's feeding tube.

5. They checked the nursing board's work against other agencies. They even found that in some cases boards outside California had taken action against nurses for things the nurses had done in California. Only after those out-of-state boards had disciplined the nurses did the California board do something. "Even when a registered nurse loses a license with another of California's professional boards, the nursing board does not always act promptly. In more than a dozen cases, individuals were able to care for patients as registered nurses after they had been severely sanctioned or even had their license revoked - by the Board of Vocational Nursing and Psychiatric Technicians."

6. Perhaps most importantly, they showed their work. The ProPublica and Times sites are full of graphics, timelines and an incredible database that allows you to search more than 2,000 sanctions against California nurses.

Charlie, Tracy and Maloy, with help from Doug Smith at the Times, have been writing about problems with nursing oversight since 2008. It's an area that begs for more reporting because nurses are such a crucial part of the health care system. As anyone who has spent time in a hospital or at a doctor's office knows, nurses are the ones who do most of the work.

As the story correctly points out, the bad nurses are the minority, but they should not be allowed to repeat their mistakes over and over and over without being encouraged to reform or to get out of the profession. As one nurse with a troubled past says in the story, "The nursing board is there to protect the public from me."