The Bartow County deputy noticed a few things right off. First, of course, the woman in the parked BMW was injecting something into her arm from a small bottle.
As he got closer he spotted the IV in her right wrist. A search turned up more drugs.
The deputy noted in his report that the suspect — a registered nurse — had been using propofol, the powerful anesthetic on which Michael Jackson overdosed and a drug rarely found outside hospitals. She later was sentenced as a first offender to a year probation, drug counseling and a $1,000 fine.
The arrest, three years ago, went unnoticed by the Georgia Board of Nursing, which regulates and licenses 150,000 nurses across the state.
A year ago, nurse Sarah Chapman was arrested again. This time police charged her and her husband, Curt Chapman, with a combined 39 felony counts related to prescription drug fraud. The couple is accused of using fake names or the identities of actual patients in falsifying prescriptions for narcotics and opiates, court records show. They were indicted this month in Bartow County Superior Court and are free on $10,000 bond each. Curt Chapman was arrested again in April and charged with writing a fake prescription on a pad stolen from the doctor’s office that now employs his wife.
Still, Sarah Chapman’s record with the Georgia Board of Nursing was pristine for years, leaving her free to practice medicine. She was doing just that in a private practice in Austell as recently as last week.
According to a police report, Chapman went to work in the Austell office of Dr. James Sexson shortly after her 2012 arrest. Both Chapman and Sexson declined to speak with a reporter visiting Sexson’s office.
There is no record showing Sarah Chapman was ever impaired while treating patients or that she endangered anyone. But in an order made public late Friday suspending her license, the nursing board claimed Chapman “poses a threat to the public health, safety and welfare and imperatively requires emergency action.”
The board “expedited” a mental exam for Chapman on Aug. 6. The exam, which took place later that month, diagnosed her with propofol addiction and recommended in-patient treatment “for a period of at least six weeks.” Chapman continued to practice for months longer.
Board President Barry Cranfill said the case is sadly typical of the board’s maddeningly slow approach to disciplining nurses, and it often means that nurses who lose their jobs because of drug problems simply find a new employer that is none the wiser.
Chapman’s first offense occurred in 2010, “and it took until November 2013 for us to do something,” Cranfill said. “That’s unacceptable,” he said.
‘It’s an absolute embarrassment to me’
Research by The Atlanta Journal-Constitution of public discipline by the board over several years found it takes the state an average of 15 months to investigate and take disciplinary action, even in cases where a nurse admits to a violation of state rules.
Cranfill says the board does not have enough money or staff to handle the workload. He has been sounding the alarm for more than year that something should be done.
“It’s an absolute embarrassment to me that it takes this long,” he said. “It should be an embarrassment to the entire state.”
Cranfill complains the board levies about $4 million annually in fees from Georgia nurses but is only given half that money back by the Legislature. If the entire amount were returned, he claims, the board could address the backlog of cases, some of which have languished for years with no action.
The board believes it has more than 3,000 unresolved nurse discipline cases, but abysmal record keeping and data management issues make it impossible for anyone to swear to an exact number. The board has more than 430 nurses on active probation but only one person assigned full time to make sure they are complying with the terms of that probation.
Unlike in the courts, where accusations generally are public, the board keeps its proceedings secret until a final vote is recorded. Sometimes wrongdoing by nurses is kept secret after as well.
Cranfill said the board was not even aware of Sarah Chapman’s 2010 plea agreement in Bartow County. It is not uncommon for the board not to know about criminal incidents because there is no law requiring employers to report nurses when they break the law, he said.
Cranfill, a nurse anesthetist, said employers would rather quietly dismiss a nurse with a drug problem than expose themselves to the embarrassment and potential liability of publicly reporting the nurse.
Mandatory reporting, with a catch
The Legislature passed a law this year requiring mandatory reporting of nurses who are caught using narcotics or otherwise violating ethical rules, but there’s a catch: the law will not go into effect unless it is properly funded, and it hasn’t been.
According to police reports and news accounts, Chapman was employed at Floyd County Urgent Care prior to her 2012 arrest. Floyd Health Systems would not confirm anything about Chapman’s employment history. Likewise Chapman’s attorney declined to answer any questions regarding his client.
Chapman came to the attention of The Atlanta Journal-Constitution by way of an anonymous letter from someone concerned that Chapman was treating their elderly aunt. The tipster knew about the 2012 arrest, but Chapman’s legal problems have continued.
In April, Curt Chapman, her husband, was arrested in Acworth for allegedly trying to pass off a fake prescription for the painkiller Percocet. According to the police report, the forged prescription came from Sexson’s office, where Sarah Chapman works.
Neither Sexson nor Curt Chapman’s attorney returned calls seeking comment, but the arrest report details a curious chain of events that shocked even the arresting officer.
According to the report, a pharmacist told the officer she was suspicious because Sexson’s patients are mostly senior citizens. She said she called Sexson’s office and spoke to a woman who said the office was aware of the stolen prescription and had reported it “to the authorities.” When the officer called the doctor’s office to find out where the offense had been reported, he got a different story.
