Fake CPR certificates show need to check credentials for more than MDs

Hospital finds staff falsifying proof of required training

When the University of California, Irvine (UCI) Medical Center discovered that 22 health care workers had used bogus certificates in cardiopulmonary resuscitation (CPR) to prove they were current with required training, leaders at the hospital were shocked. They immediately launched an investigation and cooperated with campus police.

They found that the problem was serious and required an immediate assessment of their policies and procedures on verifying credentials. What they found also highlights how important it is for risk managers to have proper procedures for verifying the credentials of all staff — not just physicians and nurses.

The problem at UCI was discovered during a routine renewal of a CPR certificate in a training class in May 2007, says Lisa Reiser, RN, MN, chief patient care services officer and chief nursing officer. The instructor noticed that an employee's old card looked unusual, unlike any she had seen before even though the cards may appear different depending on where the employee underwent CPR training. Upon investigation, the hospital determined that the card was fraudulent.

That one curious CPR card sparked an internal review of all 2,000 employees with CPR certification, led by the human resources department. Doctors, nurses, and assistants at UCI Medical Center are required to renew their CPR certification by taking a test every two years. The free course, endorsed by the American Heart Association, lasts less than a day and is offered during work hours at the medical center.

Hospital investigators checked the CPR cards held by all employees and looked for any sign that the cards were bogus, such as poor printing quality or an unfamiliar training provider. They found that 22 employees had fake cards.

UCI Medical Center removed all 22 workers from patient care while the investigation continued with a multidisciplinary team that included human resources, compliance, clinicians, risk management, and the public information office. The first priority was protecting patient safety, but the hospital also wanted to ensure that the investigation was thorough and fair to the employees. "The employees pretty much admitted to what occurred. They said they falsified the cards," Reiser says. "It was an unfortunate incident and a good lesson for us to learn."

Can be difficult to verify cards

Reiser notes that CPR cards and similar certifications held by staff can be more challenging to verify than a physician's credentials because there are so many providers. To verify a physician's education and licensure, the hospital can go to the university and the state database, for example. But for CPR cards and similar training, there are many sources and the employer often relies on the physical proof provided by the employee. As UCI Medical Center found out, that proof can be easy to fake.

The UCI Medical Center found that the employees who faked their CPR cards had some connections within the hospital, but Reiser declines to say exactly how they knew each other. The staff members were from different patient care areas, she says. Because there was some connection and cooperation between the involved employees, the hospital views the case more as one incident in which 22 cards were faked, rather than 22 completely separate and unrelated incidents, she explains.

"That is less than 1% of our employees, which is still enough for us to be concerned," Reiser says. "It would have been worse if we found 22 isolated incidents of this, as opposed to all of them being connected."

Hospital leaders took the incident very seriously, Reiser says, and invited the university police department and the American Heart Association to participate in the investigation. No criminal charges resulted, but the hospital is disciplining the 22 employees found to have fake cards. Reiser says the hospital still is working through the disciplinary process and cannot comment on the specific punishment for any employee.

"We offer the CPR course here and make it really easy for staff to get that certification. In the past year we have had 700 employees get certified through us," Reiser says. "So as far as why these staff members didn't take advantage of that and went this route instead, we can't really say."

Falsified credentials are common in health care, says Mark Anthony Kadzielski, JD, a partner with the law firm of Fulbright & Jaworski in Los Angeles. Kadzielski works with health care providers facing liability from falsified credentials and those trying to improve their verification processes. He says the problem is less common among medical staff, partly because employers tend to verify their credentials and partly because it is harder to falsify something as substantial as physician licensure, for instance.

"It's easier to falsify something like CPR certification, and employers are usually eager to hire those people. They might be in desperate need for employees for coverage, and you might not go the extra mile to ensure they are as qualified as they say," Kadzielski says. "Corners get cut because you need warm bodies."

Health care providers often focus exclusively on verifying the credentials of medical staff, Kadzielski says, and they ignore the liability risk from staff members who lie about their qualifications. The risk from the staff level is significant, he says.

"The CPR card maybe doesn't sound like a big deal to some people, and maybe that's why they didn't bother taking the class," Kadzielski says. "But the worst case scenario is the employee has to give CPR to someone, it doesn't turn out well, and then the plaintiff's attorney starts waving that fake CPR card in court, asking why the hospital didn't bother to verify it. The argument will be that 'If he had been properly trained in CPR, he could have saved Grandma.'"

The employer would be liable because the hospital, in effect, asserted that the employee was competent in CPR when he or she actually wasn't, and it was the hospital's obligation to confirm the training. An unreasonable expectation? Maybe, he says, but that decision could be left to a jury, and a fake CPR card would be a sensational revelation in court.

Kadzielski also points out that The Joint Commission and state regulators may check training and certification during site visits. "Imagine if the surveyor asked to see an employee's CPR card, and it looked like a really bad fake," he says. "That's going to be a bad day for you."

Reiser says UCI Medical Center leaders tried to respond aggressively but reasonably to the discovery of the false certifications. The hospital thoroughly investigated and initiated disciplinary action as appropriate, she says, but at the same time hospital leaders did not want to overreact and assume the incident meant current policies and procedures were inadequate.

"This resulted from individual bad judgment," she says. "The immediate response is wanting to put in more controls to make sure this doesn't happen again in the future, but you have to balance that with what is realistic to do."

Source verification can be labor-intensive and time-consuming for CPR cards, Reiser notes. Even if an investigator calls each training provider to verify the card, many providers don't have a database for quick access. They have to go find the paper sign-in sheet to see if the person's name is there, she adds.

"So instead of implementing a verification process that might be unrealistic and unnecessary, we're taking a longer view and looking at our certification requirements and how they might be improved in a way that would make it easier to verify the certification," she says. Possible changes could include requiring staff to be certified in-house at UCI, but hospital leaders first want to be sure the added administrative burden would be justified.

"The take-home lesson from this experience is that you have to balance the response organizationally and the processes you may or may not change, especially when the problem is individuals acting egregiously with no just cause," Reiser says. "We didn't feel that this incident revealed some major flaw in our system, so we don't want to overreact with new policies and procedures."

Sources

For more information about the UCI incident, contact:

  • Mark Anthony Kadzielski, JD, Fulbright & Jaworski, 555 S. Flower St., 41st Floor, Los Angeles, CA 90071. Telephone: (213) 892-9200. E-mail: mkadzielski@fulbright.com.
  • Lisa Reiser, RN, MN, Chief Patient Care Services Officer and Chief Nursing Officer, University of California, Irvine Healthcare, 101 The City Drive South, Orange, CA 92868. Telephone: (714) 456-7890.