VA Health Care: Veterans at Risk from Inconsistent Screening of  
Practitioners (31-MAR-04, GAO-04-625T). 			 
                                                                 
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.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-04-625T					        
    ACCNO:   A09624						        
  TITLE:     VA Health Care: Veterans at Risk from Inconsistent       
Screening of Practitioners					 
     DATE:   03/31/2004 
  SUBJECT:   Health care personnel				 
	     Physicians 					 
	     Data bases 					 
	     Personnel evaluation				 
	     Evaluation methods 				 
	     Crimes or offenses 				 
	     Hiring policies					 
	     Licenses						 

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GAO-04-625T

United States General Accounting Office

GAO Testimony

Before the Subcommittee on Oversight and Investigations, Committee on
Veterans' Affairs, House of Representatives

For Release on Delivery

Expected at 10:00 a.m. EST

Wednesday, March 31, 2004 VA HEALTH CARE

         Veterans at Risk from Inconsistent Screening of Practitioners

Statement of Cynthia A. Bascetta Director, Health Care-Veterans' Health and
Benefits Issues

GAO-04-625T

Highlights of GAO-04-625T, a testimony before the Subcommittee on
Oversight and Investigations, Committee on Veterans' Affairs, House of
Representatives

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.

March 31, 2004

VA HEALTH CARE

Veterans at Risk from Inconsistent Screening of 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.

Four Facilities' Compliance with Existing Key VA Screening Requirements

Compliance with key screening requirements

Key screening requirements Facility A Facility B Facility C Facility D

Credentials verified for practitioners VA A  WA  A
intends to hire

Credentials verified for practitioners W  WW  W
currently employed in VA

List of Excluded Individuals and Entities W  AA  A
queried for practitioners VA intends to hire

Background investigation completed or
requested for practitioners currently W  AA  W
employed in VA

GAO recommended that VA expand its existing verification process to
require that all state licenses and national certificates be verified by
contacting state licensing boards and national certifying organizations,
expand the query of a national database to include all licensed
practitioners, and fingerprint all practitioners who have direct patient
care access. GAO also recommended that VA conduct oversight of its
facilities to ensure their compliance with all screening requirements. VA
generally agreed with the report's findings and plans to develop a
detailed action plan to implement GAO's recommendations.

www.gao.gov/cgi-bin/getrpt?GAO-04-625T.

To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cynthia A. Bascetta at (202)
512-7101.

Declaration for Federal Employment form
completed for practitioners currently W  WW  W
employed in VA

Source: GAO analysis of VA facility files.

W Indicates a compliance rate of 90 percent or greater.

A Indicates a compliance rate of less than 90 percent.

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.

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to discuss the findings and recommendations
in our report, which you are releasing today, on the Department of
Veterans Affairs (VA) policies and practices for screening health care
practitioners.1 VA employs about 190,000 individuals, including
physicians, nurses, pharmacists, and therapists, at its facilities, and it
supplements these practitioners with contract staff, medical consultants,
and medical residents. VA has screening requirements intended to help
ensure that its health care practitioners' professional credentials are
verified and their personal backgrounds are checked for evidence of
incompetence or criminal behavior.

While such requirements cannot guarantee safety in health care settings,
they are intended to minimize the chance of patients receiving care from
someone who is incompetent or who may intentionally harm them. According
to medical forensic experts, however, the deliberate harm of patients by
health care practitioners is a problem in the health care sector in
general. The well-publicized case of Dr. Michael Swango, who pleaded
guilty to murdering three veterans while a medical resident training at
the VA facility in Northport, New York, and was sentenced to three
consecutive life terms without the possibility of parole, illustrates the
potentially disastrous effect of inadequate screening of health care
practitioners.

You asked us to examine VA's policies and practices intended to ensure
that health care practitioners at its facilities have appropriate
professional credentials and personal backgrounds to provide safe care to
veterans. Specifically, we (1) identified key VA screening requirements
and assessed the extent to which selected VA facilities complied with
these screening requirements for its health care practitioners and (2)
determined the adequacy of the key VA screening requirements for health
care practitioners.

