The Los Angeles Times published this story, a collaboration with ProPublica, in its Sunday editions.
Dozens of nurses convicted of crimes, including sex offenses and attempted murder, have remained fully licensed to practice in California for years before the state nursing board acted against them, a Los Angeles Times investigation found.
The newspaper, in a joint effort with the nonprofit investigative news organization ProPublica, found more than 115 recent cases in which the state didn't seek to pull or restrict licenses until registered nurses racked up three or more criminal convictions. Twenty-four nurses had at least five.
In some cases, nurses with felony records continue to have spotless licenses -- even while serving time behind bars.
Nurse Haydee Parungao sits in a federal prison in Danbury, Conn., serving a nearly five-year sentence after admitting in 2006 that she bilked Medicare out of more than $3 million.
In her guilty plea, Parungao confessed to billing for hundreds of visits to Southern California patients that she never made, charging for visits while she was out of the country and while she was gambling at Southern California casinos.
Yet according to the state of California, she is a nurse in good standing, free to work in any hospital or medical clinic.
Reporters reviewed stacks of nursing board files and court pleadings, consulted online databases and newspaper clippings and conducted interviews with nurses and experts in several states. The review included an analysis of all accusations filed and disciplinary actions taken since 2002 -- more than 2,000 in all, finding misdemeanors and felonies ranging from petty theft and disorderly conduct to assault, embezzlement and bail jumping.
Among the cases in which the board acted belatedly or not at all:
- An Orange County man continued to renew his nursing license for years even after he was imprisoned for attempted murder.
- A Redding nurse racked up 14 convictions from 1996, a year after she was licensed, through 2006, a year before the board caught up with her. The charges included driving under the influence, driving with a suspended license and possession of a controlled substance.
- A San Pedro man amassed convictions for receiving stolen property, possession of cocaine and possession of burglary tools before the board placed him on probation. He subsequently was arrested two more times, for possessing cocaine and a pipe to smoke it. In response, the board extended his probation.
- A Calimesa nurse has a clean record despite a felony conviction for lewd and lascivious acts with a child.
"I'm completely blown away," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego and an expert on professional licensing boards in California. "Nurses are rendering care to sick people, to vulnerable people. . . . This is a fundamental failure on the part of this board."
California has the largest number of registered nurses in the nation. Hospitals and clinics rely on the Web site of the California Board of Registered Nursing, in part, when checking out job applicants because all accusations and disciplinary actions are posted there for public review.
If the nursing board's Web site says that a convicted nurse has a clean record, D'Angelo Fellmeth said, "It's like fraud. It's consumer fraud."
A top nursing board official says her agency is taking the newspaper's findings seriously but was unable to say why individual cases were missed.
"We're just really putting our arms around the issue," said Heidi Goodman, the board's assistant executive director. "It's important. It's vital. It is what we do. That's our mandate: Public protection."
The newspaper's investigation found the board's screening process to be flawed in two significant ways.
First, it allows a large portion of the 343,000 active registered nurses to escape the state's scrutiny. The state began requiring applicants to submit their fingerprints in 1990, so that the board would be flagged by law enforcement agencies whenever a licensed nurse was arrested. But the rule does not apply to nurses licensed before then -- a group that now numbers about 146,000.
California misses a second chance at catching errant nurses when they apply to renew their licenses every two years. Unlike many states, California does not ask nurses to disclose criminal convictions that occurred since the last time they applied.
Even California's vocational nursing board, which oversees nurses with a lesser degree of training, requires renewing nurses to report convictions. California's registered nurses are asked only to pay a fee and verify that they have completed continuing education courses.
As a result, Goodman said the board must rely on complaints and anonymous tips to discover convictions among roughly 40 percent of its nurses.
She conceded that the system has gaps. Prompted in part by questions from the Times, the board plans to ask the Legislature for permission to add a question about convictions to its renewal application. Goodman said the board does not believe it has the authority to change the application on its own.
The state Department of Consumer Affairs, which provides support for all state licensing boards, also is considering asking the Legislature for permission to seek fingerprints from nurses and other health licensees who have not provided them.
Goodman said the board is doing what it can with its limited budget and staff. It can't pursue cases it doesn't know about, she said.
"I don't know what I don't know," she said. But, she added: "I don't view it as a problem. I'm just viewing it as taking a look at opportunities."
At times, the board's slow pace has put patients at risk.
