Few licensing boards conduct criminal background checks

The Federation of State Medical Boards says increased access to state and national data banks could help states develop screening systems.

By Jay Greene, amednews staff. Nov. 5, 2001. - Correction

Since the flaws in the nation's physician credentialing procedures were exposed during the murder investigation that led to the conviction of medical school graduate Michael Swango, medical licensing boards have looked for ways to strengthen the system -- including conducting criminal background checks on physician applicants.

The major obstacle boards face is convincing law enforcement agencies to allow them access to state and national criminal data banks, licensing officials say. But that reluctance may be changing.

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After Sept. 11, the White House created the Office of Homeland Security to encourage law enforcement agencies to share information. The Federation of State Medical Boards hopes this climate of greater cooperation will make it easier to access crime dat a.

"What we need is a commitment from federal law enforcement agencies to share this information," said Andrew Watry, executive director of the North Carolina Medical Board. "It shouldn't be so hard to get."

Since 1998, when FSMB recommended that boards conduct criminal background checks on physicians applying for licenses or permits, officials have been working to help them gain access to crime data.

"Part of the problem is obtaining access to FBI data banks," said Dale Austin, FSMB's interim executive director. "We are finding that state law enforcement agencies are more apt to work with boards if there is appropriate language in state statutes th at require background checks."

Only six state medical boards screen applicants for criminal convictions through law enforcement agencies. Only two -- Florida and California -- require fingerprints for further verification with the Federal Bureau of Investigation's National Crime Inf ormation Center, the FSMB said. (See correction.)

Besides California and Florida, the other four states that conduct criminal background checks are Louisiana, New Jersey, North Carolina and Rhode Island, FSMB said. North Carolina is taking steps to require fingerprinting for 2,000 new applicants each year, Watry said.

Boards in Idaho and Kansas are also permitted by their states to conduct criminal background checks if they deem it necessary.

How the system works

Physicians are asked on their applications to disclose if they have ever been convicted or pled no contest to a crime. Medical boards then forward applicant names, fingerprints or other information to state law enforcement departments. Using their acce ss to the FBI's NCIC, states discover if the applicant has a criminal record.

"About 3% to 5% of applicants have criminal records," said Ronald Joseph, executive director of the Medical Board of California. "Some disclose that to us and some don't."

With 3,777 applications submitted in 2001, California found criminal records for an estimated 113 to 189 doctors. That year, California denied 20 applications, or less than 0.5% of the total, and another 20 were withdrawn for unspecified reasons, Josep h said.

Typical crimes include insurance fraud, drug trafficking, driving under the influence, failure to pay child support, tax evasion and theft. "One applicant [in North Carolina] held a college coed in a box for 100 hours," Watry said. "We denied that lice nse. You don't want to give a person like that access to the house of medicine."

Another case in California involved an applicant who was convicted of insurance fraud while working part-time in a physician office and waiting for his medical license. "Part of his job was to create false patient records," Joseph said. "We denied his license. He went to prison."

In some cases, however, doctors who have committed crimes are awarded probationary licenses. For example, one physician was convicted of kidnapping while he was in high school. "He made that mistake a long time ago. We issued him a probationary license , and he was required to take courses in ethics," Joseph said.

Last year, Florida began requiring all physicians, chiropractors and podiatrists to submit fingerprints to renew their licenses. Of 48,000 renewals, state officials discovered 15 physicians who had failed to state their criminal convictions on their re newal applications. Approximately 4%, or 2,000, had committed crimes, a state official said.

"There are a surprising number who do not disclose crimes on their applications," Joseph said. "We are able to verify this with fingerprints. States that don't perform background checks run a serious risk of exposing the public to doctors with criminal records that may impact patients or the health care system."

Resident physician checks

While a fraction of the nation's 750,000 practicing physicians are screened for criminal histories, resident doctors face even less scrutiny.

In 1996, the FSMB recommended that residents comply with the same licensure requirements as practicing physicians. AMA policy states that U.S.-trained residents should be licensed prior to their second year. The AMA does not have a policy on criminal b ackground checks on physicians or residents.

Most states do not require resident physicians to apply for licenses until their second year of residency, FSMB said. Some 37 states require permits.

North Carolina requires training licenses for first-year residents that include criminal background checks. "We turn down several residents each year who have already matched into a program," Watry said.

Licensing loopholes also exist for international medical graduates, FSMB officials say. While IMGs seeking a residency match first must receive a certificate from the Educational Commission for Foreign Medical Graduates verifying their medical credenti als, the majority of states require three years of residency training for IMGs before issuing a license. For about 3,000 non-U.S. citizen IMGs each year, the U.S. Dept. of State also requires a temporary immigration visa.

To seek a visa, IMGs must apply through a U.S. embassy in the physician's sponsoring country. Embassy officials enter the IMG's name through a database called the Counselor Lookout And Support System.

Data captured in CLASS contains such red flag items as previous immigration violations, health problems, crimes of "moral turpitude" and "terrorist-type activities," said a state department spokesman. The spokesman declined to comment on whether the da tabase contains other crimes.

To enhance visa checks, legislation has been introduced in Congress to add the FBI's NCIC database into the CLASS system, the spokesman said. On crimes committed outside the United States, an FBI spokesman said NCIC only contains warrants issued by Int erpol and does not contain convictions in other countries.

"We have always viewed the role of a physician to be a very trusted professional in our society," Joseph said. "Prior to issuing a license we must put them through all the appropriate checks, including whether they have a criminal record."

Correction

This story reported that FSMB told AMNews that only two states require fingerprints. Seven states require physicians to submit fingerprints as part of criminal background checks for medical licensure, said the Federation of State Medical Boards. Those seven states are California, Florida, Idaho, Virginia, South Carolina, Texas and Louisiana. In addition, New Jersey, North Carolina and Rhode Island conduct criminal background checks but do not require fingerprints. Kansas is permitted to conduct a criminal background check if they deem it necessary. AMNews regrets the error.

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