In March 2004, we reported on VA’s screening policies and the gaps we  found in VA’s requirement for screening applicants that may result in VA  health care practitioners’ personal backgrounds and professional  credentials not being thoroughly screened. VA Has Taken Steps to Improve Health Care Practitioner Screening Requirements, but Gaps Remain

VA has taken steps to improve health care practitioner screening by  partially implementing each of the four recommendations made in our  March 2004 report; however, gaps still remain in VA’s health care  practitioner screening requirements. To address our recommendation, VA  expanded the verification requirement to include licenses and certificates  of all applicants VA intends to hire. VA Policy on Fingerprint- Only Background Investigations Addressed Our Recommendation, but Was Not Fully Implemented

In August 2005, VA issued a policy that when implemented across VA will  address our recommendation to expand the use of fingerprint-only  background investigations for practitioners previously exempt from  background investigations who have direct access to patients. VA’s policy  requires, at a minimum, that all newly hired health care practitioners’  fingerprints be checked against a criminal history database. In response to our inquiry, VA surveyed its  facilities and found that as of October 19, 2005, 37 facilities did not have  electronic fingerprint machines operational by September 1, 2005. Since  then VA has made progress; as of February 1, 2006, 2 VA medical facilities  had not implemented this new requirement. None of the seven  facilities had a compliance rate of 90 percent or more for all five screening  requirements we reviewed. Recommendations for Executive Action

To better ensure the safety of veterans receiving health care at VA medical  facilities, we recommend that the Secretary of Veterans Affairs take the  following two actions:    expand the HRM oversight program to include a review of VA facilities’  compliance with screening requirements for all types of salaried and  nonsalaried health care practitioners and    standardize a method for documenting facility officials’ review of  fingerprint-only background investigation results and decisions regarding  suitability to work in VA medical facilities. Specifically, we determined the extent to which (1) VA has  taken steps to improve health care practitioner screening by implementing  the four recommendations made in our March 2004 report and (2) VA  medical facilities are in compliance with VA’s health care practitioner  screening requirements. To determine the extent to which selected VA medical facilities we visited  are in compliance with VA’s health care practitioner screening  requirements, we chose a judgmental sample of seven VA medical facilities  that varied in geographic location to assess the extent to which these  selected facilities complied with the screening requirements included in  our review. We reviewed each selected health care practitioner’s personnel file to  determine whether the facility had documented evidence that it complied  with the following VA screening requirements:    determine the position risk level by completing VA Form 2280;    ensure completion of background investigations;    query the Healthcare Integrity and Protection Data Bank (HIPDB) for all  applicants after October 1, 2004;    complete an employment checklist for those hired after October 1, 2004;    verify state licenses and national certificates for applicants and employed  health care practitioners. See appendix II for detailed information on  the seven VA facilities’ compliance with each VA screening requirement in  our review.
Why GAO Did This Study

In March 2004, GAO reported on gaps in VA's requirements for screening the professional credentials and personal backgrounds of health care practitioners (GAO-04-566). GAO found that VA's requirements did not ensure thorough screening of VA practitioners. VA concurred with four recommendations GAO made to improve practitioner screening. GAO was asked to determine the extent to which (1) VA has taken steps to improve practitioner screening by implementing GAO's recommendations and (2) VA facilities are in compliance with VA's practitioner screening requirements. GAO reviewed VA's current practitioner screening policies to determine if gaps remain, interviewed VA officials, and sampled about 60 practitioner files at each of seven VA facilities selected based on size and geographic location.

What GAO Found

VA has taken steps to improve health care practitioner screening by partially implementing each of four recommendations made in GAO's March 2004 report; however, gaps still remain in VA's practitioner screening requirements. In response to two of GAO's recommendations, VA expanded its screening requirements for all VA applicants to include a verification of all state licenses and national certificates and requires facility officials to query the Healthcare Integrity and Protection Data Bank (HIPDB), which contains information on individuals involved in health care-related civil judgments and criminal convictions and licensing and certification actions. VA, however, has not yet expanded these screening requirements to apply to all health care practitioners currently employed at VA facilities, as GAO recommended. In response to the third GAO recommendation, VA issued a policy in August 2005 that requires individuals who previously were exempt from receiving any level of background investigation to have, at a minimum, their fingerprints screened against a criminal history database. As of October 19, 2005, 37 VA medical facilities had not fully implemented this new requirement because they had not obtained or installed the necessary electronic fingerprint equipment. Since then VA has made progress; as of February 1, 2006, 2 medical facilities had not installed the equipment. Finally, VA has partially implemented GAO's fourth recommendation to conduct oversight of its facilities' compliance with VA practitioner screening requirements; however, GAO found the oversight does not address all of the facility compliance issues GAO previously identified. GAO found poor compliance with four of the five selected VA practitioner screening requirements at the seven VA facilities visited in 2005. None of the seven facilities had a compliance rate of 90 percent or more for all five screening requirements GAO reviewed. Two facilities that had implemented VA's fingerprint-only background investigations--a relatively new form of background investigation--did not comply with VA's requirement to document that the results of the fingerprint check against a criminal history database had been reviewed and used to make a decision on the individual's suitability to work at a VA medical facility.