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States Fail to Report Disciplined Caregivers to Federal Database

Hundreds of state agencies have failed to tell the federal government about health professionals they disciplined, ProPublica has learned, meaning frontline workers who have a record of on-the-job misconduct, incompetence or criminal acts aren’t flagged to potential employers.

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Hundreds of state agencies nationwide have never told the federal government about health professionals they disciplined, undermining a central database meant to weed out dangerous caregivers.

The federal database is supposed to contain disciplinary actions taken against doctors, nurses, therapists and other health practitioners around the country so that hospitals and select others can run background checks before they hire new employees.

Federal officials discovered the missing reports after a ProPublica investigation in February found widespread gaps in the data, including hundreds of nurses and pharmacists who had been sanctioned for serious wrongdoing.

Since then, regulators nationwide -- prodded by federal health officials -- have submitted 72,000 new records to the database, nearly double the total submitted for all of 2009.

All states are required by law to report the licensed health workers they've sanctioned to databases run by the U.S. Health Resources and Services Administration (HRSA). But ProPublica found that many state agencies either didn't know about the requirement or simply weren't complying.

The failure to report means frontline health workers who have a record of on-the-job misconduct, incompetence or criminal acts aren't flagged to hospitals or other potential employers, who pay a fee to run checks on job applicants.

Wisconsin, for example, has not reported sanctions against emergency medical technicians. The state's Department of Health Services website, however, shows that more than two dozen EMTs have been disciplined, including several for criminal convictions and one for stealing drugs from an ambulance.

An agency spokeswoman said officials are working to submit the missing information.

HRSA's analysis of 13 nursing boards flagged by ProPublica as missing records shows the depth of the problem. Since being contacted by HRSA, those boards collectively have reported more than 2,000 missing cases, including 147 in California and 66 in Illinois. Florida alone had 972.

Despite the important public safety role of the database, federal officials have little power to enforce compliance. Earlier this month, they took what they said is the strongest action allowed against scofflaws: They put a checkmark next to state names indicating they were "noncompliant" and posted the information on the HRSA website.

"That's the tool we've been given by Congress," said Mary Wakefield, administrator of HRSA, noting that no prior administration had even used that before.

Twenty-one states and Puerto Rico were thus chastised for not reporting on at least one category of health professional or ignoring the government's requests for information. Kentucky was flagged for 10 professions; Louisiana, six; and Alabama and New Mexico, five each.

Many states were listed as "working toward compliance," meaning they were in the process of submitting missing information, or "under review" by the federal government.

Congress ordered the government to create a database of disciplinary actions against all health providers more than two decades ago; information about doctors and dentists was first made available in the National Practitioner Data Bank in 1990. But hospitals could begin searching other professions only in March of this year. The database is not open to the public.

The completeness of the database is important because health professionals often have licenses in multiple states. If a hospital checks just one state's oversight board, disciplinary actions elsewhere may not turn up.

California, for example, recently discovered that 3,500 registered nurses with clean records there had been disciplined in other states.

ProPublica's report in February found that no sanctioned pharmacists had been reported by South Dakota or New Hampshire and only one each in Alabama, Delaware, Ohio and Tennessee. But a search of those states' websites showed hundreds of sanctions, including a pharmacist in Ohio who ran an Internet pill mill that dispensed nearly 1.5 million drug doses without valid prescriptions.

Wakefield acknowledged that her agency is just beginning to assess the completeness of the information. After ProPublica detailed the gaps in the data, federal officials sent letters to the nation's governors requesting help and held numerous training sessions.

HRSA is still trying to sort out the compliance status of 450 licensing boards and agencies that appear to never have reported discipline for some of the professions they oversee. The agency plans to report additional information in October.

Officials are in the process of comparing disciplinary actions reported to the federal database to what states have listed on the states' own public websites. "This is a work in progress," Wakefield said.

The review did not examine state agencies overseeing doctors and dentists because they have been reporting actions for nearly a decade more than others.

Some state officials said they were surprised to be labeled noncompliant.

David Potters, executive director and general counsel of West Virginia's pharmacy board, acknowledged that his board had not submitted all of its disciplinary actions, but said he had turned in a plan to catch up.

Consumer advocate Dr. Sidney Wolfe, who has pushed for a more accurate databank, said the agency's work in recent months is a huge step forward.

