VA Facilities Demonstrated Mixed Compliance with Key VA Screening Requirements

We identified key VA screening requirements and found mixed compliance  with these requirements in the four facilities we visited. All four facilities generally complied with VA’s existing policies for  verifying the professional credentials of practitioners currently employed  in VA facilities, either by contacting the state licensing boards for  practitioners such as physicians or physically inspecting the licenses or  national certificates for practitioners such as nurses and respiratory  therapists. VA has not conducted oversight of its facilities’ compliance with the key  screening requirements. These  reviews did not include determining whether the facilities were verifying  professional credentials. Gaps in Key VA Screening Requirements Create Vulnerabilities

Gaps in VA’s requirements for screening the professional credentials and  personal backgrounds of practitioners create vulnerabilities in its  screening processes that could place patients at risk by allowing health  care practitioners who might harm patients to work in VA facilities. Another available national  database, the Healthcare Integrity and Protection Data Bank (HIPDB),  contains information on professional disciplinary actions and criminal  convictions involving all licensed health care practitioners, not just  physicians and dentists. As with physical inspection of state licenses,  physical inspection of national certificates alone can be misleading; not all  certificates are marked if restricted, and they can be forged. Implementing fingerprint-only checks for practitioners who are currently  exempt from background investigations would detect practitioners with  criminal histories. However,  compliance with the existing key screening requirements was mixed at the  four facilities we visited. In addition, VA does not  require all practitioners with direct patient care access, such as medical  residents, to have their fingerprints checked against a criminal history  database. In our report, we recommend that VA take the following four actions:    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 practitioners VA intends to hire  and currently employed practitioners,    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 practitioners currently employed in VA,  require fingerprint checks for all health care practitioners who were  previously exempted from background investigations and who have direct  patient care access, and    conduct oversight to help ensure that facilities comply with all key  screening requirements for practitioners VA intends to hire and  practitioners currently employed by VA.
Mr. Chairman, this concludes my prepared remarks.
Why GAO Did This Study

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.

What GAO Found

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.