VA Policy Requires Its Facilities to Check Many Practitioners’ Professional Credentials and Personal Backgrounds

We identified key VA screening requirements that are intended to ensure  that VA facilities employ health care practitioners who have valid  professional credentials and personal backgrounds appropriate to deliver  safe health care to veterans. Licensing boards and certifying organizations  have various options for disciplining practitioners. Although the screening  requirements for some occupations, such as physicians, are adequate  because they require verifying all licenses by contacting state licensing  boards, screening requirements for other occupations are less stringent. Physical inspection of credentials alone can be misleading; not  all state licenses and national certificates indicate whether they are  restricted, and licenses and certificates can be forged. In addition, VA does not require that all  practitioners undergo background investigations, including fingerprinting,  to check for criminal records. These gaps create vulnerabilities because  VA may remain unaware of health care practitioners who could place  patients at risk. VA Has Adequate Requirements for Verifying Professional Credentials of Certain Practitioners

VA’s requirements for verifying the professional credentials of applicants it  intends to hire and employed practitioners in group A, such as physicians  and dentists, are complete and thorough. VA has not conducted oversight of its facilities’ compliance with the key  screening requirements. HIPDB  is a national database that contains reports of disciplinary actions and  criminal convictions involving all licensed practitioners, not just  physicians and dentists. 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. Recommendations for Executive Action

To better ensure the safety of veterans receiving health care at VA  facilities, we recommend that the Secretary of Veterans Affairs direct the  Under Secretary for Health to 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 applicants and 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 continued employment,  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 applicants and current employees. Specifically, we (1) identified  key VA screening requirements for its health care practitioners, (2)  determined the adequacy of these screening requirements, and (3)  assessed the extent to which selected VA facilities complied with these  screening requirements.
Why GAO Did This Study

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.

What GAO Found

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.