Background checks protect patients

Background checks for criminal records or other questionable behavior should be a standard risk management strategy for all health care providers, and meeting minimum requirements is not the best way to go, say providers and experts in background screens.

About 25% of states require some sort of background screening for health care workers, says Jenifer DeLoach, senior vice president with Kroll, a risk consulting firm in Nashville, TN. Even without a state requirement, hospitals and other providers should conduct background checks to protect themselves from claims of negligence if an employee commits a crime, such as assaulting a patient or fellow employee, and turns out to have a criminal history, she says.

"Health care workers have access to vulnerable patient populations, controlled substances, people's private property," DeLoach says. "They also have access to huge amounts of data, including personal financial information. People seeking access to this data, or drugs, or patients they can victimize, will apply and seek positions in hospitals."

DeLoach says risk managers should be especially vigilant now that the economy is down and more people are seeking new career opportunities.

"A lot of folks are very cognizant that nursing is one field that is hiring, so a lot of people are entering nursing programs to start anew," she says. "There's going to be an influx of new talent, and that will mean people who are moving from one state to another for a hiring opportunity. And there can be people in that group who lost their jobs for questionable reasons or who are trying to start over again after a conviction."

Even in states that require a minimum level of screening, providers should consider going beyond that minimum to ensure that the screening is effective, DeLoach says. Budget considerations may limit how much screening can be done, but she reminds risk managers to consider the potential liability from negligently hiring someone with a questionable background. A background check typically costs around $25 for the most basic level to around $60 for a more thorough scan, DeLoach says.

"Some states will require only that the provider conduct a state-specific criminal background check, which is OK as far as that goes," she says. "But if you think about someone who has lived in several states and jurisdictions, perhaps only recently moved to your state, they may not have a record that would show up in that screening."

The better option would be to do a seven-year criminal search nationwide rather than just the minimum required by the state, she says.

"People with criminal records or other problems know that it will be a problem in hiring, so they do their research. They're wise about the laws and what kind of screening takes place," DeLoach explains. "They move to get a fresh start and hope, or sometimes they've researched it and know, that you will only look so far."

Ongoing screening also needed

DeLoach points out that for health care providers, the quality of the staff can be the facility's brand. Many hospitals market their staff as exceptional, making them the "face" of the organization and a key drawing point for patients who can choose among facilities for delivering babies or other care. If an employee commits a crime and that incident is publicized by the media, that marketing effort stalls and the organization can suffer a significant downturn in business, she says.

Criminal records are not the only concern, of course. Background checks can include screening for changes to a physician or other professional's credentials, such as disciplinary actions. Some regulatory agencies require periodic checks of physician credentials, DeLoach notes.

Ongoing screening also can be important after the employee is hired or the physician is granted privileges, DeLoach says. Some states require a periodic check for any new criminal charges, but DeLoach says it is a good idea even if it is not required. Many providers conduct an annual screening of the entire employee population, she says.

"We also can do a payroll screening in which we draw off the names of every employee from the payroll data and compare that to our background screening records, not necessarily to do a new background check on everyone, but to ensure that everyone has already been screened at some point," DeLoach says. "We want to make sure that everyone has been checked and no one missed that step for some reason, such as employees being merged from another organization."

Be wary of false credentials

Remember that background checks should involve more than criminal records. Risk managers should encourage a healthy degree of skepticism in anyone involved in recruiting, interviewing, and hiring staff, says Jeff Wizceb, vice president for business development with screening company HR Plus, a division of AlliedBarton Security Services, based in Chicago.

In today's competitive employee market, up to 70% of applicants include false information on their resumes and job applications, he says. As a result, many companies may hire the wrong individual, who could possibly damage the reputation of the company with one incident.

"There are more and more fake job reference sites springing up on the Internet, where users can pay to have falsified references sent to prospective employers," Wizceb says. "It is becoming a larger human resources issue, much like the emergence of the fake college degrees in the past."

A thorough background check can help protect the provider if the employee's actions prompt a lawsuit, Wizceb says.

"You can bring out your documentation showing that you acted in good faith and obtained a good background check on this person, looking for any indication he was going to pose a risk," Wizceb says. "Maybe something still happened with that person, but you can show that you did your due diligence; and there were no red flags suggesting that this person was a danger and that you should have known when you hired him."

Wizceb points out that the provider's employees are not the only concern. Contractors and other third parties often have the same access to patients, drugs, and data that employees have, or sometimes even more access. Risk managers should ensure that those people are being properly screened by their employers, Wizceb says.

Be known for tough screening

The need to screen employees is particularly acute with home health workers and similar staff who have extensive access to patients, says Pernille Ostberg, president of Matrix Home Care in West Palm Beach, FL, which employs health care workers and services clients in 30 counties throughout the state of Florida.

"From my perspective, based on 30 years in the home care industry, there's simply no substitute for screening out the bad apples before they get into the system," she says. "And, of course, any caregiver found to be involved in criminal behavior should be turned in to the police immediately."

Ostberg points out that any negative incident with an employee, such as criminal behavior or charges of abuse or fraud, should prompt the organization to go back and look at how that person was hired. The review may reveal weaknesses in your background screening process, such as a criminal history that could have been found if the check has been more extensive, she says.

Ostberg personally reviews every background check before an employee is hired. She advocates extremely thorough screening, because over the years she has seen links between seemingly innocuous behavior in a person's record and subsequent malfeasance on the job. For instance, Matrix studies a person's driving record, even if the person will not be driving on the job.

"A bad background screen is often mirrored in the driving record. We can see that a history of driving infractions, things like failing to use a turn signal or speeding, can correlate to an employee who is going to be a problem for us later on," she says. "A lot of traffic stops on the record can mean there is more going on than just what the person ultimately got a ticket for, and it can sometimes reveal red flags like being combative with the police."

Ostberg notes that people with questionable backgrounds seek out the facilities that do not conduct thorough checks. If your organization becomes known as the provider that is lax in screening, your risk of hiring people with bad backgrounds will skyrocket, because those people are drawn to you and can't get hired elsewhere, she says.

"Whenever we open a new facility in a community, we are inundated by applicants with bad backgrounds," she says. "They're checking to see if we screen people thoroughly, and once word gets out that we do, those people stop applying."


For more information on background checks, contact:

• Jenifer DeLoach, Senior Vice President, Kroll, Nashville, TN. Telephone: (615) 320-9800, ext. 20559.

• Jeff Wizceb, Vice President Business Development, HR Plus, A Division of AlliedBarton Security Services, Chicago. Telephone: (773) 864-2387. E-mail:

• Pernille Ostberg, MBA, RPH, President, Matrix Home Care, West Palm Beach, FL. Telephone: (888) 806-9040.