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Board staff outlines enforcement process; notes 15,293 complaints to date in FY25 and 1,496 sanctions last year
Summary
Assistant Director of Enforcement Danielle Green told the board July 18 that the agency is complaint-driven, had received 15,293 complaints so far in fiscal 2025, and that 1,496 licenses were sanctioned in the prior fiscal year; staff also explained the investigation flow, confidentiality rules, and when matters become public or proceed to SOAH.
Assistant Director of Enforcement Danielle (Danny) Green provided a step-by-step overview July 18 of how the Texas Board of Nursing investigates complaints, the legal authorities guiding the work, and the points at which matters become public and may proceed to a contested hearing at the State Office of Administrative Hearings (SOAH).
Green said the agency is complaint-driven and that, "as of this point in fiscal year 2025, we've received 15,293 complaints." She described the distinction between external complaints (reports from employers, patients, family members and other mandatory reporters) and internal complaints generated through eligibility checks, criminal background checks, and disclosures during licensure or renewal.
Green walked board members through the typical investigation flow: intake review to determine whether the complaint alleges conduct covered by the Nurse Practice Act (Texas Occupations Code, Chapter 301), evidence collection including subpoenas for records and witness interviews, potential expert review (for APRN matters), requests for evaluations (for example, chemical-dependency assessments), and a case-review step that determines whether there is sufficient evidence to allege a violation. If there is insufficient evidence, the case is closed; if evidence supports a violation, staff may offer a proposed agreed order or, if settlement cannot be reached or the respondent fails to respond, file formal charges that can lead to a contested hearing at SOAH. Green noted that formal charges and related filings become public.
Green also explained exceptions to routine notice, saying investigators may not notify a respondent if doing so would jeopardize the investigation — for example, in scenarios involving large-scale diversion or “pill mill”-type operations, investigators may coordinate with criminal authorities and execute on-site actions without prior notice to preserve evidence. Green told board members the enforcement unit has five teams, about 30 investigators, six eligibility staff, nine nurse investigators, 15 criminal-justice investigators and five supervisors, and that the board recently was granted seven additional FTEs to expand investigative capacity.
Board members asked how staff screen out frivolous or retaliatory complaints and whether false complaints can carry liability; Green and enforcement staff said the intake review screens for jurisdictional sufficiency, the agency closes complaints lacking evidence of a violation, and instances of demonstrably false or retaliatory filings are uncommon. The panel also noted that some types of complaints result in remedial actions (education, monitoring or TPAP referrals) handled administratively while others progress to formal disciplinary orders or SOAH hearings.
Green provided data on outcomes: she said 1,496 licenses were sanctioned in the last fiscal year, and that over 99% of licensees in each licensure category have no current discipline. She described the compliance and monitoring processes that follow ratified orders, including assignment of case managers to track drug screens, employer attestations, and other conditions of orders.
Green’s briefing was offered as board development and did not require board action.