“Dr. Sexson did not appear to know what I was talking about, and when I asked if he had filed a report for a stolen or missing prescription pad, he denied ever doing so,” the officer wrote.
To his surprise, the officer said, he got a call from Curt Chapman a little more than an hour later. He asked how Chapman got his mobile phone number and Chapman reportedly told him his wife works for Sexson and he got it from her.
The officer said Chapman confessed to stealing the pad while helping Sexson move offices, but he did not implicate his wife.
‘Meanwhile, those nurses remain in practice’
Sarah Chapman’s case is just one example of the problems facing the nursing board. The vast majority of pending cases involve nurses struggling with addiction while working with patients.
Debbie Hackman, CEO of the Georgia Nurses Association, said nurses are no more prone to addiction than the general population, but an addicted nurse poses a special risk.
“In order to protect the public, the Georgia Nurses Association believes nurses with substance abuse disorders need immediate intervention, professional assessment, removal from practice and referral to addiction recovery programs,” she said. “Unfortunately these investigations take years, meanwhile those nurses remain in practice.”
Hackman said the association supports increased funding to the board, but the association has taken a more polite tone in its pleas compared to Cranfill, whose impolitic hammering on the board’s plight and his willingness to air his complaints publicly has ruffled feathers at the Capitol.
Senate Health and Human Services Chairwoman Renee Unterman, a former nurse herself, has had many conversations with Cranfill on the topic. Many conversations.
“Am I going to try to get more money for them? The answer is yes, but it’s not because of Barry’s tactics,” she said. “He makes people mad and I have to cover his tracks.”
Cranfill has argued the board needs to have an independent budget and threatened to cut fees in protest. He has even publicly advocated that someone (he’s suggested the Georgia Association of Nurses) should sue the state over it. His appearance in September before a House study committee on the state’s troubled professional licensing boards was icy if not downright hostile.
But Cranfill, appointed to the board in 2010, is unapologetic. Past nursing boards have worked through the system for decades on funding issues, but the problem has gotten no better, he said.
Unterman said the disciplinary backlog is “definitely unacceptable,” but she’s worried about more than just discipline on one of the state’s dozens of licensing boards under Secretary of State Brian Kemp.
“It’s a system that is broken and the secretary of state has said it is broken,” she said. Carving out the nursing board into a separate budget item will not fix that, she said.
Gov. Nathan Deal’s office reached out in September when Cranfill threatened to cut licensing fees. Deal met with board members in September.
Deal spokesman Brian Robinson said there was nothing new to report from the meeting with Cranfill and other members of the board. He noted, however, that the board has the power to suspend the license of nurses convicted of crimes.
“We’re told by the board that once convicted they can remove someone’s license immediately,” he said in an email to the AJC.
Not quite, Cranfill said. Simply learning that a nurse has been convicted isn’t enough to pull a license, he said. The attorney general’s office requires legal proof of the conviction before the board can summarily suspend a license, so the board refers the cases to their part-time investigators to get the correct documentation and submit it to the attorney general.
“It goes in that queue,” he said.
That same queue where a backlog of work means it takes an average of 15 months for even a simple case to re-emerge for a final board vote.
‘Even if they showed up to work drunk’
There are limited circumstances under which the board can summarily suspend a nurse’s license, such as when a nurse constitutes an imminent danger to the public. But in his experience, cases where the board’s state attorney would agree to such a suspension are very rare.
“Even if they showed up to work drunk we’d be hard pressed to get a (summary suspension),” he said. The board’s summary suspension of Chapman shows that even “emergency” measures can take months to process.
Instead, the board can try for what is called an “indefinite suspension,” but that requires the nurse to sign a form agreeing to the suspension, Cranfill said.
That’s not a criticism, Cranfill said. Due process is important, but the board cannot move those cases along without more resources, he said.
Cranfill said he wants to give the Legislature another shot at fixing the problem when it reconvenes in January. After that, he’ll look at other options.
Cranfill points to a 1977 federal court decision that required the state to return all license fees collected by real estate agents to the Georgia Real Estate Commission.
Patients and nurses should at least get “the same benefits of people who are real estate customers,” he said.
The Georgia Board of Nursing takes years to process disciplinary complaints against nurses, but not every state struggles so much.
North Carolina, for example, is a model state by comparison.
The states regulate a similar number of nurses, but while cases take 15 months or longer to be resolved in Georgia, the North Carolina Board of Nursing resolves narcotics complaints against nurses in about four months and malpractice cases within 45 days.
Why the difference?
The North Carolina board has a $7.3 million budget, paid by nurse licensing fees. Georgia’s nursing board limps along on a budget of $2 million.
The Georgia board has a dedicated staff of eight people and shares investigators with other state boards that license hairdressers, sports agents and other professions. The North Carolina board has a staff of 50, including eight full-time investigators, five of whom are registered nurses.
The Atlanta Journal-Constitution reported in July that the state nursing board usually takes more than a year, and sometimes much longer, to investigate complaints against nurses. After that the governor intervened in the controversy and a House committee convened a special hearing. But in the months since, the AJC finds that little has actually changed.