To do our work, we selected 43 occupations in which practitioners have
direct patient care access or have an impact on patient care and
identified

1U.S. General Accounting Office, VA Health Care: Improved Screening of
Practitioners Would Reduce Risk to Veterans, GAO-04-566 (Washington, D.C.:
Mar. 31, 2004).

the key screening requirements that applied to these occupations.2 To
identify the key screening requirements, we reviewed VA employment
screening policies and interviewed VA headquarters and facility officials
and practitioners. To assess the extent to which VA facilities complied
with the key screening requirements, we visited four VA facilities and
reviewed a statistically random sample of about 100 practitioners'
personnel files at each site. We selected facilities to visit based on
geographic variation, affiliations with medical schools to train
residents, and types of health care services provided. Additionally, we
obtained documentation on how quickly facilities took action after
obtaining the results of background investigations. Our results cannot be
generalized to other facilities. To determine the adequacy of the key
screening requirements, we examined whether these screening requirements
were complete, and whether VA applied them to all practitioners it
intended to hire, practitioners currently employed in VA, contract health
care staff, medical residents, and volunteers. We also interviewed
representatives of state licensing boards and national certifying
organizations and officials and representatives of organizations that
operate national databases containing information on state licenses and
national certificates. We did our work from August 2003 through March 2004
in accordance with generally accepted government auditing standards.

In summary, we identified key VA screening requirements and found mixed
compliance with these requirements in the four facilities we visited. The
key screening requirements are those that are intended to ensure that VA
facilities employ health care practitioners who have valid professional
credentials and personal backgrounds to safely deliver health care to
veterans. While we found that all facilities generally checked, on a
periodic basis, the professional credentials of practitioners currently
employed in VA, they did not verify all of the credentials of all of the
practitioners they intended to hire. Furthermore, VA facilities varied in
how quickly they took action after obtaining the results of background
investigations. During the site visit at one facility, we discovered
returned background investigation results that were over a year old but
had not been reviewed. We brought them to the attention of facility
officials, who reviewed the reports and then terminated a nursing
assistant who had been fired by a previous non-VA employer for patient
abuse. Although VA established an

2Although VA has many employment screening requirements, such as whether
the applicant is a United States citizen, we selected only those
requirements that pertain to patient safety, such as verification of
credentials and background investigations.

office more than a year ago to perform oversight of human resources
functions, including whether its facilities comply with these key
screening requirements, that office has not conducted any compliance
reviews at facilities. Furthermore, VA has not implemented a policy for
the human resources program evaluation to be performed by this office and
has not provided funds to support this office. This pattern of mixed
compliance creates vulnerabilities to the extent that VA remains unaware
of practitioners it employs who could place patients at risk.

We also found gaps in the key VA screening requirements that VA officials
used to verify the professional credentials and personal backgrounds of
health care practitioners. We found adequate screening requirements for
certain practitioners, such as physicians and dentists, for whom
facilities are required to verify all licenses by contacting state
licensing boards. However, existing screening requirements for others,
such as nurses currently employed in VA, are less stringent because they
do not require that facilities verify all state licenses that a nurse may
holdonly one must be checkedand they require only physical
inspection of the license rather than contacting the state licensing board
to verify the status of the license. VA also does not require verifying
national certificatesthe credentials held by other health care
practitioners, such as respiratory therapistsby contacting the
national certifying organizations for practitioners VA intends to hire and
periodically for those employed in VA. Physical inspection alone can be
misleading; not all professional credentials indicate whether they have
had disciplinary actions taken against them, and credentials can be
forged. VA also does not require facility officials to query a national
database, for other than physicians and dentists, that contains reports of
professional 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.

