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VA’S CURRENT PROCEDURES FOR BACKGROUND

CHECKS AND CREDENTIALING

HEARING

BEFORE THE

SUBCOMMITTEE OVERSIGHT AND INVESTIGATIONS

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

MARCH 31, 2004

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–35

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEPHEN E. BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

SILVESTRE REYES, Texas 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

STEPHEN E. BUYER, Indiana, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

JOHN BOOZMAN, Arkansas 

DARLENE HOOLEY, Oregon 

LANE EVANS, Illinois 

BOB FILNER, California 

TOM UDALL, New Mexico

(II) 
(III)

C O N T E N T S 

March 31, 2004

Page

VA’s Current Procedures for Background Checks and Credentialing ................. 1

OPENING STATEMENTS 

Chairman Buyer ...................................................................................................... 1

Prepared statement of Chairman Buyer ........................................................ 35

Hon. Darlene Hooley ............................................................................................... 2

Hon. Tom Udall ....................................................................................................... 3

Hon. Lane Evans, prepared statement of .............................................................. 44

WITNESSES 

Bascetta, Cynthia A., Director, Health Care—Veterans’ Health and Benefits 

Issues, U.S. General Accounting Office; accompanied by: Marcia Mann, 

Assistant Director; and Mary Ann Curran, Senior Analyst ............................. 9

Prepared statement of Ms. Bascetta ............................................................... 59

Grubbs, Cynthia, Director, Office of Policy and Planning, Bureau of Health 

Professions, Health Resources and Services Administration, Department 

of Health and Human Services; accompanied by: Mark Pincus, Acting Associate Director of Policy, Division of Practitioner Data Banks, Bureau of 

Health Professions; Pat Stroup, Director, Office of Legislation; Maury 

Huguley, Legislative Coordinator, Office of Legislation; and Roger McClung, 

Office of Assistant Secretary for Health, Department of Health and Human 

Services ................................................................................................................. 5

Prepared statement of Ms. Grubbs ................................................................. 45

Murphy, Frances M., M.D., Deputy Under Secretary for Health for Health 

Policy Coordination, Veterans Health Administration, Department of Veterans Affairs; accompanied by: Thomas J. Hogan, Deputy Assistant Secretary for Human Resources Management; Kathryn W. Enchelmayer, Director, Credentialing and Privileging; Barbara Panther, Director, Recruitment 

and Placement Policy, Office of Human Resources Management; Robert 

W. Swanson, Management Analyst, Office of Management Support; Paul 

S. Rosenfeld, M.D., Chief of Staff, VA Medical Center, Veterans Health 

Administration, New Orleans, LA; Sanford M. Garfunkel, Director, Washington VA Medical Center, Veterans Health Administration, District of 

Columbia; William E. Cox, Acting Director, VA Medical Center, Veterans 

Health Administration, Big Spring, TX; and Timothy B. Williams, Director, 

VA Puget Sound Health Care System, Veterans Health Administration, 

Seattle, WA ........................................................................................................... 7

Prepared statement of Dr. Murphy ................................................................. 52

MATERIAL SUBMITTED FOR THE RECORD 

Article: 

‘‘VA OIG Case of 2000. . . . The Ohio Murder and Assault,’’ submitted 

by Chairman Buyer ...................................................................................... 37

Statement: 

American Medical Association ......................................................................... 75

Written committee questions and their responses: 

Congressman Boozman to Department of Veterans Affairs ......................... 81

Congressman Udall to Department of Veterans Affairs ............................... 82

(1)

VA’S CURRENT PROCEDURES FOR 

BACKGROUND CHECKS AND CREDENTIALING 

WEDNESDAY, MARCH 31, 2004

U.S. HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC 

The subcommittee met, pursuant to notice, at 10:06 a.m., in room 

334, Cannon House Office Building, Hon. Steve Buyer (chairman of 

the subcommittee) presiding. 

Present: Representatives Buyer, Hooley, Evans, Boozman, and 

Udall. 

OPENING STATEMENT OF CHAIRMAN BUYER 

Mr. BUYER. The Subcommittee on Oversight and Investigations 

of the Committee on Veterans’ Affairs will come to order. Today is 

March 31, 2004. 

Good morning to everyone. The purpose of today’s hearing is to 

review the Department of Veterans Affairs’ current employment 

practices with regard to its procedures for personal background 

checks and credentialing of its health care practitioners. 

In the past, the oversight subcommittee has touched upon this 

subject in several hearings. However, because there have been repeated serious lapses in the system over the years, we believe this 

issue warrants further scrutiny by this hearing today. In fact, there 

are several high profile cases which illustrate why it’s so important 

to ensure that the VA has an effective policy in place. 

One of the most compelling examples is the 1993 case of Dr. Michael Joseph Swango. In 1993, even though this doctor had a criminal record, he was able to secure a medical residency at a VA facility in Northport, NY. This doctor is currently in prison serving 

three consecutive life sentences for murdering three veterans at the 

Northport facility. The question is, at the present time could someone such as this doctor avoid detection and be successful in gaining 

employment with the VA today under credentialing procedures? 

I believe we all recognize that such lapses do not happen solely 

in the VA. But it is my role and this subcommittee’s in providing 

the oversight of the Department of Veterans Affairs to examine 

these issues that affect the safety of veterans, and that’s the focus 

of this subcommittee. 

Let’s look at what the VA’s Office of Inspector General was able 

to detect through its fugitive felon program that was initiated in 

2001. Using the VA benefit system files, the IG was able to identify 

9,700 matches for referrals to law enforcement agencies. In addi-
2

tion, over 6,500 fugitive felons identified in these matches have 

been referred to the Department for benefit suspension. Due to 

these identifications, 35 VA employees were arrested. Twenty-nine 

other employees were identified as fugitive felons but were not arrested because they were non-extraditable. They have been referred 

to the Veterans Health Administration for possible administrative 

action. 

If any of us here today find ourselves in a position of having to 

seek medical care, we deserve to be treated by health care practitioners who have completed the necessary educational requirements, have passed their boards, and are licensed to practice medicine. Veterans deserve to have the very same level of confidence 

when they enter a VA medical facility. 

