License Lapse and Continuing Competence Audit at a Skilled Nursing Facility
Leilani is a licensed physical therapist at a 120-bed skilled nursing facility in Honolulu. She believed her Hawaii license renewal was due July 31, so she continued treating residents through the first three weeks of July. In fact, the license expired on June 30. During that 18-day period she provided skilled treatment to 41 residents, including a patient with a new below-knee amputation. On July 22 she submitted a renewal application listing 24 continuing competence hours: a 10-hour employer in-service on fall prevention with no approved-provider number, an 8-hour online journal quiz, and a 6-hour CPR card. She also completed a 3-hour ethics course in 2023. The facility administrator tells her to keep working until the board "clears the paperwork" because coverage is short. An audit letter arrives requesting documentation.
1. Did Leilani violate Hawaii licensure law, and what must she do immediately about patient care and the audit?
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Practicing on an expired license is unlicensed practice under HRS chapter 461J. Renewal is not retroactive, and a pending application does not authorize treatment. Leilani must stop skilled patient care immediately until the board issues an active license or written authorization. She should notify the administrator in writing, remove herself from the schedule, and document which residents she treated during the lapse. For the audit, she must submit truthful records and a written explanation; she must not backdate notes or alter records. She should self-report the lapse to the board rather than wait for the audit to become a complaint. The facility must arrange licensed coverage and review billing for the 18 days, because claims for services by an unlicensed person may be false claims. She should preserve treatment records and obtain legal or risk-management advice. Continuing to work at the administrator's request would compound the violation.
2. Evaluate whether her 24 hours satisfy Hawaii's continuing competence requirement and describe a remediation plan.
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Hawaii requires 30 continuing competence hours per biennium; the category limits and approved-provider rules are in HAR title 16, chapter 110. Her 24 hours are not automatically 24 qualifying hours. CPR is generally not continuing competence in physical therapy unless the board specifically approves it. An employer in-service without an approved-provider number may fail the rule unless it meets documentation criteria. Journal self-study is often capped. The 2023 ethics course may fall outside the current biennium. She should obtain the rule, map each certificate to a category, and replace disallowed hours with approved courses, likely at least 12 to 15 additional hours, including ethics if required. She should keep certificates for audit and submit only truthful entries. If hours are deficient, the board may renew with a deficiency plan or deny renewal; falsifying the attestation would be a separate disciplinary violation.
3. What exposure do the facility and supervising therapist face for allowing her to continue working?
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The facility faces licensing and reimbursement risk. Allowing an unlicensed person to provide skilled services can support a board complaint, survey deficiency, and civil or criminal false-claims exposure. The administrator's instruction to keep working is not a defense. A supervising PT who knowingly permits unlicensed practice may face discipline for aiding and abetting or unprofessional conduct. The facility should immediately suspend her patient-care duties, notify its compliance officer and insurer, audit bills for the lapse period, and consider correcting or refunding claims. It should document corrective action and train schedulers to verify license status before assignments. If the board requests records, the facility must provide accurate information and must not retaliate against Leilani for complying. The supervising therapist should not sign off on notes for services she did not supervise.