Filing a Complaint Against a Nurse in Boston: What the Massachusetts Board of Registration in Nursing Does Next

Massachusetts Nurse Facing a Board of Nursing Complaint: What Happens Next

Massachusetts License Defense Attorney · Professional License Defense

If you are a nurse in Boston, whether at Massachusetts General Hospital, Brigham and Women’s, Beth Israel Deaconess, Boston Children’s, Boston Medical Center or a smaller practice or facility, a letter from the Massachusetts Board of Registration in Nursing is not something to set aside. The letter will usually ask for a written response by a deadline, and that deadline is real. Missing it can become a separate ground for discipline.

This guide explains who the Board is, how a complaint moves from an investigation to a possible hearing, what the Board can do, and what you should do in the first days after the letter arrives. The short version: call an attorney promptly, and respond on time, through counsel.

Who regulates Boston nurses

The Board of Registration in Nursing is a state board that serves within the Department of Public Health (G.L. c. 13, § 9). It licenses registered nurses and licensed practical nurses and authorizes advanced practice registered nurses. Its disciplinary rules reach a nurse’s license, an APRN authorization, or both.

The Board’s power to discipline comes from G.L. c. 112, § 61 and the nursing statutes in c. 112, §§ 74 through 81C. Its procedures for investigations, complaints and Board actions are in 244 CMR 7.00. The Standards of Conduct for nurses are in 244 CMR 9.00.

How a complaint starts

Anyone can send the Board information alleging that a nurse engaged in misconduct: a patient, a family member, a coworker, an employer, or another agency (244 CMR 7.02(1)). The Board first looks at whether the conduct, if true, would be a ground for Board action. The grounds are listed in 244 CMR 7.03 and include:

Violating the nursing statutes, the Board’s regulations, or a Board order or Consent Agreement
Breaching the Standards of Conduct in 244 CMR 9.03 and 9.04
Practicing beyond your scope of practice
Conduct that violates recognized standards of care
Falsifying or altering patient records, or making incorrect entries or leaving out essential ones
Practicing while impaired, or obtaining or using drugs unlawfully
Knowingly giving the Board false information
Being convicted of a crime, or being disciplined by another licensing agency for substantially the same reasons
Failing, without cause, to respond in writing to a pending investigation or complaint, or to appear before the Board when asked

In a large Boston hospital, issues such as a medication error, a documentation gap, a controlled-substance discrepancy or a dispute over delegation can move from an internal review to a Board matter. The process that follows is the same wherever you practice in Massachusetts.

The deadline that matters: your written response

When the Board asks you to respond, you must give a signed, written response within 21 days of receiving the request (244 CMR 7.02(2)). If you believe the law exempts you from answering or producing a document, you must say so in writing and cite the legal authority you rely on.

Failing to respond without cause is itself a ground for discipline (244 CMR 7.03(1)(p)). So is failing to appear before the Board without cause when asked (7.03(1)(o)). A nurse who ignores the letter can face a second problem on top of the first.

You may have heard that you have “10 days to notify the Board that you have an attorney.” No such rule exists in the nursing regulations. No regulation requires it, but many Board letters ask you to tell the Board within 10 days whether you will be represented by an attorney. If your letter does, follow it. The deadline to watch is the response deadline in the Board’s letter. Once you retain counsel, your attorney notifies the Board, handles communications from that point, and prepares a response that you review and sign.

Keep your address of record current. The Board can treat a notice as received on the date it was delivered to that address, or on the date delivery was attempted if you moved without a forwarding address (244 CMR 7.06(2)). A letter sitting at an old apartment does not stop the clock.

The investigation

The Board can ask you for a written response and relevant documents, and it can gather more information to test the allegations (244 CMR 7.02(1)). In practice, that can mean requests for records, policies and statements, and contact with the people involved.

The Board’s staff are doing their job: protecting the public. They are not your advocate. What you write becomes part of the record, and it can be used if the matter goes to a hearing. That is why the response deserves care:

Be accurate. Check every date, time and detail against the chart before you put it in writing.
Answer what was asked. A focused response is usually better than a long one that opens new issues.
Do not alter records. Never change, add to or “clean up” documentation after the fact. Altering records is a separate ground for discipline.
Show what you have done. Remediation, education and supportive references can matter, and counsel can help you present them.

How an investigation can end before formal charges

Not every investigation leads to discipline. Before a formal docketed complaint is opened, the Board may close the investigation, or close it and send an advisory letter (244 CMR 7.02(3)). An advisory letter is not discipline. It explains why the matter was closed and reminds the nurse of the rules that apply, without a finding that the nurse did what was alleged. It is, however, a public notice (244 CMR 7.06(1)).

If the evidence supports specific grounds for action, the Board may open a formal docketed complaint (7.02(1)(d)). Even then, the Board can dismiss the complaint for lack of jurisdiction, insufficient evidence, or because the allegations would not warrant action even if true, again with an optional advisory letter (244 CMR 7.04(1)).

Many matters are resolved by agreement. The Board and the nurse may enter a Consent Agreement setting out agreed Board action, or an agreement that the nurse will refrain from practice, along with other lawful terms (244 CMR 7.04(4)). A nurse may also offer a permanent voluntary surrender. If the Board accepts it, the surrender is discipline, it resolves the complaint, and the Board may treat the allegations as true (7.04(3)). Orders and Consent Agreements, whether disciplinary or not, are generally public records (7.04(6)). The terms of any agreement deserve careful review before you sign.