Today’s hearing will show that the VA has been working diligently to improve its credentialing and background checks of applicants seeking employment with the VA. However, there are several 

issues that need some clarification. 

One such issue involves the VA’s credentialing program, called 

VetPro. For instance, I wonder if VetPro is working as envisioned. 

I also wonder why the Federal Credentialing Program initiated by 

the VA and HHS, under whose auspices VetPro was developed and 

maintained, was dismantled last fall. While representatives of the 

VA have stated publicly that VetPro is an excellent tool for 

verifying credentials, I also wonder why the GAO was silent on 

VetPro in its report. I find it perplexing that such an omission 

would be made since this is one of the chief mechanisms used by 

the VA to verify credentials of physicians and dentists. Hopefully 

both the VA and HHS will shed some light on this. 

The VA has several key screening requirements in place for 

verification of credentials and to investigate personal backgrounds 

of health care practitioners. These checks include the query of the 

Federation of State Medical Boards (FSMB), the National Practitioner Data Bank (NPDB), the List of Excluded Individuals and 

Entities (LEIE), and, on a limited basis require fingerprinting and 

background check which is performed by the Office of Personnel 

Management. 

Today’s witnesses are the Department of Veterans Affairs, the 

Department of Health and Human Services, and the General Accounting Office. When I spoke with the American Medical Association yesterday, I was assured by the AMA that they will have a 

representative here in the room. They will listen to this hearing, 

and I’ve asked them to provide a written statement with regard to 

their impressions of this hearing, and if they can get that statement to me within 10 days, we’ll make it an official part of this 

record. It’s hard to do a hearing I believe on credentialing and not 

hear from the perspective of doctors, in particular the AMA. I believe it will be very beneficial to this subcommittee. 

And at this point, I will yield to the ranking member for comments that she may have. 

OPENING STATEMENT OF HON. DARLENE HOOLEY 

Ms. HOOLEY. Thank you, Mr. Chair, and I really appreciate you 

bringing up the AMA. I think that’s important, and I’m glad you’ve 

done that. 
3

For the VA to provide adequate health care for veterans, a number of things must come together. There must be an adequate 

budget to support an infrastructure, including state of the art 

equipment and practices. Additionally, VA employees must be dedicated to their jobs so as to maximize the care veterans receive. In 

overwhelming numbers, this is the case today. 

When vacancies are filled at the VA, they are usually filled with 

clinicians and staff with the same high levels of dedication and interest. These newcomers are dedicated to providing excellent care 

for our veterans. It would nice if we could accept every applicant 

at their word, to accept the credentials they present at face value. 

But America’s duty to veterans requires a higher standard and 

greater rigor in evaluating potential VA health care employees. 

Most who apply do so with the hope of finding employment in a 

clinical setting where they can put their training to its intended 

use. 

History tells us that very few will apply with intent to do harm 

to those in their charge, but even one would be too many. Agencies 

with health care oversight sometimes chronicle and substantiate 

instances of abuse, malpractice and neglect in a broad spectrum of 

health care agencies across America. Every so often we read a story 

about a nurse’s aide intentionally administering a fatal dose of 

medication or an intentional abuse of a patient. 

The VA is not immune from those problems. Even with the best 

screening, problems of this type may sometimes occur. This is a 

key reason why effective and continuing oversight is so important. 

Once individuals are accepted into the VA system to provide patient care, continuous monitoring of performance and behavior is 

important. One sound remedy involves fostering a culture that is 

proactive in its self-policing actions in the current system. 

We can, however, also minimize and eliminate known problems 

through effective screening during the hiring process. The GAO recently reported on gaps discovered in their review of the VA screening process for clinicians and others with direct patient access. 

These gaps deserve our full attention. 

In addition to hearing comments on the screening process, I 

would like to expand the scope of this hearing and inquire about 

the screening process for all individuals with access to clinical or 

research laboratories, especially Level 3 labs where select biological, chemical and radiological agents are used or stored. Both the 

GAO and IG have reported problems regarding screening for laboratory personnel in the past. I’m interested to hear about the VA’s 

progress in making those environments more secure. 

And I yield back to my chair. 

Mr. BUYER. Oh, I’m sorry. Thank you for joining us. I should 

have looked to the right. Do you have any opening comment you’d 

like to make? Thank you, Mr. Udall. 

OPENING STATEMENT OF HON. TOM UDALL 

Mr. UDALL. Thank you, Mr. Chairman, very much. And I appreciate you, Mr. Chairman, and Ranking Member Hooley for putting 

this hearing together. 

I think most of us understand the seriousness of this issue when 

we look at the most well known cases of VA health care providers 
4

with criminal records or fake credentials that have somehow 

slipped into the system. One of these cases involved a Dr. Michael 

Joseph Swango. Despite the fact that Dr. Michael Joseph Swango 

had a criminal record, he was able to secure a medical residency 

at the VA facility in Northport, NY. Dr. Swango is currently in 

prison serving three consecutive life sentences for murdering three 

veterans at the Northport facility during 1993 to 1995. 

This is one of the more notorious examples, but it is not the only 

instance. Never should our veterans be subject to such despicable 

behavior. I hope that this hearing, Mr. Chairman, is a step in the 

direction of making sure that something like this never happens 

again. 

In reading over the testimony we’ll hear today, I am disturbed 

by what seems to be a very avoidable problem. Not only will we 

hear about gaps in the VA’s current screening requirements, but 

also a lack of follow-up in some cases on background investigation 

results. It is incumbent upon us to figure out if this is a matter 

of VA culture, lack of funds, disorganization, or none of the above. 

The VA is no doubt a complex system, but the health of our veterans is at stake. 

I thank our witnesses who will be testifying for coming today and 

look forward to hearing their testimony, and, Mr. Chairman, at 

this point, yield back. Thank you. 

Mr. BUYER. Thank you, Mr. Udall. We have one panel today, and 

I recognize Ms. Cynthia Grubbs. She’s the Director of the Office of 

Policy and Planning, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and 

Human Services. I’d ask that you recognize individuals that you’ve 

brought with you, please. 

Ms. GRUBBS. Thank you, Chairman. I have Mr. Maurice 

Huguley, Mr. Mark Pincus. 