To better ensure the safety of veterans receiving health care at VA
facilities, in our report we recommend that VA conduct more thorough
screening of practitioners VA intends to hire and practitioners currently
employed in VA by expanding its verification requirement that facility
officials contact state licensing boards and national certifying
organizations for all state licenses and national certificates; expanding
the query of a national database to include all licensed practitioners
that VA intends to hire and periodically for practitioners currently
employed in VA; and requiring fingerprint checks for all health care
practitioners who were previously exempted from background investigations
and who have direct

Background

patient care access. Furthermore, we recommend that VA conduct oversight
to help ensure that facilities comply with all screening requirements. In
commenting on a draft of our report, VA generally agreed with our findings
and conclusions and stated that it will develop a detailed action plan to
implement our recommendations.

VA operates the largest integrated health care system in the United States
providing care to nearly 5 million veterans per year. The VA health care
system consists of hospitals, ambulatory clinics, nursing homes,
residential rehabilitation treatment programs, and readjustment counseling
centers. In addition to providing medical care, VA is the largest educator
of health care professionals, training more than 28,000 medical residents
annually as well as other types of trainees.

State licenses are issued by state licensing boards, which generally
establish licensing requirements, and licensed practitioners may be
licensed in more than one state.3 "Current and unrestricted licenses" are
licenses that are in good standing in the state where they are issued. To
keep a license current, practitioners must renew their licenses before
they expire and meet renewal requirements established by state licensing
boards. Renewal requirements include criteria, such as continuing
education, but renewal procedures and requirements vary by state and
occupation. When a licensing board discovers a licensee is in violation of
licensing requirements or established law, for example, abusing
prescription drugs or intentionally or negligently providing poor quality
care that results in adverse health effects, it may place restrictions on
or revoke a license. Restrictions imposed by a state licensing board can
limit or prohibit a practitioner from practicing in that particular state.
Some, but not all, state licenses are marked to indicate that the licenses
have had restrictions placed on them. Generally, state licensing boards
maintain a database of information on restrictions, which employers can
obtain at no cost either by accessing the information on a board's Web
site or by contacting the board directly.

National certificates are issued by national certifying organizations,
which are separate and independent from state licensing boards.4 These

3State licenses are issued by offices in states, territories,
commonwealths, or the District of Columbia, collectively referred to as
state licensing boards.

4Some practitioners may hold both national certificates and state
licenses.

  VA Facilities Demonstrated Mixed Compliance with Key VA Screening Requirements

organizations establish professional standards that are national in scope
for certain occupations, such as respiratory and occupational therapists.
Practitioners who are required to have national certificates to work at VA
must have current and unrestricted certificates. Practitioners may renew
these credentials periodically by paying a fee and verifying that they
obtained required educational credit hours. A national certifying
organization can restrict or revoke a certificate for violations of the
organization's professional standards. Like state licensing boards,
national certifying organizations maintain databases of information on
disciplinary actions taken against practitioners with national
certificates, and many can be accessed at no cost.

We identified key VA screening requirements and found mixed compliance
with these requirements in the four facilities we visited. The key
screening requirements are those that are intended to ensure that VA
facilities employ health care practitioners who have valid professional
credentials and personal backgrounds to deliver safe health care to
veterans. None of the four VA facilities complied with all of the
screening requirements. In addition, VA does not currently conduct
oversight of its facilities to determine if they comply with the key
screening requirements.

Key VA screening requirements include:

o  verifying the professional credentials of practitioners VA intends to
hire;

o  	verifying periodically the professional credentials of practitioners
currently employed in VA facilities;

o  	querying, prior to hiring, the Department of Health and Human
Services' Office of Inspector General's List of Excluded Individuals and
Entities (LEIE) to identify practitioners who have been excluded from
participation in all federal health care programs;5

o  	ensuring that background investigations are requested or completed for
practitioners currently employed in VA facilities;

o  	ensuring that the Declaration for Federal Employment form (Form 306)
is completed by practitioners currently employed in VA facilities; and

5LEIE, a database maintained by the Department of Health and Human
Services' Office of Inspector General, provides information to the public,
health care providers, patients, and others relating to parties excluded
from participation in Medicare, Medicaid, and all federal health care
programs.

o  	verifying that the educational institutions listed by a practitioner
VA intends to hire are checked against lists of diploma mills that sell
fictitious college degrees and other fraudulent professional credentials.

