Posted on 12/23/2003 6:23:31 AM PST by NativeNewYorker
Calling the killings of 30 to 40 patients claimed by a nurse "a complete and utter failure of the health-care system," New Jersey's two U.S. senators yesterday pushed for a mandatory national tracking system for nurses.
The system would require hospitals to report disciplinary actions and firings of nurses to a data bank. The information would then be used for background checks during hiring.
Nurse Charles Cullen's claims of engineering killings at nine hospitals and a nursing home in New Jersey and Pennsylvania over 16 years signals the need for immediate changes to the way the industry shares information about caregivers, Democratic Sens. Jon S. Corzine and Frank Lautenberg said.
With Cullen's record of "two states, 16 years, six firings, three jobs quit, two times attempted suicide and one lawsuit, you would think the system would be able to put together that this was a troubled individual," Corzine said.
The senators also requested congressional hearings to examine how Cullen was able to continue caring for patients and a probe by the General Accounting Office, the investigative arm of Congress, into similar lapses nationwide.
Cullen, 43, of Bethlehem, Pa., has surrendered his New Jersey nursing license. The state nursing board said it had not received complaints about him.
On Friday, Pennsylvania's nursing board suspended his license. It had been in good standing, despite a complaint by St. Luke's Hospital, near Bethleham, that he was suspected of stealing drugs.
The senators called for nurses to be included in the National Practitioner Data Bank. Under federal law, hospitals must report to the data bank all disciplinary actions of more than 30 days against doctors. Verdicts and settlements against doctors in malpractice cases must also be reported.
Hospitals must check with the data bank before they hire doctors.
A different federal database, the Healthcare Integrity and Protection Data Bank, does have information on nurses and other health-care providers, including criminal convictions, license suspensions, and medical fraud convictions. But it is not open to hospitals or the public.
While licensing boards for nurses in New Jersey and Pennsylvania require the reporting of certain types of problems, neither routinely keeps track of fired nurses.
Other states, such as Texas, Ohio and Florida, have tougher tracking systems for nurses.
Registered nurses who are fired in Texas, for example, must be reported to that state's Board of Nurse Examiners, which may investigate, said Anthony Diggs, director of enforcement at the Texas nurses board.
"Multiple firings could be a red flag," he said. "Our mission is to protect the public from unsafe practice."
The board also investigates complaints, which, along with the firings, are kept on file permanently.
Diggs said hospitals checking on nurse credentials could learn about earlier problems.
Texas takes many more disciplinary actions against nurses than Pennsylvania or New Jersey.
In the year ending Sept. 30, Texas had 176,756 licensed nurses. Diggs said the board had sanctioned 940 registered nurses, including 280 who surrendered or lost their licenses.
Pennsylvania, which has 20,000 more registered nurses, has revoked 16 licenses this year. An additional 27 nurses gave up their licenses.
New Jersey had 134,000 licensed nurses in 2002, the latest year for statistics were available. That year, 68 licenses were revoked or surrendered.
Ohio instituted changes in 2001 after two "angel of death" cases involving health-care practitioners.
As a result of strengthened reporting requirements for employers - which had already included firings - complaints to the Ohio Board of Nursing rose dramatically, said Lisa Ferguson-Ramos, the board's compliance manager. By the end of the year, she said, she expects to receive more than 2,200 complaints - a 22 percent increase over last year.
Andrea Aughenbaugh, executive director of the New Jersey State Nurses Association, said the state had an all-or-nothing reporting system that discourages health-care workers from reporting colleagues.
Each complaint against a nurse is supposed to get a full investigation. If no disciplinary action is taken by the nursing board, the complaint is kept secret.
As a result, Aughenbaugh said, many nurses fear that a complaint lodged against a colleague will simply disappear.
Conduct that must be reported to the board includes action "that clearly violates expected standards of care and may result in various degrees of harm" and "conduct that demonstrates a pattern of poor judgment or skill."
Cullen's behavior would seem to meet the reporting requirement.
He was fired from St. Barnabas Medical Center in Livingston, N.J. He quit Warren Hospital in Phillipsburg, N.J., two months after being questioned in the death of a 91-year-old patient, although the hospital said it could find no wrongdoing by him. And he was cited for "poor performance" and fired by Morristown (N.J.) Memorial Hospital.
But because no complaint ever came out of New Jersey's medical facilities, he never came to the state's attention.
Pennsylvania's reporting of problem nurses or firings is not mandatory. "The board needs to be made aware of a problem though a consumer complaint, employer complaint, complaint from another state, or a law enforcement agency," said Brian McDonald, spokesman for the Pennsylvania Department of State, which oversees the nursing board.
As in New Jersey, complaints are not made public unless the board takes disciplinary action.
Andrew Wigglesworth, president of the Delaware Valley Healthcare Council, which represents 75 hospitals, said his group was considering setting up its own tracking system.
"We are looking at creating an employment registry patterned after a similar program in the Dallas-Fort Worth area," he said. "It would combine background checks and other employment reference functions in a centralized service to help area hospitals guard against individuals going from institutions to institution."
Wigglesworth noted that there might be some legal constraints to such a registry.
Many question how Cullen could have gone for so long without notice.
"It was so obvious 10 years ago that he was mentally ill that it's just unbelievable that he carried on," said Aughenbaugh, of the New Jersey State Nurses Association.
"I'd like to know from nurses themselves about what happened," she said.
I decided to go with a new guy. Might be me, though I don't recall being asian.
The Pennsylvania Bureau of Professional and Occupational Affairs has a searchable database of licenses (including doctors). http://www.licensepa.state.pa.us/default.asp
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