Mr. BUYER. Would you let me know what they also do? 

Ms. GRUBBS. Sure. Mr. Maurice Huguley works in the Office of 

Legislation at HRSA. Mr. Mark Pincus is a Senior Policy Analyst 

and the Associate Director for Policy at the National Practitioner 

Data Banks. And Ms. Pat Stroup also is the Director of the Office 

of Legislation at HRSA. 

Mr. BUYER. Thank you. Also recognize Ms. Cynthia Bascetta, Director of the Health Care, Veterans’ Health and Benefits Issues, 

General Accounting Office. And did you bring staff with you? If so, 

please recognize them. 

Ms. BASCETTA. Yes, I did. Behind me is Marcia Mann, the Assistant Director who led this review, and Mary Ann Curran, the analyst in charge of the review. 

Mr. BUYER. Thank you. Also recognize Dr. Frances Murphy, Deputy Under Secretary for Health Policy Coordination, Veterans 

Health Administration, Department of Veterans Affairs. Dr. Murphy, if you could introduce who is also here with you and what 

they do. 

Dr. MURPHY. Accompanying me today are medical center directors from Seattle, Washington, DC, Big Spring, TX, and New Orleans here today. In addition, we have the DAS for Human Resources, Mr. Tom Hogan, his staff member, Ms. Barbara Panther, 

Bob Swanson from our Office of Management Support, and Kate 
5

Enchelmayer, who is from the Office of Quality and Performance 

and is in charge of VetPro and credentialing for licensed independent practitioners. 

Mr. BUYER. All right. Thank you very much. Let’s go ahead, and 

we’re going to open up. And instead of going left to right, we’re 

going to go right to left. Is that all right with you, Dr. Murphy? 

Dr. MURPHY. Fine. 

Mr. BUYER. All right. Ms. Grubbs, before I yield to you, I want 

to—by process, I’ll ask that witnesses limit their oral testimony to 

5 minutes. Your complete written statements will be part of the official record, and I will now yield to Ms. Grubbs for her testimony. 

STATEMENTS OF CYNTHIA GRUBBS, DIRECTOR, OFFICE OF 

POLICY AND PLANNING, BUREAU OF HEALTH PROFESSIONS, 

HEALTH RESOURCES AND SERVICES ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES; ACCOMPANIED BY: MARK PINCUS, ACTING ASSOCIATE DIRECTOR 

OF POLICY, DIVISION OF PRACTITIONER DATA BANKS, BUREAU OF HEALTH PROFESSIONS; PAT STROUP, DIRECTOR, 

OFFICE OF LEGISLATION; MAURY HUGULEY, LEGISLATIVE 

COORDINATOR, OFFICE OF LEGISLATION; AND ROGER 

McCLUNG, OFFICE OF ASSISTANT SECRETARY FOR HEALTH, 

DEPARTMENT OF HEALTH AND HUMAN SERVICES; FRANCES 

M. MURPHY, M.D., DEPUTY UNDER SECRETARY FOR HEALTH 

FOR HEALTH POLICY COORDINATION, VETERANS HEALTH 

ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS; 

ACCOMPANIED BY: THOMAS J. HOGAN, DEPUTY ASSISTANT 

SECRETARY FOR HUMAN RESOURCES MANAGEMENT; KATHRYN W. ENCHELMAYER, DIRECTOR, CREDENTIALING AND 

PRIVILEGING; BARBARA PANTHER, DIRECTOR, RECRUITMENT AND PLACEMENT POLICY, OFFICE OF HUMAN RESOURCES MANAGEMENT; ROBERT W. SWANSON, MANAGEMENT ANALYST, OFFICE OF MANAGEMENT SUPPORT; PAUL 

S. ROSENFELD, M.D., CHIEF OF STAFF, VA MEDICAL CENTER, 

VETERANS HEALTH ADMINISTRATION, NEW ORLEANS, LA; 

SANFORD M. GARFUNKEL, DIRECTOR, WASHINGTON VA 

MEDICAL CENTER, VETERANS HEALTH ADMINISTRATION, 

DISTRICT OF COLUMBIA; WILLIAM E. COX, ACTING DIRECTOR, VA MEDICAL CENTER, VETERANS HEALTH ADMINISTRATION, BIG SPRING, TX; AND TIMOTHY B. WILLIAMS, DIRECTOR, VA PUGET SOUND HEALTH CARE SYSTEM, VETERANS HEALTH ADMINISTRATION, SEATTLE, WA; CYNTHA A. 

BASCETTA, DIRECTOR, HEALTH CARE—VETERANS’ HEALTH 

AND BENEFITS ISSUES, U.S. GENERAL ACCOUNTING OFFICE; 

ACCOMPANIED BY: MARCIA MANN, ASSISTANT DIRECTOR; 

AND MARY ANN CURRAN, SENIOR ANALYST 

STATEMENT OF CYNTHIA GRUBBS 

Ms. GRUBBS. Thank you, and good morning. I’m here to speak 

with you today on the National Practitioner Data Bank, the 

Healthcare Integrity and Protection Data Bank, and the Federal 

Credentialing Program. 

The National Practitioner Data Bank (NPDB) was created in response to the requirements of the Health Care Quality Improvement Act of 1986 and plays a vital role in the process of health care 
6

practitioner credentialing. Authorized users of the NPDB include 

state licensing boards, hospitals, managed care organizations, other 

health care entities and professional societies. 

Hospitals are required to submit queries regarding staff practitioners every 2 years and/or each time they higher, affiliate, or 

grant privileges to a practitioner. The NPDB receives adverse information on licensure, clinical privileges and professional society actions taken against physicians and dentists. The NPDB also receives information on medical malpractice payments, Drug Enforcement Administration actions and Medicare/Medicaid exclusions 

taken against physicians, dentists, nurses and other health care 

practitioners. 

NPDB data is intended to supplement a comprehensive and careful professional peer review. The data bank is used by entities to 

verify information the practitioner submits in his or her application 

for privileges, licensure or affiliation. 