Some nurses with convictions for drug or alcohol-related crimes later were accused of taking drugs intended for patients.
Before one nurse lost her license, she was twice convicted of drunk driving, failed to complete a rehabilitation program and later appeared drunk at three separate nursing jobs, according to the board's complaint against her.
The case of a different nurse convicted in 1994 of smuggling rock cocaine to her jailed husband was not resolved until 2003.
"The exceedingly serious criminal conduct that is the subject of this matter most certainly would have resulted in a revocation of her license" if the charges had been brought sooner, an administrative law judge wrote when the case ended. "No explanation is apparent for the significant delay."
As a result, the judge gave the nurse probation.
Another serious case was similarly drawn out.
In April 1994, an Orange County jury convicted Stephen Menchaca of the attempted murder of his wife. A judge later wrote that Menchaca "hit her on the head with a hard object, pushed her to the ground, put towels in her mouth and over her head and struck her head against the floor."
Menchaca was sentenced to life plus three years in prison.
The nursing board didn't act until eight years later -- after Menchaca had renewed his license repeatedly while in prison. His license finally was revoked in February 2003.
Goodman recalled the case well. "That was a real strange one," she said, adding that the board acted after an anonymous complaint. Asked how he was able to renew his license, she said, "The address of record we had wasn't in prison, so somebody was able to do something on his behalf unbeknownst to us."
Menchaca did not respond to a request for comment sent to him in state prison in Lancaster.
Goodman said many hospitals conduct their own criminal background checks. And, she said, one minor crime such as a drunk driving conviction may not indicate that a nurse shouldn't be allowed to practice, a view shared by outside experts. Even so, multiple convictions generally warrant some sort of discipline, Goodman said. "There's obviously a problem. There's obviously a pattern."
The board could have found out about some nurses' criminal histories or accusations against them just as the Times and ProPublica did -- by reviewing government databases.
By comparing the state's Megan's Law database, which lists registered sex offenders, with the state's list of registered nurses, for instance, reporters immediately found three cases in which the names and addresses of sex offenders matched those of registered nurses with clean records.
Armed with additional information about the state's nurses, such as birth dates, the board might find even more matches.
One of those in the Megan's Law database was Thomas Walker Carson, 52, who was convicted in 1989 of lewd and lascivious conduct with a child under 14 and in 1997 for failure to register as a sex offender.
In an interview outside his home in Calimesa, Carson said he continues to work as a nurse and has never been contacted by the nursing board. "The people I work with know all about me and my office knows all about me," he said. "It's never been a problem."
Carson, a former medic in the Air Force, said his conviction took place nearly 20 years ago and involved a friend's 13-year-old sister.
Asked why he didn't tell the nursing board about his conviction, Carson said, "I'm not going to volunteer for more grief...They don't ask me anything on my renewals. I just pay for a class and pay a fee."
He now works as a home health nurse with an older patient, he said, not children. But he said he still must provide for his two children and believes he is a good nurse.
"I personally am not dangerous," he said. "I wasn't dangerous then."
The nursing board's Goodman said she was unaware that any sex offenders were licensed in good standing.
"I'm sure with Megan's Law being what it is, I'm sure there's a database out there and it would be very interesting -- wouldn't it? -- to run names against a database," she said. "I don't know. I'm thinking out loud."
Reporters also matched the state's list of registered nurses against the federal government's database of health providers banned from Medicare. It found four examples of banned nurses that the board has never disciplined, one of whom was found guilty of patient abuse or neglect.
The conviction of Parungao, who now is in federal prison, is listed on the U.S. Internal Revenue Service Web site as one of its significant health care fraud prosecutions of 2007.
Her lawyer, Donald Etra, said there's a distinction between "financial impropriety and medical competence."
"There is no question that Ms. Parungao was a terrific nurse and there was never any question that she was competent and gave great care to the patients entrusted to her," Etra said. "That's what the board should focus on."
Sometimes the board doesn't act upon convictions in California until another state does.
In May 1989, Michael Jay Lutzow was convicted of committing a lewd act on a child in San Diego. Six years later, the California board issued him a nursing license.
In September 2006, Arizona's nursing board rejected Lutzow's application for a license based on his California conviction and other factors.
Nearly a year later, California filed an accusation against Lutzow, citing the Arizona denial.
He did not return calls seeking comment.
In April, the board put him on three years' probation. One of the conditions: He must practice as a nurse in California.
Researcher Maloy Moore also contributed to this story.