To show the variability in the level of compliance among the four VA
facilities we visited, we measured their performance in five of the six
screening requirements, against a compliance rate of at least 90 percent
for each requirement, even though VA policy allows no deviation from these
requirements. Table 1 summarizes the compliance results we found for the
five requirements among the four VA facilities we visited. For the sixth
requirement to match the educational institutions listed by a practitioner
against lists of diploma mills, we asked facility officials if they did
this check and then asked them to produce the lists of diploma mills they
use.

Table 1: Facilities' Rate of Compliance with Existing Key VA Screening
Requirements

Compliance with key screening requirementsa Key screening requirements
Facility A Facility B Facility C Facility D

                 Credentials verified for practitioners   A     W    A      A 
                                     VA intends to hire                  
                 Credentials verified for practitioners   W     W    W      W 
                               currently employed in VA                  
                      LEIE queried for practitioners VA   W     A    A      A 
                                        intends to hire                  
                     Background investigation requested   W     A    A      W 
                         or completed for practitioners                  
                               currently employed in VA                  
                     Declaration for Federal Employment   W     W    W      W 
                       form completed for practitioners                  
                               currently employed in VA                  

Source: GAO analysis of VA facility files.

W Indicates a compliance rate of 90 percent or greater.

A Indicates a compliance rate of less than 90 percent.

Note: Some screening requirements do not require verifying all licenses a
practitioner might hold or verifying professional credentials by
contacting state licensing boards or national certifying organizations.

aTested for significance at the 95 percent confidence level.

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. They also generally ensured that practitioners VA intended to
hire had completed the Declaration for Federal Employment form, which
requires the practitioner to disclose, among others things, criminal
convictions, employment terminations, and delinquencies on federal loans.
However, three of the facilities did not follow VA's policies for
verifying the professional credentials of practitioners VA intends to
hire, and three did not compare practitioners' names to LEIE prior to
hiring them. Two of the four facilities conducted background
investigations on practitioners currently employed in their facilities at
least 90 percent of the time, but the other two facilities did not.

We also asked officials whether their facilities checked the educational
institutions listed by a practitioner VA intended to hire against a list
of diploma mills to verify that the practitioner's degree was not obtained
from a fraudulent institution. An official at one of the four facilities
told us he consistently performed this check. Officials at the other three
facilities stated that they did not perform the check because they did not
have lists of diploma mills.

In addition to assessing the rate of compliance with the key screening
requirements, we found that VA facilities varied in how quickly they took
action to deal with background investigations that returned questionable
results, such as discrepancies in work or criminal histories. The Office
of Personnel Management (OPM) gives a VA facility up to 90 days to take
action after the facility receives investigation results with questionable
findings. We reviewed the timeliness of actions taken by facility
officials from August 1, 2002, through August 23, 2003, at the 4
facilities we visited and 6 additional facilities geographically spread
across the VA health care system. We found that officials at 5 of the 10
facilities took action within the 90-day time frame, with the number of
days ranging on average from 13 to 68. Officials at 3 facilities exceeded
the 90-day time frame on average by 36 to 290 days. One facility took
action on its cases prior to OPM closing the investigation, and another
facility did not have the information available to report.

One of the cases that exceeded the 90-day time frame involved a nursing
assistant who was hired to work in a VA nursing home in June 2002. In
August 2002, OPM sent the results of its background investigation to the
VA facility, reporting that the nursing assistant had been fired from a
non-VA nursing home for patient abuse. During our review, we found this
case among stacks of OPM results of background investigations that were

  Gaps in Key VA Screening Requirements Create Vulnerabilities

stored in a clerk's office on a cart and in piles on the desk and on other
workspaces. After we brought this case to the attention of facility
officials in December 2003, they reviewed the report and then terminated
the nursing assistant, who had worked at the VA facility for more than 1
year, for not disclosing this information on the Declaration for Federal
Employment form.