The NPDB is not funded by taxpayer dollars but entirely by user 

fees. It has successfully covered its costs for nearly 14 years. The 

current $4.25 query fee is substantially lower than fees charged for 

databases of similar though much less complete information. The 

NPDB is able to provide information within hours to requesters 

using the latest technology. 

The Healthcare Integrity and Protection Data Bank, or HIPDB, 

commenced operations in late 1999. The purpose of the HIPDB is 

to combat fraud and abuse in health insurance and health care delivery, and to promote quality care. Like the NPDB, HIPDB information is intended to be used in combination with other sources. 

Health plans and federal and state agencies are required to report adverse actions taken against health care providers, suppliers 

and practitioners. The HIPDB collects health care-related criminal 

convictions and civil judgments, federal or state licensing and certification actions, exclusions from participation in federal or state 

health care programs, and other adjudicated actions, including contract terminations taken by health plans. These same organizations, federal and state agencies and health plans, have access to 

the HIPDB information. 

The HIPDB operations are funded through user fees also that 

are charged to health plans and state agencies. These fees have not 

generated sufficient revenue to fully fund its operations. Therefore, 

it has received supplemental funding from the Health Care Fraud 

and Abuse Control Act. 

In terms of the use of the data banks by the Department of Veterans Affairs, the VA facilities use both the NPDB and the HIPDB. 

VA facilities submitted 31,750 queries and 119 reports to the 

NPDB in 2003. In 2003, the VA submitted 30,836 queries and one 

report to the HIPDB. VA facilities query the HIPDB for free. 

The Federal Credentialing Program was developed to replace the 

paper-based credentialing processes with electronic storage techniques for easier retrieval of credentials and faster communication 

of credentialing information. 

In 1997, the Veterans Health Administration and the Health Resources and Service Administration signed an interagency agreement establishing a formal partnership to develop this electronic, 

web-based credentialing data base. The resulting software applica-
7

tion, VetPro, allows providers to enter credentialing information, 

and a credentialer, through primary source verification, authenticates the data. The system shares an interface with the NPDB 

and HIPDB to allow for seamless querying of the databanks. 

By 2001, the FCP was used by all 172 VA facilities. By 2003, the 

U.S. Public Health Service Office of Emergency Preparedness, Immigration and Naturalization Service, National Aeronautics and 

Space Administration and the National Health Service Corps had 

entered into 1-year interagency agreements to participate in the 

FCP. 

However, by 2003, the landscape of the federal government had 

changed. The Office of Emergency Preparedness and the Immigration and Naturalization Services were transferred to the U.S. Department of Homeland Security. The Division of Commissioned 

Personnel’s internal business process changed, which eliminated 

their need of the FCP. Therefore, in October of 2003, HRSA transferred responsibility for the management of all FCP-related activities, including the VetPro software, to the VA, where we understand the system continues to operate effectively. 

Thank you for this opportunity to inform you about the National 

Practitioner Data Bank, the Health Care Integrity and Protection 

Data Bank, and the FCP. 

[The prepared statement of Ms. Grubbs appears on p. 45.] 

Mr. BUYER. Thank you, Ms. Grubbs. Dr. Murphy. 

STATEMENT OF FRANCES M. MURPHY 

Dr. MURPHY. Mr. Chairman and members of the subcommittee, 

I’m pleased to be here today to discuss VA’s procedures for background checks and credentialing of its health care providers. We 

take very seriously our responsibility to ensure that these individuals are properly qualified and trained to provide care for our Nation’s veterans. 

Therefore, we appreciated the opportunity to review the recent 

draft GAO report which has just been published on the improved 

screening of practitioners. I have submitted a full statement that 

responds to many of the GAO preliminary findings that we 

reviewed. 

At this time I’d like to briefly discuss some of the important 

points made in that statement. Credentialing is a systematic process of screening and evaluating qualifications and other credentials, including competence and health status. It must be completed 

prior to a practitioner’s initial medical staff appointments and must 

be brought up to date before reappointment, which occurs at a minimum of every 2 years. 

Since 1990, VA has performed primary source verification on 

physicians and dentists. In 1997, full primary source verified 

credentialing was expanded to all licensed independent practitioners. 

In March of 2001, VA launched VetPro, its web-based 

credentialing data bank. VetPro ensures the consistency of the 

credentialing process for independent practitioners across VA’s 

health care system. Through VetPro, VA is able to maintain a 

valid, reliable electronic databank of over 39,000 health care providers’ credentials that are accurate and easily accessible. 
8

By April of 2004, VA will require that all physicians assistants 

and advance practice registered nurses are also credentialed 

through VetPro. We are pleased that the GAO found that our reviews of the credentials of licensed independent practitioners was 

complete and thorough. Similarly, the Joint Commission on Accreditation of Healthcare Organizations has stated that VetPro represents a state-of-the-art system for consistent, high quality, safe 

and effective credentialing. 

VA has learned important lessons from this success and will use 

this best practice to improve its other credentialing and suitability 

programs. 

Two nationwide flagging systems under the auspices of the Department of Health and Human Services are available to VA for 

query as supplements to the other information obtained during the 

credentialing process. One is the National Practitioner Data Bank 

or the NPDB. As previously discussed, this databank permits discreet inquiry into specific areas of practitioners’ licensure, professional society memberships, medical malpractice payment history, 

and record of clinical privileges. 

VA requires that all practitioners who are privileged and are 

practicing independently be queried against the NPDB before privileges are granted, changed or renewed. 

The second database is the Health Integrity and Protection Data 

Bank, or HIPDB. This is a flagging system to alert users that a 

more comprehensive review of the practitioners’, providers’, or suppliers’ past actions may be prudent. 

VA currently performs a joint query of both the HIPDB and the 

NPDB for all licensed independent practitioners. However, we 

agree that we must go further in the future. Therefore, VA plans 

to issue a policy requiring a query of the HIPDB on all new hires 

by May of 2004. We also intend to begin querying the HIPDB on 

current employees prior to their reappointment. This will occur following appropriate notification to employee bargaining units of our 

intent, and is expected to be in place by August of 2004. 

