When trying to keep tabs on nurses convicted of crimes, California regulators rely on law enforcement, local prosecutors, anonymous tips and medical employers.
The system also depends, to an extent, on nurses to self-report past convictions when they renew a license. And nurses are supposed to report to authorities whenever they know a peer has engaged in illegal activity.
But a review by The Tribune finds the process is spotty and unreliable.
The problem stems from the fact that about 146,000, or 41 percent, of registered nurses in the state were not fingerprinted when they were licensed, according to figures provided by the state Board of Registered Nursing. Fingerprints are the trigger for alerting regulators to nurses with criminal histories. Both vocational and registered nursing agencies insist they are protecting the public, despite the loophole.
Regulators at the Bureau of Vocational Nursing require nurses to report each other, asking if they are willing to be fingerprinted and requiring fingerprints if they have been disciplined, said Angelina Martin, the bureaus enforcement division chief.
The bureau also requires nurses to self-report criminal convictions on their license renewal forms.
Those who regulate nurses also believe that when nurses are arrested, someone will tell them.
You not only rely on your board but you rely on the community, reasoned Ruth Ann Terry, executive officer of the state Board of Registered Nursing. Weve been trying to work really good with them and to inform them that there are licensing bodies.
The approach, combined with anonymous tips and calls from employers, has added about 750 registered nurses to the fingerprinting database, say regulators.
The process is not foolproof, however.
Police do not report nurses to regulators, and many authorities dont know that nursing boards have enforcement power.
Court officials commonly dont learn of a persons profession during a case and thus arent able to alert the nursing boards.
Jerret Gran, a San Luis Obispo County chief deputy district attorney, said the occupations of the accused rarely come up.
Court clerks and judges agree.
Nurses could be coming through here every day and I wouldnt know it, said Superior Court Judge Michael Duffy. I would be willing to probably say less than 10 percent of cases are where the persons occupation is an issue.
Although state law requires prosecutors to notify health boards if a nurse is charged with a felony, local prosecutors did not regularly do so and many were unaware of the requirement.
The San Luis Obispo County District Attorneys Office has changed its practice after being contacted by The Tribune for this story.
I think bottom line is we have changed and implemented some policies, said Gran. You brought it to our attention. We looked into it.
Changes on the way
Statewide changes may also be coming, according to a story in the Los Angeles Times.
The Times reported that state regulators plan to take emergency measures to resolve the problems in the system. The Times, which wrote about the problems in a story on Oct. 5, said the nursing board will begin asking nurses whether they have been convicted of any crimes in recent years during the renewal process.
The Board of Registered Nursing must also develop emergency regulations to obtain fingerprints from all nurses licensed before 1990. The measures, however, would have to be approved by the states Office of Administrative Law, according to Carrie Lopez, director of the California Department of Consumer Affairs, which oversees the agency.
She said she anticipated that all nurses who have not been fingerprinted will have to do so when renewing after March 1, 2009. Lopez said she also has directed her staff to develop legislation expanding the requirement to other state licensing boards.
Trying to shore up the hole
Adrienne Tuttle, human resources director for French Hospital Medical Center in San Luis Obispo, thinks fingerprinting nurses licensed before 1990 would be the right step.
Its just so unfortunate, she said, because that would ultimately take care of the problem.
Like most hospitals in California, French does not conduct ongoing criminal background checks after the initial hiring process.
But Catholic Healthcare West hospitals including French and Arroyo Grande Community Hospital try to close that loophole by keeping abreast of a nurses license status rather than relying on regulators to contact them. They check a nurses license when it comes up for renewal.
French and Arroyo Grande also require nurses to sign agreements vowing to notify them if they commit a crime.
I think there is a large level of trust, said Megan Maloney, spokeswoman for French. I would think if somebody in our department has heard of somebody doing something (criminal) it would likely come to our attention.
Officials at Tenet Healthcare headquarters in Dallas declined to comment on how their hospitals monitor nurses for criminal activity. Tenet owns Sierra Vista Regional Medical Center in San Luis Obispo and Twin Cities Community Hospital in Templeton.
Atascadero State Hospital has devised its own system for tracking nurses. Since at least 1981, the hospital has fingerprinted new nurses and sent their prints to the state Department of Justice database, which notifies ASH when a nurse is arrested, according to Executive Director Jon De Morales. The hospital also checks local arrest reports weekly.
When criminal activity began creeping into the ranks of nurse assistants in California, a state agency solved the problem through legislation and fingerprinting.
Regulators at the California Department of Public Health helped push through a law in 1998 requiring nurse assistants and home health aides to be fingerprinted when renewing their license, said department spokeswoman Lea Brooks.
But not all nursing advocates believe fingerprinting professionals is a good idea. Deborah Burger, president of the California Nurses Association, thinks it criminalizes the profession.
I think they need to look at other processes before they penalize these nurses who are not guilty of any crimes, said Burger, suggesting instead a system based on Social Security numbers or dates of birth. It sounds like theyre trying to create a system where you have to give up your fingerprints to get a job and pretty soon you have to give your fingerprints to be a garbage collector.
A Texas model
Fingerprinting nurses in Texas began in 2003. Attention from a newspaper article listing registered sex offenders who were working as nurses created more urgency to track crimes by nurses.
In 2006 Texas required that nurses be fingerprinted during the license renewal process every two years. Officials there expect to have all of the states roughly 250,000 nurses in their system by this year at a cost of about $1.6 million a year, according to Mark Majek, the Texas Board of Nursings operations director.
Texas aims to have criminal background checks completed on all of its nurses by 2013.
Leslie Parrilla can be reached at 783-7645.
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