VA has not conducted oversight of its facilities' compliance with the key
screening requirements. Instead, VA has relied on OPM to do limited
reviews of whether facilities were meeting certain human resources
requirements, such as completion of background investigations. These
reviews did not include determining whether the facilities were verifying
professional credentials. Although VA established the Office of Human
Resources Oversight and Effectiveness in January 2003 to conduct such
oversight, the office has not conducted any facility compliance
evaluations. In addition, VA has not implemented a policy for the human
resources program evaluation to be performed by this office and has not
provided the resources necessary to support this office.

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. For
certain VA practitioners, screening requirements include the verification
of all state licenses by contacting the state licensing boards to verify
that licenses are current and unrestricted. For example, all state
licenses for physicians and dentists are verified by contacting state
licensing boards to ensure the licenses are in good standing when VA
intends to hire them and periodically during employment. Similarly, all
licenses for nurses and pharmacists VA intends to hire are verified by
contacting the state licensing boards. However, once hired, periodic
screening for nurses and pharmacists simply involves a VA official's
physical inspection of one state license, even if the practitioner has
multiple state licenses, creating a gap in the verification process.

VA's requirements allow a practitioner to select the license under which
he or she will work in VA, and this license can be from any state, not
necessarily the one in which the VA facility is located. A practitioner
may have a restricted state license as a result of a disciplinary action,
yet show a facility official a license from another state that is
unrestricted. VA facility officials informed us that checking one state
license was sufficient because state licensing boards share information on
disciplinary actions

and licenses are marked when restricted. However, according to state
licensing board officials, one cannot determine with certainty that a
license is valid and unrestricted unless the licensing board is contacted
directly. These officials explained that state licensing boards do not
always exchange information about disciplinary actions taken against a
practitioners and not all states mark licenses that are restricted.
Moreover, licenses can be forged, even though state licensing boards have
taken steps to minimize this problem. Therefore, physical inspection of a
license alone can be misleading.

To supplement the screening of the state licenses of physicians and
dentists, VA requires facilities to query two national
databasesthe National Practitioner Data Bank (NPDB) and the
Federation of State Medical Boards (FSMB) databasewhich contain
information about disciplinary actions taken against practitioners.
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. VA is
currently accessing HIPDB automatically when it queries NPDB for
physicians and dentists because the databases share information. However,
VA does not require its facilities to do so for all licensed practitioners
even though it is authorized to query HIPDB without a fee.

VA also requires that practitioners it intends to hire and who must have
national certificates to work in VA facilities, such as respiratory
therapists, disclose the national certificates and any state licenses they
have ever held. However, VA facility officials are not required to check
state licenses disclosed by these practitioners and are only required to
physically inspect the national certificates. 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. The only way to know with certainty if a national certificate
is current and unrestricted is to contact the issuing national certifying
organization.

In addition to gaps in VA's verification of professional credentials, VA
has not implemented consistent background screening requirements, which
would include fingerprint checks, for all practitioners. Although VA
requires background investigations for some practitioners currently
employed in VA, it does not require these investigations for all types of
practitioners. VA requested and received OPM's permission to exempt
certain categories of health care practitioners from background
investigations based on VA's assessment that these types of practitioners

do not need to be investigated. Table 2 lists the practitioners that VA
exempts from background investigations.

Table 2: Types of Practitioners VA Exempts from Background Investigations

Types of practitioners
VA exempts Length of appointment

Contract health care  o  6 months or less in a single continuous
appointment or

practitioners or practitioners series of appointments
who work without direct
compensation from VA

Medical consultants  o  1 year or less and not reappointed

o  	1 year or more but less than 30 days in a calendar year and not
reappointed

Medical residents  o  1 year or less of continuous service at a VA
facility

Source: Department of Veterans Affairs, VA Manual MP-1, Part I, Chapter 5,
Change 1 (Washington, D.C.: 1979).