VA takes seriously the completion of appropriate adjudication of 

background investigations on its employees, and we expect full 

compliance with established policies and procedures. Nonetheless, 

GAO found inconsistent implementation and compliance with VA’s 

key screening requirements. GAO recommended that we conduct 

oversight to help ensure that VA facilities consistently apply existing policies. In light of this recommendation, we are establishing 

mechanisms and long-range goals for improving compliance with 

applicable federal regulations and VA policies. 

We are providing facilities electronic lists of completed investigations upon which they must take immediate action. We’re instructing our facilities to report on the status of all overdue investigations by April of 2004, and are requiring weekly reports until all 

actions have been completed and all investigations have been submitted. Network coordinators will monitor submission of the required reports. 

GAO also recommended that VA require fingerprints for all 

health care practitioners who were previously exempted from background investigations and who have direct patient access. 
9

On March 11, 2004, VA’s National Leadership Board approved a 

requirement that electronic fingerprint checks be extended to all 

VHA paid without-compensation employees, trainees, volunteers 

and contractors. We expect full implementation of the recommendation during the first quarter of calendar year 2005. 

VA employment policy requires that all selectees for positions 

funded by VA’s health care programs be screened against the list 

of excluded individuals and entities. VA also matches current VHA 

employees in VHA’s employment database with individuals on this 

list on a monthly basis. When current employees are identified 

from the list, facilities must initiate action to separate them or 

clear the exclusion. 

GAO identified concerns in the pre-employment and post-employment credentialing reviews of such health care providers as nurses, 

dieticians and respiratory therapists. GAO recommended expanding the verification requirement for contacting state licensing 

boards and national certifying organizations to include verification 

checks of all applicants and employed practitioners with state licenses and national certificates. 

We agree that this must be an integral part of the credentialing 

review process and will implement these procedures in the near future, possibly modeled on the credentialing process used for VA’s 

independent providers. 

Mr. Chairman, VA is already in compliance with the standard in 

the community for background checks and credentialing procedures 

for independent providers. However, we acknowledge that we must 

further improve our overall credentialing system. 

Meeting industry standards is not enough. We intend to establish a higher standard for veterans health care system. We intend 

to create a systematic credentialing and oversight process to ensure 

overall exemplary performance in the future. 

This completes my statement, and my colleagues and I will be 

happy to answer any questions that you or other members of the 

subcommittee may have. 

[The prepared statement of Dr. Murphy appears on p. 52.] 

Mr. BUYER. Thank you, Dr. Murphy. 

Ms. Bascetta, you are now recognized. 

STATEMENT OF CYNTHA A. BASCETTA 

Ms. BASCETTA. Mr. Chairman and members of the subcommittee, 

thank you for inviting us to discuss our report on VA’s screening 

of its health care practitioners. 

Let me tell you about the findings that VA has responded to in 

its testimony. You asked us to review compliance with VA’s screening requirements and to determine if the requirements are adequate. To address your concerns, we visited four facilities, and at 

each one we reviewed the personnel files of about 100 practitioners 

who have direct patient care access. We also interviewed VA officials in headquarters and the field and discussed verification procedures with state licensing boards and national certifying organizations. 

I’d like to highlight two problems. First, we found mixed compliance with VA’s key screening requirements. And second, some of 

the requirements are inadequate because they do not result in com-
10

plete and thorough screening. These two problems have created 

vulnerabilities that could allow incompetent practitioners or practitioners who might deliberately harm patients into VA’s health care 

system. 

Based on our discussions with medical forensic experts, similar 

risk to patient safety is a problem in the general health care sector 

as well. In commenting on our draft, and as you just heard, VA 

generally agreed with our findings and conclusions and stated its 

intent to provide a detailed action plan to implement our recommendations when our final report is issued. 

Mr. Chairman, to keep problem practitioners away from patients, 

VA expects 100 percent compliance with its screening requirements 

to screen out practitioners who may have restricted or fraudulent 

credentials, criminal backgrounds or questionable work histories. 

While some facilities in our review were doing a good job in some 

areas, we were frankly disappointed by the degree of compliance 

we found. We identified failures to verify credentials, failures to 

query national databases that contained reports about practitioners 

who have had disciplinary actions taken against their licenses, failures to check for practitioners whose credentials may be from diploma mills, and failures to respond to the results of background 

investigations in time to prevent practitioners with prior criminal 

records from caring for veterans. 

Equally disturbing was the lack of oversight by headquarters to 

monitor compliance of its facilities with key screening requirements. 

In spite of the clear risk of inadequate screening, we note that 

VA has conducted no oversight to date. VA did establish an oversight office in January 2003 but has yet to approve either the resources to support this function or the proposed program evaluation to be used in assessing facility compliance. 

Mr. Chairman, even if compliance were perfect, we found gaps in 

VA’s requirements that could allow some practitioners access to patients without adequate checking of their professional credentials. 

To VA’s credit, this is not the case for all occupations. In fact, the 

complete and thorough requirements for physicians and other licensed independent practitioners serve as a model. They require 

verifying all licenses a practitioner holds and doing so by directly 

contacting state licensing boards. 

In contrast, for some practitioners already employed by VA, such 

as nurses and pharmacists, the screening requirement for periodic 

verification of their credentials is not complete, because they can 

present only one license for verification, even if they hold multiple 

licenses. As a result, they could conceal licenses that may have disciplinary actions taken against them. 

Moreover, the requirement calls for simply viewing the license. 

But this practice is not as thorough as contacting state licensing 

boards, which is the only sure way to identify restricted licenses or 

forged credentials. 

Besides verifying credentials, VA requires querying national 

databases that flag problems with physicians and dentists, but it 

overlooks querying HIPDB, which could provide similar warning 

flags for all other licensed practitioners. 
11

Finally, VA has not implemented consistent background checks 

for all practitioners, including fingerprinting to look for criminal 

histories. OPM began to offer a fingerprint only check in 2001, 

which can be done within 3 weeks at a cost of less than $25. In 

commenting on our draft report last week, VA told us it plans to 

fingerprint volunteers, contract health care practitioners, medical 

residents, and practitioners who work without direct VA compensation, but it has not issued guidance to implement its plan except 

for volunteers. 

