VA Health Care:
Veterans at Risk from Inconsistent Screening of Practitioners
GAO-04-625T: Published: Mar 31, 2004. Publicly Released: Mar 31, 2004.
Additional Materials:
- Highlights Page:
- Full Report:
- Accessible Text:
Contact:
(202) 512-7207
contact@gao.gov
Office of Public Affairs
(202) 512-4800
youngc1@gao.gov
The Department of Veterans Affairs (VA) employs about 190,000 individuals including physicians, nurses, and therapists at its facilities. It supplements these practitioners with contract staff and medical residents. Cases of practitioners causing intentional harm to patients have raised concerns about VA's screening of practitioners' professional credentials and personal backgrounds. This testimony is based on GAO's report VA Health Care: Improved Screening of Practitioners Would Reduce Risk to Veterans, GAO-04-566 (Mar. 31, 2004). GAO was asked to (1) identify and assess the extent to which selected VA facilities comply with existing key VA screening requirements and (2) determine the adequacy of these requirements for its practitioners.
GAO identified key VA screening requirements that include verifying state licenses and national certificates; completing background investigations, including fingerprinting to check for criminal histories; and checking national databases for reports of practitioners who have been professionally disciplined or excluded from federal health care programs. GAO reviewed 100 practitioners' personnel files at each of four facilities it visited and found mixed compliance with the existing key VA screening requirements. GAO also found that VA has not conducted oversight of its facilities' compliance with the key screening requirements. GAO found adequate screening requirements for certain practitioners, such as physicians and dentists, for whom all licenses are verified by contacting state licensing boards. However, existing screening requirements for others, such as nurses and respiratory therapists currently employed in VA, are less stringent because they do not require verifying all state licenses and national certificates. Moreover, they require only physical inspection of these credentials rather than contacting licensing boards or 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 and criminal convictions 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. This pattern of gaps and mixed compliance with key VA key screening requirements create vulnerabilities to the extent that VA remains unaware of practitioners who could place patients at risk.
Feb 11, 2021
-
Electronic Health Records:
VA Has Made Progress in Preparing for New System, but Subsequent Test Findings Will Need to Be AddressedGAO-21-224: Published: Feb 11, 2021. Publicly Released: Feb 11, 2021.
Feb 1, 2021
-
Veterans Community Care Program:
Immediate Actions Needed to Ensure Health Providers Associated with Poor Quality Care Are ExcludedGAO-21-71: Published: Feb 1, 2021. Publicly Released: Feb 1, 2021.
Jan 14, 2021
-
Prescription Drugs:
Department of Veterans Affairs Paid About Half as Much as Medicare Part D for Selected Drugs in 2017GAO-21-111: Published: Dec 15, 2020. Publicly Released: Jan 14, 2021.
Dec 10, 2020
-
VA Construction:
VA Should Enhance the Lessons-Learned Process for Its Real-Property Donation Pilot ProgramGAO-21-133: Published: Dec 10, 2020. Publicly Released: Dec 10, 2020.
Dec 9, 2020
-
VA Disability Benefits:
Process for Identifying Conditions Presumed to be Service Connected and Challenges in Processing Complex Gulf War Illness ClaimsGAO-21-253T: Published: Dec 9, 2020. Publicly Released: Dec 9, 2020.
Nov 12, 2020
-
Veterans Health Care:
Agency Efforts to Provide and Study Prosthetics for Small but Growing Female Veteran PopulationGAO-21-60: Published: Nov 12, 2020. Publicly Released: Nov 12, 2020.
Sep 30, 2020
-
VA Health Care:
Additional Steps Could Help Improve Community Care Budget EstimatesGAO-20-669: Published: Sep 30, 2020. Publicly Released: Sep 30, 2020. -
Veterans Community Care Program:
Improvements Needed to Help Ensure Timely Access to CareGAO-20-721T: Published: Sep 30, 2020. Publicly Released: Sep 30, 2020.
Sep 28, 2020
-
Veterans Community Care Program:
Improvements Needed to Help Ensure Timely Access to CareGAO-20-643: Published: Sep 28, 2020. Publicly Released: Sep 28, 2020.
Sep 21, 2020
-
VA Disability Benefits:
VA Should Continue to Improve Access to Quality Disability Medical Exams for Veterans Living AbroadGAO-20-620: Published: Sep 21, 2020. Publicly Released: Sep 21, 2020.
Looking for more? Browse all our products here