VA Health Care:

Improved Screening of Practitioners Would Reduce Risk to Veterans

GAO-04-566: Published: Mar 31, 2004. Publicly Released: Mar 31, 2004.

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Cases of practitioners causing intentional harm to patients have raised concerns about the Department of Veterans Affairs' (VA) screening of practitioners' professional credentials and personal backgrounds. GAO was asked to (1) identify key VA screening requirements, (2) evaluate their adequacy, and (3) assess compliance with these screening requirements. GAO reviewed VA's policies and identified key VA screening requirements for 43 health care occupations; interviewed officials from VA, licensing boards, and certifying organizations; and randomly sampled about 100 practitioners' personnel files at each of four VA facilities we visited.

GAO identified key screening requirements that VA uses to verify the professional credentials and personal backgrounds of its health care practitioners. These requirements include verifying professional credentials; completing background investigations for certain practitioners, including fingerprinting to check for criminal histories; and checking national databases that contain reports of practitioners who have been professionally disciplined or excluded from federal health care programs. GAO found adequate screening requirements for certain practitioners, such as physicians, for whom all licenses are verified by contacting state licensing boards. However, screening requirements for others, such as currently employed nurses and respiratory therapists, are less stringent because they do not require verification of all licenses and national certificates. Moreover, they require only physical inspection of the credential rather than contacting state licensing boards and national certifying organizations. Physical inspection alone can be misleading; not all credentials indicate whether they are restricted, and credentials can be forged. VA also does not require facility officials to query, for other than physicians and dentists, a national database that includes reports of disciplinary actions involving all licensed practitioners. In addition, many practitioners with direct patient care access, such as medical residents, are not required to undergo background investigations, including fingerprinting to check for criminal histories. VA has not conducted oversight of its facilities' compliance with the key screening requirements. This pattern of mixed compliance and the gaps in key VA screening requirements creates vulnerabilities to the extent that VA remains unaware of practitioners who could place patients at risk.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To better ensure the safety of veterans receiving health care at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to require fingerprint checks for all health care practitioners who were previously exempted from background investigations and who have direct patient care access.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA issued a policy in August 2005 that requires facility officials to, at a minimum screen, the fingerprints of all newly employed practitioners against a criminal history database by September 1, 2005. This requirement includes all practitioners working at the VA facility, including trainees such as medical residents. All VA medical facilities have installed and are using the necessary fingerprint equipment to implement VA's policy.

    Recommendation: To better ensure the safety of veterans receiving health care at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to expand the query of the Healthcare Integrity and Protection Data Bank to include all licensed practitioners that VA intends to hire and periodically query this database for continued employment.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Not Implemented

    Comments: VA partially implemented this recommendation when it issued a memorandum on July 13, 2004, which directs all of its medical facilities to query the national databank (Healthcare Integrity and Protection Data Bank (HIPDB)) for all applicants prior to employment and most volunteers prior to being given an assignment. VA's requirement to query the HIPDB for all applicants and new volunteers goes beyond our recommendation to query on those applicants who are licensed. VA has not begun to query HIPDB on a periodic basis for continued employment as recommended. VA issued a policy in December 22, 2006, requiring HIPDB screening for applicants. VA has determined that a query of the HIPDB for continued employment is not necessary and does not plan to implement this portion of the recommendation. The recommendation is closed not implemented.

    Recommendation: To better ensure the safety of veterans receiving health care at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to expand the verification requirement that facility officials contact state licensing boards and national certifying organizations to include all state licenses and national certificates held by applicants and employed practitioners.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: (1) VA implemented this recommendation by directing its medical facilities to document the verification of all state licenses and national certificates (held by all practitioners applying for VA positions) with the issuing state licensing board or national certifying organization. (2) On 12/22/06, VA issued a policy (VHA directive 2006-067) requiring facility officials to credential all health care practitioners who claim licensure, registration, or certification through its electronic system and establish a mechanism for ensuring that multiple licenses and certifications are consistently held in good standing. The policy also requires facility officials to verify with the issuing state licensing board and/or certifying organization all licenses currently and previously held for all applicants and current employees.

    Recommendation: To better ensure the safety of veterans receiving health care at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to conduct oversight to help ensure that facilities comply with all key screening requirements for applicants and current employees.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA has instituted a quarterly personnel suitability and security file review with reports electronically generated and disseminated to all VA medical centers. The electronic report is to be used by medical center leadership to ensure that the required investigations have been initiated and adjudicated within required timeframes. VHA's System-wide Ongoing Assessment and Review Strategy (SOARS) teams continue to include personnel security and suitability as a focus of their reviews of VA medical centers.

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