In 1996, the FSMB recommended that to better ensure patient 

safety, states should check the criminal histories of medical residents who have varying degrees of unsupervised care. For the same 

reason, one of the VA facilities we visited has already implemented 

fingerprint-only checks of its medical residents and contract health 

care practitioners. 

In summary, these are serious weaknesses with profound implications for patient safety. VA’s intent to provide an action plan to 

comply with our recommendations should be an immediate priority, 

and it apparently is. 

This concludes my remarks, and I’d be happy to answer any 

questions you might have. 

[The prepared statement of Ms. Bascetta appears on p. 59.] 

Mr. BUYER. We have been joined by Mr. Lane Evans, Ranking 

Member of the full committee, and also Mr. Boozman. If any of you 

have any opening statements, we will submit them for the record. 

Mr. Evans? 

Mr. EVANS. I echo your request. I’d like them entered into the 

record. 

Mr. BUYER. Yes. It will be so granted. Mr. Evans, your written 

statement shall be entered into the record. 

[The prepared statement of Congressman Evans appears on p. 

44.] 

Mr. BUYER. Mr. Boozman? Thank you. I yield myself at this time 

5 minutes. Ms. Bascetta, when was the last time the GAO looked 

at this credentialing issue for the VA? 

Ms. BASCETTA. Mr. Chairman, not in my tenure. I believe we 

have not looked at this issue in the last 10 years. 

Mr. BUYER. And your tenure would be defined by what period of 

time? 

Ms. BASCETTA. Six years. 

Mr. BUYER. Six years. Not in your tenure, and to your knowledge, not in 10 years? 

Ms. BASCETTA. Right. 

Mr. BUYER. Are you able to tell us whether or not DOD, the Department of Defense, has similar problems with regard to 

credentialing? 

Ms. BASCETTA. We haven’t looked at the credentialing process at 

DOD. 

Mr. BUYER. At DOD? All right. In your testimony, you can grab 

it if you’ve got it there in front of you, on your opening page, you 

have a chart with regard to the four facilities. 

Ms. BASCETTA. Right. 
12

Mr. BUYER. You lay them out, Facility A, Facility B, Facility C 

and Facility D. It’s a very simple chart but at the same time will 

you please identify the facilities for me, Facility A, B, C and D? 

Ms. BASCETTA. Yes, sir. Facility A is Big Spring, TX. Facility B 

is Washington, DC. Facility C is New Orleans, and Facility D is 

Seattle. 

Mr. BUYER. All right. On page 7 of your testimony you state that 

during one of your facility reviews you found a case that exceeded 

the 90-day timeframe involving a nurse assistant who was hired to 

work in a VA nursing home in June of 2002. In August of 2002, 

OPM sent the results of its background investigation to the VA facility, reporting that the nursing assistant had been fired from a 

non-VA nursing home for patient abuse. During your review, you 

found this case among a stack of OPM results of background investigations that were stored in a clerk’s office on a pile on a desk in 

some work spaces. 

When you brought this to the attention of the facility officials in 

December 2003, they terminated the nursing assistant who had 

worked at the VA facility for more than one year. In which facility 

did this travesty occur? 

Ms. BASCETTA. Mr. Chairman, that was at the Washington, DC 

facility. 

Mr. BUYER. Who heads up the Washington, DC facility? Would 

you please scoot up to the microphone? 

Mr. GARFUNKEL. Yes, sir. 

Mr. BUYER. Please identify yourself. 

Mr. GARFUNKEL. Sanford Garfunkel. I’m the director of the 

facility. 

Mr. BUYER. And how long have you been the director of the DC 

facility? 

Mr. GARFUNKEL. Approximately eight years. 

Mr. BUYER. For eight years? 

Mr. GARFUNKEL. Yes, sir. 

Mr. BUYER. Would you please tell the subcommittee how this was 

allowed to happen under your watch and what happened to the 

people who were responsible to ensure that the personnel action 

was fulfilled? 

Mr. GARFUNKEL. Sir, first of all, I need to say that in our effort 

to identify this nursing assistant, we could not do so. The only 

nursing assistant that we could identify that would come close to 

this scenario is a nursing assistant who we understand was found 

guilty at one point of spousal abuse or abuse at home and subsequently resigned. So I honestly could not identify this individual. 

I will tell you that, without making excuses, that we had issues 

in our HR service subsequent to this review. We have a new team 

in our HR service, a new chief, very conscientious, who is taking 

appropriate actions to assure that we have systems in place that 

make sure that we have adequate follow-up on issues like this. 

Mr. BUYER. Let me ask this. Where did the system fail us? 

Mr. GARFUNKEL. I think the system failed perhaps, without making excuses, Congressman. 

Mr. BUYER. I’m not asking for any. 

Mr. GARFUNKEL. I understand. 

Mr. BUYER. Let’s go right at it. 
13

Mr. GARFUNKEL. I think perhaps not enough emphasis was put 

on the importance of making sure that we had adequate follow-up. 

I’m told that when any result did come back from these reviews, 

background checks that did show a significant issue, that immediate action was taken, and in other cases there were delays in 

follow-up. 

In this case, and I’ll tell you very honestly, in the next case, 

which is ours as well, we found very different results than what 

this report would indicate, and so as forceful action as might be indicated from this report was not taken. 

Mr. BUYER. And for whom would you be referring? Yourself? 

Mr. GARFUNKEL. I’m sorry? 

Mr. BUYER. You said forceful action was not taken. 

Mr. GARFUNKEL. No. I’m talking about forceful action was not 

taken to the employee because the results of the background check 

that we got was different than the results that are shown in this 

report. 

Mr. BUYER. Who’s responsible for compliance? 

Mr. GARFUNKEL. I am ultimately, sir. 

Mr. BUYER. That’s correct. There is no sinister design by the way 

we’ve set out this panel here today. We want the subcommittee to 

explore this. Health and Human Services do it a particular way. 

You try to coordinate with the VA. For whatever reason, we’re 

going discover why some things were dismantled. 

We bring in the Government Accounting Office to do an examination. They can be openly critical with regard to the VA headquarters with regard to oversight, but their criticism is the oversight of the compliance with regard to what the hospital directors 

have done or not done, correct? 

Mr. GARFUNKEL. Yes, sir. 

