Veterans Affairs health centers hired and retained physicians, nurses and other clinicians despite their records of alleged misconduct.
According to a government watchdog report, some of these clinicians had also lost state licenses to practice.
The Management of medicine Accountability Office (GAO) in its 102-page report focused on clinicians who were part of the VA's medical staff as of Sept. 30, 2016. The agency took a random sampling of 57 of the 1,664 VA providers with a record in the National Practitioner All about medicine Bank. This online repository lists disciplinary action taken by state licensing boards and professional societies against individual clinicians.
Since providers have to surrender their licenses for many different reasons that could be as minor as failing to finish a continuing education course, the egregiousness of the cases listed in the report vary considerably.
One case showing the disconnect between facilities involved a physician hired in 2010 within one VA regional network. His record included a reprimand from one state licensing board for failing to review an X-ray and discuss it with the patient. Later, the patient was diagnosed with Stage 4 cancer that had metastasized. In 2007, the doctor had to surrender his license in a different state as well because of that reprimand.
When later in 2010 the doctor applied to a VA facility, he wasn't hired based on that history, but was hired at a different medical center within a separate regional network.
The Veterans Health Administration told the GAO that it's up to the facilities to make their hiring decisions and ascertain their clinicians meet the VA's licensing standards. But the officials also couldn't tell the GAO why the two different facilities came to different conclusions about hiring the doctor.
In another case, a VA center hired a physician in 2016 who surrendered a state license in 2004 after a former patient alleged "unprofessional conduct" on his part, and claimed there was probable cause to "substantiate charges of disqualification from the practice of medicine."
According to records from the licensing board, the doctor in question agreed never to apply for a medical license in that state again.
He was hired by a VA facility, and according to the GAO continues to work there. This was due to a technicality in the VA's requirements around a provider's license. The department would bar an applicant who has surrendered a license only after state formally warns it could be revoked. However, this particular physician gave his up before the licensing board filed charges against him. Subsequently, he wasn't disqualified from working at the VA. He also had an active, unrestricted license in another state when the VA hired him.
The GAO also included the VA facility hire of a registered nurse who had a reprimand on his license due to his substance use. He was hired in 2002 and received the reprimand in 2008, whereupon the VA center learned about prior undisclosed convictions.
The licensing board in its reprimand wrote that "there exists serious risks to public health and safety as a result of impaired nursing care due to intemperate use of controlled substances or chemical dependency."
This nurse also had three DUI convictions between 1984 and 1999, an assault conviction in 1998, and a disorderly conduct-fighting in public conviction in 2006.
The GAO report said the nurse is still working at the VA, and department policy stated that a reprimand on a license doesn't necessarily disqualify someone from employment as long as he or she has at least one full, current, active and unrestricted license.
The registered nurse didn't tell the Veterans Health Administration about his license reprimand until September of 2008, but officials told GAO that they did not discipline him for not disclosing his prior convictions.
"They said that they determined that the licensure issue was an ethical concern, rather than a patient-care concern," the report said. "VHA Central Office officials told us that there are no separate credentialing policies or guidance related specifically to substance use; instead these are treated as suitability issues."
As the GAO conducted its investigation, the VA ran its own review of medical staff and ultimately fired 11 clinicians who didn't meet licensure requirements, according to the report, and an official with the GAO said at least five of the providers in the report who did not meet those requirements were removed.
Ndidi Mojay, a spokesperson for the VA, noted that the GAO's oversight "focuses exclusively on providers hired during previous administrations," but said in January 2018 all the department's health facilities finished their review of all their medical staff to make sure they complied with licensing standards.
Mojay also reiterated the GAO's report that the department's across-the-board review resulted in the firing of 11 clinicians "who were hired improperly."
She added this past January the VA revised its longtime licensing policy "to make sure the department is better able to ensure its providers meet licensure qualification requirements."
The report was requested by Rep. Jack Bergman (R-Mich.), ranking member of the House VA Committee's oversight and investigations panel.
It comes as the VA is poised to start expanding its community care program — a politically charged effort as Democrats criticize the Trump administration for pushing privatization.