The Medical Investigation on the Nursing Home that killed Donna Sonnenber

The Department of Public Health (DPH) investigated the actions of the nursing home as a whole; that is where its jurisdiction lies. Another department has jurisdiction over the professionals who work in nursing homes: the Department of Registration and Education (DRE). DRE licenses a wide array of professionals in the state, including doctors, nurses, and nursing home administrators. When DPH officials thought the professionals involved in Donna Sonnenberg’s care should be investigated, they asked the appropriate department to investigate: DRE. DRE’s general mandate is to protect the public health, safety, and welfare through licensing the appropriate professional and occupational groups; 32 such groups in all, with 81 licensing categories (according to a 1981 auditor general’s report).

The department, along with its boards and committees, sets standards, tests, licenses, investigates, inspects, and disciplines these groups. About 455,000 people and agencies hold DRE licenses, including architects, private detectives, funeral directors, physicians, real estate brokers, embalmers, public accountants, barbers, collection agencies, horseshoers, psychologists, and dentists. The department’s duties vary from profession to profession. Statutes governing some occupations detail the qualifications for getting a professional license but stop there, without saying what acts by the licensed professionals DRE is to monitor. At theother extreme, some statutes set up virtually no minimum qualifications for licensure but focus on specific actions that DRE must regulate. Most professions fall between these poles, with detailed licensing qualifications and some (though not much) attention to actions by licensees.

The auditor general’s report (1981) criticized this lack of uniformity, pointing out that itmakes DRE’s job all the harder. The auditor general’s report also criticized the variability and poor definition of the responsibilities of the department’s boards and committees. In 28 of the 32 professional areas DRE handles, a board or committee develops standards for licensure and acts as a hearing board in *DRE’s enabling statute is Ill. Rev. Stat. ch. 127, IT IT 60-62. Chapter Ill contains most of the relevant statutes concerning professionals.

The director of DRE appoints the members of all but two boards; the governor appoints the members of the Medical Disciplinary Board and the Board for Opinions on Professional Nursing, with senate approval. Most boards are made up of professionals in the appropriate area; the Medical Disciplinary Board and the Nursing Home Administrators Licensing Board are two of the only three boards with members from outside the profession. Most boards have considerable authority in DRE matters. For example, in medical investigations the director of DRE may not take disciplinary measures “except upon the action and report in writing of the Board” (Ill. Rev. Stat. ch. 111, ft 4449).

In some of DRE’s other licensing areas, the department can exercise none of its duties or functions without board approval. The auditor general’s report criticized the general lack of clear separation of powers and responsibilities. The statutes governing the professions, the boards and committees, and the Department, as now written, cannot be efficiently administered nor consistently complied with. A system of checks and balances between the boards and committees and the Department has not been achieved. Most enforcement control authority is vested in boards and committees; most responsibility is placed with the Department. The Department cannot act without board/committee approval, and the boards/committees cannot unilaterally enforce the acts. A more reasonable division of authority and responsibility needs to be achieved, and statutory conflicts and inconsistencies need to be addressed. We merely report this criticism here.

The reader might bear it in mind in discussions of the Medical Disciplinary Board’s involvement in the Sonnenberg case. Medical Investigations The Medical Disciplinary Board, which handles complaints against physicians, is made up of five physicians, one chiropractor, one doctor of osteopathy, and two members who have nothing to do with medicine. The non-medical members, added to the board a year and a half ago (by Public Act 82-1036), have no vote in the board’s decisions. Acting as the chief enforcement officer for the board is the medical coordinator, a doctor. He reviews all complaints that come into the office and decides if there’s enough information to bring the complaint before the Complaint Committee. If he needs moreinformation, he may ask for a preliminary investigation.