Mr. BUYER. All right. So that’s what we’re sort of laying out here 

today for open discussion. And we’re not going after anybody here. 

We’re trying to figure out how we can improve our system, and 

that’s what our goal is. 

I now yield to Ms. Hooley for any questions she may have. 

Ms. HOOLEY. Yes. Ms. Bascetta, thank you very much. I think 

you did an excellent job on your report. GAO previously reviewed 

the issue of VA research lab vulnerabilities. There were two basic 

components to the review: physical security and a variety of procedural and accounting mechanisms, and the human element. What 

can you tell us about the screening process for those individuals 

with access to select biological, chemical, or radiological agents in 

the VA lab, especially their Level 3 research labs? 

Ms. BASCETTA. Let me give you a little background on what we 

did. At the request of the chairman and Congressman Evans, who 

were the lead requesters on our work—there were several other requesters involved who had jurisdiction over other federal labs—we 

looked, as you said, at the issue of security in those labs, and we 

found what I would characterize as a similar lax mindset with regard to the issue of security, particularly with regard to concern 

about individuals who might have malicious intent. 

And the focus of our review was actually on CDC’s administration of the select agent program, but at the same time, the VA inspector general as well as the IGs in the other departments with 
14

federal laboratories were doing extensive work on security with regard to personnel policies. They’ve been working on this since right 

after the anthrax event in October 2001, and I believe they are still 

working on it. Their work is classified, so I can’t discuss it. But I 

know they made a number of recommendations and are following 

up with all of the agencies to determine their compliance with 

those regulations. 

CDC published guidance I believe in December 2002, and their 

guidance covered everything from physical security to revised and 

tightened personnel regulations that recommended background 

checks for anybody with access to a federal laboratory, including 

visitors. 

Ms. HOOLEY. Let me just follow up on that. You said you are following up on your recommendations. And what’s been the result of 

your follow-up? 

Ms. BASCETTA. Well, our recommendations were directed at 

CDC’s management of the select agent program which governs the 

transfer of these agents between laboratories. That was the major 

focus of our work. And CDC has issued much tighter regulations 

and guidance to its laboratories. 

Under the Patriot Act, the IGs were looking at compliance with 

the security of personnel access to those laboratories, and that 

work is classified. 

Ms. HOOLEY. Okay. So are we complying—are they complying 

with your recommendations now? 

Ms. BASCETTA. CDC is, yes. 

Ms. HOOLEY. Okay. Just very quickly, you wanted to reduce 

vulnerabilities in patient care and you had all the oversight. My 

question is, on your recommendations, how can the VA accomplish 

these actions? And what will it take, other than your recommendations for VA to act to close their credentialing gap? 

Ms. BASCETTA. Well, I think Dr. Murphy’s testimony reflects the 

first and most important step, which is to acknowledge that they 

have problems that they are committed to correcting. 

I think from the credentialers’ standpoint, the most important 

thing that the Department can do is simplify the process. Now they 

have a rather confusing mix of requirements that vary by type of 

practitioner and by a point in the process, that is, for applicants 

or those already employed. If they have one standard, that is, if 

they check all licenses for everybody and that they do so by directly 

contacting the state licensing boards, that will simplify the guidance to the field as to what they should be doing. 

But in a situation like this, the other most important cultural 

piece I think I’d call it is the mindset, the vigilance to ensure that 

this is always a top priority, and that 100 percent compliance is expected, no deviation is allowed. 

Ms. HOOLEY. And will you follow-up—being oversight—and look 

at what their compliance is? 

Ms. BASCETTA. We always follow up with our recommendations, 

yes. 

Ms. HOOLEY. And do you know how the VA’s performance compares to the private sector regarding screening and credentialing? 
15

Ms. BASCETTA. No. We have not looked at the private sector, but 

as I mentioned briefly in my statement, we did speak with experts 

who believe that similar problems exist in the private sector. 

Ms. HOOLEY. Thank you. I yield back. 

Mr. BUYER. Mr. Boozman, you are now recognized. 

Mr. BOOZMAN. Yes. When there is a vacancy, say a hospital 

needs a gastroenterologist or whatever, what is the process? I 

guess you go for the interview. At that time, you know, if the interview goes well and they decide whatever, who actually does the 

credentialing? What kicks in? 

Dr. MURPHY. I’m going to ask our technical expert to——

Mr. BUYER. Dr. Boozman, would you yield for just a second? 

Mr. BOOZMAN. Yes. 

Mr. BUYER. That is a wonderful question. And rather than—to 

Dr. Murphy, I’ll just propose this to you. Let’s ask one of the directors of one of the hospitals what they actually do now, and then 

we can get comment, and I’ll be more than happy to yield additional time, with no objection. I think it would be interesting to 

find out. Do you concur? 

Mr. BOOZMAN. Sure. 

Mr. BUYER. Thank you. I’ll let you select one of the four. 

Mr. BOOZMAN. Just whoever. 

Dr. MURPHY. Do we have a volunteer? Tim? 

Mr. WILLIAMS. Okay. I’m Tim Williams from the VA Puget Sound 

Health Care System in Seattle. And just to go through the process, 

we would receive a request from either one of our contractors if we 

got this individual through a contract, or if it came from one of our 

service lines, somebody who applied directly for a position at the 

facility. That would then—we would do a background check after 

that, once we have the name. They’re considering this individual 

for a position, and then we would do the background check relative 

to the professional credentials, medical school, licensing and all of 

that, and then we would look at——

Mr. BOOZMAN. So somebody at that facility would do the——

Mr. WILLIAMS. That’s correct. I have a medical staff officer who 

is responsible for this, does it on an ongoing basis, uses VetPro, 

uses Priv Plus, uses a variety of sources to be able to do that including, you know, telephone calls to the state licensing boards and 

to the universities along the way. So, yes, it would be done at the 

facility. 

Mr. BOOZMAN. Okay. How does that differ? Were you ever in the 

private sector in hospital management? 

Mr. WILLIAMS. A really long time ago. But I can tell you that 

what the physicians that we hire tell us is that we are much more 

thorough, that we ask for more information, we ask for more documentation than what they get from other private sector facilities. 

