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Legislation on drawing board to expand NPDB to nurses and others

Credentialing Resource Center Connection, May 27, 2004

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Dear credentialing colleagues:

The United States is home to over three million licensed or registered healthcare professionals.

These professionals include nurses, physicians, dentists, podiatrists, pharmacists, and social workers. These individuals are assisted by an army of nurse's aides, assistants, and other caregivers. They work in healthcare settings of all types and are trusted by patients.

The media occasionally reports to the public when this trust has been misplaced. For example, in his book "Blind Eye," author James Stewart reported on the infamous case of Michael Swango, the doctor who was accused of poisoning numerous patients and colleagues and is serving a life sentence for those crimes. The national press recently reported on the murderous exploits of former nurse Charles Cullen who admitted to killing patients in Pennsylvania and New Jersey healthcare facilities. Many other disturbing examples have undoubtedly crossed your desk over the years.

Just yesterday an article in "USA Today" reported that 13% of healthcare facilities inspected in seven states failed to verify licensure status, failed to conduct criminal background checks, or lacked required screening to protect residents and patients.

History demonstrates that nature abhors a vacuum, and the government abhors disregard for patient safety. For example, the HHS is currently encouraging the adoption of safer patient care practices in acute care facilities.

We should also expect our elected representatives to bring rationality to hiring practices in healthcare facilities. While at the Hart Senate Office building in Washington D.C. yesterday, I found that at least two senators are so concerned about the absence of rigorous standards in the hiring of healthcare workers that they are drafting legislation designed to remedy the situation.

New Jersey senators Jon S. Corzine and Frank Lautenberg plan to introduce legislation to expand the existing physician registry (the National Practitioner Data Bank) to include nurses and other licensed healthcare practitioners who provide direct patient care. (Go to www.corzine.senate.gov to learn more about the proposed bill.)

How extensive might the problem of unqualified healthcare workers be? Probably no more extensive than with the physician population. Perhaps three to five percent of healthcare professionals have something in their backgrounds about which an employer would want to know. However, we do know that a significant percent of employment applications contain falsifications or serious omissions. We also can easily safely assume that drug abuse among these individuals is similar to that reported among physicians. We also know that tens of thousands have had licensure problems and thousands have been convicted of criminal actions, not to mention the many that have been discharged due to competency concerns identified by their employers. The overall percentage is small but the number is large. Perhaps as many as 150,000 healthcare workers have an "interesting" background.

Ernest A.Codman, MD, stated in 1916 that, "hospitals, if they wish to be sure of improvement, must find out what their results are, and must analyze their results to find their strong and week points."  If he were alive today, Codman might rephrase as follows: "hospitals and the other important healthcare facilities of our time must adopt the very best systems for screening all healthcare professionals, not only those who hold a license to practice medicine or surgery. We owe it to our patients and to ourselves."

That's it for today.

All the best,
Hugh Greeley
http://www.greeley.com/seminars/

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