OPM began to offer a fingerprint-only checka new screening
optionfor use by federal agencies in 2001. Compared to background
investigations, which typically take several months to complete,
fingerprint-only check results can be obtained within 3 weeks at a cost of
less than $25.6 In commenting on a draft of our report, VA said that it
planned to implement fingerprint-only checks for all contract health care
practitioners, medical residents, medical consultants, and practitioners
who work without direct compensation from VA, as well as certain
volunteers. However, VA has not issued guidance to its facilities
instructing them to implement fingerprintonly checks on all these
practitioners. VA did issue guidance to its facilities to implement
fingerprint-only checks for volunteers who have access to patients,
patient information, or pharmaceuticals.

Implementing fingerprint-only checks for practitioners who are currently
exempt from background investigations would detect practitioners with
criminal histories. According to the lead VA Office of Inspector General
investigator in the Dr. Swango case, if Dr. Swango had undergone a
fingerprint check at the VA facility where he trained, VA facility
officials would have identified his criminal history and could have taken
appropriate action. Additionally, one of the facilities we visited had
implemented fingerprint-only checks of medical residents training in the

6Departments and agencies may obtain fingerprints in two ways: either
using paper or using computerized technology, which became available in
1999. Computerized technology typically produces fingerprint match results
in 2 days.

Concluding Observations

facility and contract health care practitioners. An official at this
facility stated that fingerprint-only checks of medical residents and
contract practitioners were a necessary component of ensuring the safety
of veterans in the facility. FSMB in 1996 recommended that states perform
background investigations, including criminal history checks, on medical
residents to better protect patients because residents have varying levels
of unsupervised patient care.

VA's screening requirements are intended to ensure the safety of veterans
by identifying practitioners with restricted or fraudulent credentials,
criminal backgrounds, or questionable work histories. However, compliance
with the existing key screening requirements was mixed at the four
facilities we visited. None of the four facilities complied with all of
the key VA screening requirements. However, all four facilities generally
complied with VA's requirement to periodically verify the credentials of
practitioners for their continued employment. Although VA created the
Office of Human Resources Oversight and Effectiveness in January 2003
expressly to provide oversight of VA's human resources practices at its
facilities, it has not provided resources for this office to carry out its
oversight function. Without such oversight, VA cannot provide reasonable
assurance that its facilities comply with requirements intended to ensure
the safety of veterans receiving health care in VA facilities.

Even if VA facilities had complied with all key screening requirements,
gaps in VA's existing screening requirements allow some practitioners
access to patients without a thorough screening of their professional
credentials and personal backgrounds. For example, although the screening
requirements for verifying professional credentials for some occupations,
such as physicians, are adequate, VA does not apply the same screening
requirements for all occupations with direct patient care access.
Specifically, VA does not require that all licenses be verified, or that
licenses and national certificates be verified by contacting state
licensing boards or national certifying organizations. Similarly, while VA
relies on two national databases to identify physicians and dentists who
have disciplinary actions taken against them, VA does not require facility
officials to query HIPDB. This national database provides information on
reports of professional disciplinary actions and criminal convictions that
may involve currently employed licensed practitioners and those VA intends
to hire. As part of its query of another database, VA accesses HIPDB
automatically for physicians and dentists, but practitioners such as
nurses, pharmacists, and physical therapists do not have their state
licenses checked against this national database. 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. These gaps create vulnerabilities that could allow incompetent
practitioners or practitioners with the intent to harm patients into VA's
health care system. In light of the gaps we found and mixed compliance
with the key screening requirements by VA facilities, we believe effective
oversight could reduce the potential risks to the safety of veterans
receiving health care in VA facilities.

In our report, we recommend that VA take the following four actions:

o  	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,

o  	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,

o  	require fingerprint checks for all health care practitioners who were
previously exempted from background investigations and who have direct
patient care access, and

o  	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. I will be pleased to
answer any questions you or other Members of the Subcommittee may have.

Contact and For further information regarding this testimony, please
contact Cynthia A. Bascetta at (202) 512-7101. Mary Ann Curran and Marcia
Mann also Acknowledgments contributed to this statement.

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