"HRSA is at least making some moves in directions that it hasn't made for a while -- and hopefully there will be many more moves," said Wolfe, of Public Citizen, a Washington, D.C., nonprofit that advocates for patient safety.

John M Ginnetti

July 19, 2010, 3:13 p.m.

Unfortunately, I was one of those disciplined nurses.  The Connecticut Board of Nursing revoked my license after my alleged failure to resuscitate a young man who died of a heroin overdose in the drug rehab facility where I was working.  When I was called to this unfortunate young man’s side (first thing in the morning), it was obvious that he had been dead for many hours.  Still, someone’s head had to roll and nurses are easy targets.  Two months after my license was revoked, in a civil malpractice trial I was found to have “not only met, but exceeded the standard of care” (In the opinion of a Yale Psychiatrist), and testimony of a world renowned forensic toxicologist proved that this patient had been dead for anywhere from 4 to 6 hours by the time I was summoned.  All charges against me were immediately dismissed.  Did the Connecticut Board reinstate my license upon learning this?  Did they apologize for their wrong-headed judgement?  Of course not.  So be aware that not every disciplined nurse is guilty.  Board hearings are administrative hearings.  Hearsay testimony is acceptable.  Standards of proof are lax.  But as they say, “nurses eat their young”.

As a disciplined pharmacist in the state of California, I was reported to the “National Data Bank”  way back in 2000.  The report was correct.
However, I just received another copy of the report “unprompted by me” stating I had done the serious actions in 2006 that had been originally reported by the CA BOP in 1997 I have been sober and “rehabilitated” and have never broken another rule/law.  I am grateful for my sobriety.  Now, I have to try to clear up this horrific slanderous lie that has been reported by the “National Data Bank”...I believe in the reporting, but, just get it correct.  Imagine the ramifications of wrong report.  Maybe your publication should report something positive about the programs that do work, and the health care professionals who graduate out of the diversion programs.  The CA BOP program is still the most strict in the Nation.  Check it out.

Norman Morley

July 19, 2010, 7:43 p.m.

I find a very large problem with these so called data banks in that the employees that are working there, either are themselves incompetent or just plain sloppy. Also, people who have been entered in these data banks, may or may not be guilty of the charges listed. As with ever so called data bank, whether State or Federal, the computer systems/software have been shown to be wanting in being up to date. Also, there doesn’t seem to be any procedures to fact check as a back up. Then, there’s also the so called fiefdom that goes along with the territory.  One only has to look @ the F.B.I.‘s own system to see what I speak of. Also, the system here in California for the D.M.V. is forever being up graded only to discover before it’d completed, that it doesn’t work. $Billions of taxpayer money is wasted, with no chance of recouping the loss. It seems that when it comes to the Government, regardless whether State or Federal, that the suppliers dump the junk when providing equipment. There used to be a time in this Country when we could count on getting our moneys worth & had systems that performed as promised. Today, the business industry think it’s O.K. to flim-flam the government in the purchase department, because everyone does it.

Sydney Farrix

July 20, 2010, 6:57 a.m.

The fallacy in the information provided is that the federal government could have sent a letter to a state agency about not having received any reports and the answer may be because there has been no action taken against those health care providers.  One state listed only has 24 providers in the category listed and none have ever been sanctioned for violating the laws in that state but they were sent a letter.  You make it sound like that state is doing something wrong.  I guess reporting just the facts doesn’t spark as much interest!

Bless you all for your candor on this topic Propublicans. Considering the 50 billion a year we spend on intelligence gathering and analysis, it behooves us to ask why Healthcare is not top of the list of areas of National and Homeland Security for accurate risk assessment and judicious inquiry.

WashingtonPost.com has a wonderful searchable database this week, which documents what you can do for Natural (sic) Security privately. See Dana Priest and William Arkin’s “Top Secret America”. It is based on 2 years research following the leads of Tim Shorrock.com “Spies for Hire” and Jeremy Skahill’s work on “Blackwater -Xe.

Bobbi Crockett

July 25, 2010, 5:55 a.m.

Paul, I strongly disagree with your thinking that National Homeland Security should have anything to do with healthcare. Of the few actual responsibilities that the government does have (as outlined in the Constitution), it does even less of them well. Do you really want more red tape and regs? I agree that patients need to be protected. However, there are already laws and regulations in place. If those regs were adhered to plus adding a provision for actual punishment (most states currently have none) then then we would have no need for further oversight. Government in any case is not the answer.