Summary suspension

In the most serious cases, the Board can suspend a license before a full hearing. It must have affidavits or documentary evidence showing that the nurse’s practice poses an immediate and serious threat, or a serious threat, to the public. In the second situation the nurse gets three business days to file opposing evidence first. A hearing on the suspension must take place within seven business days of the order (244 CMR 7.05). If you receive a summary suspension order, contact counsel immediately.

The Order to Show Cause and the hearing

If the matter is not dismissed or settled, prosecuting counsel may start formal proceedings with an Order to Show Cause, which requires you to show why the Board should not act against your license (244 CMR 7.04(2)). You must file a written answer within 21 days of receiving it (801 CMR 1.01(6)(d)(2)).

The hearing is a formal adjudicatory proceeding under Chapter 30A and the Standard Adjudicatory Rules of Practice and Procedure (801 CMR 1.01). The Board may designate an administrative hearings counsel as the Presiding Officer to conduct it (244 CMR 7.04(2)(a)). Each side can present evidence and witnesses and cross-examine the other side’s witnesses. The Board must find that a ground under 244 CMR 7.03 exists before it imposes a sanction, and the Board then issues the final order.

Possible outcomes

After a hearing, the Board may order one or more of the following (244 CMR 7.04(2)):

Stayed probation: not discipline; you practice under temporary conditions.
Reprimand: discipline in the form of a formal, public rebuke, without practice restrictions.
Probation: discipline; you practice subject to conditions.
Suspension: discipline; you may not practice for a set period or until conditions are met.
Revocation: discipline; you may not practice.

An order can set conditions you must meet before the Board will consider a petition to modify the order or to reinstate your license. The Board may also resolve matters in other ways permitted by law, including a fine where the law permits (244 CMR 7.04(7)). Which outcome is realistic depends on the facts, any patient harm, your history and what you have done since.

Appealing a Board decision

A nurse whose license is suspended, revoked or cancelled may petition the Supreme Judicial Court for review under G.L. c. 112, § 64. The court reviews the decision using the standards in G.L. c. 30A, § 14(7). It does not hold a new trial, and the statute bars the court from staying the suspension or revocation before it enters its decree. Because the appeal is decided on the record made before the Board, the hearing is where the evidence has to be put in.

What to do when the letter arrives

Write down the date you received the letter and calendar the response deadline.
Call an attorney promptly, before you contact the Board or write anything.
Do not contact the complainant or the patient’s family about the complaint.
Do not change any record. Gather what you are allowed to access and share it with your attorney.
Respond on time, through counsel. If you need more time, your attorney can ask for it before the deadline, but do not assume an extension will be granted.
Tell your attorney about any related employer investigation, malpractice claim, criminal matter or prior Board history.

Representation from someone who knows the bedside

Attorney Richard Alan Gaudet has been a registered nurse since 2010, including in critical care, and a respiratory therapist since 2005. He is an administrative law practitioner who handles Board of Nursing investigations, responses and hearings. That clinical background helps in reading a chart, understanding a unit’s workflow, and explaining a clinical decision to the Board in terms it recognizes.

If you are a Boston nurse who has received a letter from the Board, contact our office as soon as you can so your response is prepared carefully and filed on time.

Frequently Asked Questions

How long do I have to respond to the Board of Registration in Nursing?

If the Board asks for a written response, it must be signed by you and submitted within 21 days of receiving the request under 244 CMR 7.02(2). Failing to respond without cause is itself a ground for discipline.

Do I have to tell the Board I hired a lawyer within 10 days?

No such rule exists in the nursing regulations. No regulation requires it, but many Board letters ask you to tell the Board within 10 days whether you will be represented by an attorney. If your letter does, follow it. The deadline that matters is the response deadline. Once retained, your attorney notifies the Board and handles communications and the response with you.

Who decides my case if it goes to a hearing?

The hearing is a formal proceeding under Chapter 30A and 801 CMR 1.01. The Board may designate an administrative hearings counsel as Presiding Officer to conduct it, and the Board issues the final order.

What can the Board do to my license?

The Board can dismiss a complaint, sometimes with a non-disciplinary advisory letter, or order stayed probation, reprimand, probation, suspension or revocation. Many matters are resolved by a negotiated Consent Agreement.

Where do I appeal a Board of Nursing decision?

A decision suspending, revoking or cancelling a license may be reviewed by petition to the Massachusetts Supreme Judicial Court under G.L. c. 112, section 64, not the Superior Court.

About the Author

Richard Alan Gaudet, Esq. is a Massachusetts attorney at the Law Offices of Richard Alan Gaudet, LLC in Middleton, Massachusetts, and an experienced administrative law practitioner who represents licensed professionals in board investigations, responses and hearings. He has been a respiratory therapist since 2005 and a registered nurse since 2010, including in critical care. He earned his J.D. in 2020 and was admitted to the Massachusetts bar in January 2021 and to the U.S. District Court for the District of Massachusetts in 2021. He is a member of the Massachusetts Bar Association. Reach him at 978-273-8337 or rgaudet@gaudetlawoffice.com. Office: 35 Village Rd., Ste 100, Middleton, MA 01949.

ABOUT THIS ARTICLE

This article was prepared by a Massachusetts attorney and is provided solely for general informational and educational purposes directed to members of the general public. It does not constitute legal advice and does not create an attorney-client relationship. The law applicable to any particular situation depends on the specific facts and circumstances of that matter. Readers are encouraged to seek the advice of a licensed Massachusetts attorney before taking any action.