Bobbi,  only a guess, but could be that Paul was making a point about the $Billions spent on our so called security projects since 9/11, but don’t seem to give a rats . . . about the health of the general public taxpayers. When you consider the vast amounts spent/wasted by this Government on other countries/peoples, yet the ones footing the bills are thrown crumbs, demands that everyone open their eyes to what is taking place. Not just repeating something someone else says, whether it’s the Pundits, the so called experts, the propagandists, the spin masters. Tunnel-vision, is a disease that has taken root in the vast majority of the public today. It’s good that we have the ability & means to add our 2 cents worth to the discussion. But there are also many who take too much for granted, don’t step back & try to see the other side of an issue, instead are quick to voice an opinion which doesn’t match up fully with reality.

Bobbi Crockett

July 25, 2010, 5:33 p.m.

I understood Paul’s point exactly. While I agree that the government sends too much overseas, I do not believe that it is the government’s place to throw us bits of anything. The government’s job is to provide fo the general welfare and common denfense.  It is not the government’s job to provide healthcare to the citizens. That is the job of the individual. It is called personal responsibility. It is also the personal responsibility as citizens to uphold the laws of the land (such as reporting abuse and implementing consequeses that are already on the books). When you ask the government to get involved in personal matters, you begin the decent down a very slippery slope. Ask someone who currently lives or has lived in a communist country. Bye the way, that you for the attempt at insult, it becomes you.

Bobbi, I presume that you are referring to MOI and the comment written. There isn’t any insult towards anyone but if you believe there is, then have the decency to explain yourself, not throw out such an accusation. It’s too easy for hit & run tactics, especially when you don’t back them up.

Bobbi Crockett

July 25, 2010, 7:19 p.m.

1.” Not just repeating something someone else says, whether it’s the Pundits, the so called experts, the propagandists, the spin masters. Tunnel-vision, is a disease that has taken root in the vast majority of the public today.”

2.” But there are also many who take too much for granted, don’t step back & try to see the other side of an issue, instead are quick to voice an opinion which doesn’t match up fully with reality.”

Your statemen t# 1 intimates that I have not formed my thoughts on my own, that I am only repeating the words of others. Which to me, is an insult. You have drawn a conclusion based on your persona bias.
Your second part of statement #1 you make blanket statements about the propogandists etc. You have nothing to back your aparent beliefe that what they speak is untrue.
Your statement in # true insinuates that people who believe differently from you are not oriented in all spheres (time, place, surroundings) therefore it is only logical to conclude that you feel not capable of making logical decisions….that we must have others spoonfeed us info (thus enters the “pundits”)

Bobbi, now you say I’m putting you or anyone else down, which is far from the truth. I believe either you’re projecting, or perhaps you’re a troll. Let’s just drop this, but if you feel a need to, you can have the last word, but do think about what you say.

Robert Jeffery, Dir of Operations, GA Med Board

July 29, 2010, 12:19 p.m.

Please note that the information in the table supplied by HRSA erroneously lists the Georgia Composite Medical Board as having compliance issues in four professions. The Board has issued a press release addressing this error (http://www.files.georgia.gov/GCMB/Files/Press release re NPDB and HIPDB reporting.pdf). To summarize, the Board is completely and strictly compliant with HRSA’s NPDB and HIPDB reporting requirements.

Robert Jeffery

Aug. 2, 2010, 11:51 a.m.

Just a note to point out that the HRSA table does have at least some erroneous information - The Georgia Composite Medical Board is, in fact, compliant with all HRSA reporting requirements. Please go to http://www.files.georgia.gov/GCMB/Files/Press release re NPDB and HIPDB reporting.pdf to view the Board’s public statement.

- Bob Jeffery, Director of Operations, Georgia Composite Medical Board

This article is part of an ongoing investigation:
When Caregivers Harm

When Caregivers Harm: America's Unwatched Nurses

California has failed to protect patients from nurses who are incompetent and dangerous.

The Story So Far

In California, nurses accused of serious wrongdoing have often been left free to practice for years while their cases were being investigated—with patients unaware of the danger.

The board that oversees the state’s registered nurses has taken more than three years, on average, to discipline nurses with histories of drug abuse, negligence, incompetence and violence.

More »

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