Mr. BOOZMAN. Do many of the private sector facilities hire people 

that—firms, that that’s all they do is do the background checks to 

vet the people? 

Mr. WILLIAMS. I don’t know that. I presume so, but I can’t speak 

definitively to that. 

Mr. BOOZMAN. Okay. I guess the other question I’d have, when, 

the case that you had when the—the very notorious case that’s doc-
16

umented here—when those sort of things happen, what broke down 

in your investigation in the process? 

Dr. MURPHY. If you’re referring to the Swango case that’s been 

talked about this morning——

Mr. BOOZMAN. Yes. He and whoever else. It doesn’t really matter. 

Dr. MURPHY. I think there are several important and key components to the credentialing process and the background security 

checks, and I’ll use those terms very specifically. 

It’s important for us to query the available public databases, the 

HIPDB, the National Practitioner Data Bank, and the Federation 

of State Medical Boards. We also do primary verification of all 

other credentials for education and certification that are provided. 

In addition, in the Swango case, if he had been fingerprinted, we 

would have been able to pick up his previous convictions, and that’s 

why VA is implementing electronic fingerprinting for all of our employees, our volunteers, our without-compensation staff and 

trainees. 

Electronic fingerprinting has an advantage over the ink- andpaper fingerprinting, because we can get the results back very 

quickly. In 48 hours, we can get the fingerprint match results. And 

I think that those additional steps that we have committed to will 

avert problems in the future. 

Another key feature is to provide the oversight to make sure that 

we are consistently applying those policies throughout the country. 

Mr. BOOZMAN. Thank you. 

Mr. BUYER. Mr. Udall, you’re now recognized. 

Mr. UDALL. Thank you very much, Mr. Chairman. Thank you, 

Dr. Murphy, for that issue that you just took up on Dr. Swango. 

Because I think that he shows—if you follow this history, and 

that’s what I want to ask both of you about. If you follow this history of what happened to him and how he ended up killing and injuring so many people, I want you to highlight for me what, Dr. 

Murphy, what you’ve changed and ask the GAO representative, 

Ms. Bascetta, what is it that you saw that were the faults. 

Because I look here. Here’s this guy—talking about Swango—he 

hires on in Ohio in 1984 and he assaults a patient there and then 

moves on from there to Adams County, Illinois, in 1985. And in 

that particular place, he poisons co-workers with arsenic and he 

gets a felony conviction in 1985 for aggravated battery for poisoning these folks. 

And then what happens after that, you’ve got a whole series of 

hirings all over the country and all over the world. I mean, look 

at this. Here in 1992 he was hired in South Dakota to work at a 

VA facility. He lied about his criminal conviction. Then you go to 

1993, he’s hired over at Stony Brook Medical Center in the VAMC 

at Northport, which is where he killed the people and was actually 

convicted for that. But he told everybody in that instance that it 

was a barroom brawl, and so he made it in the facility. He lied 

about his background. 

He then goes overseas and is hired in 1995 at a hospital in 

Zimbabwe and ends up giving patients there toxic substances, and 

then in Saudi Arabia in 1997, he’s hired through an employment 

agency located in Portland, Oregon and assigned as a physician in 
17

Saudi Arabia, and that’s where he’s arrested for the false 

statements. 

But if you’d look at this very early on, he has a felony conviction 

for poisoning patients with arsenic. And yet a number of medical 

centers and VA facilities hire him and they never detect what’s 

going on. And so my first question to Ms. Bascetta is, and it sounds 

like you said that many of the things, the mistakes that were made 

here, are still things that could have caused problems. So you 

might have the possibility of this same kind of thing occurring. And 

I’d like to know, based on this history of Dr. Swango, what is it 

that you see that are problems that would let a doctor that has 

these evil intentions get into the system? 

Ms. BASCETTA. You make several very good points by laying out 

this unbelievable history. First and most important, as you pointed 

out, he had a criminal conviction that was in his record that would 

have been picked up on fingerprinting before not only the VA hired 

him but some private sector hospitals that were in the mix, as well. 

Nobody checked him against a criminal record database. So he’s 

definitely not the problem of the VA alone. 

And I might also point out that the reason that he was ultimately convicted was because the IG would not let it go, and they 

wanted him behind bars. 

Another point is that the databases that VA and the other hospitals check are only as good as the reports that are in them. And 

my understanding in the Swango case is that despite many, many 

people having deep misgivings about his behavior, he was pretty 

much passed from place to place. 

The Institute of Medicine talks about this briefly in one of their 

reports on licensing and databases and how people with problems, 

problem practitioners can fall between the cracks. Sometimes it’s 

because a facility is worried about liability if they admit that somebody that has been working within their facility could have potentially caused harm, either from incompetence or deliberately. 

And finally, we have to be sure that when people get information 

that indicates that somebody could be a bad actor that they use the 

appropriate judgment in taking action to keep that person out of 

the facility. And that’s closing the loop and assuring that VA officials and others act appropriately when they’re armed with information about a practitioner’s past. 

Mr. UDALL. And, Dr. Murphy, have we closed some of those loopholes today so that a doctor like Dr. Swango wouldn’t get into the 

VA today? You talked about fingerprinting. I mean, talk about 

some of the other things that she’s laid out there. 

Dr. MURPHY. There are actually several different ways that this 

individual could have been picked up if he applied to VA today. The 

Health Integrity and Protection Data Bank from HHS includes 

some corrections information, and it should have indicated a problem with this individual’s past history. 

Currently we have put in place a policy to do electronic 

fingerprinting for all VA staff. The fingerprinting would have 

picked this up. In addition, VA staff who are undergoing background checks would be screened for past convictions, and the adjudication process would avert our hiring full time staff with these 

kinds of problems in their backgrounds. 
18

So I think there are a number of ways that our current policies 

and the improvements that we’re making on the basis of the GAO 

recommendations will allow us to make sure that we have high 

quality health care providers and practitioners in the VA system. 

Mr. UDALL. Thank you. And thank you for allowing us to go a 

little bit over, Mr. Chairman. 

Mr. BOOZMAN (presiding). Ms. Grubbs, how many people are employed in the Bureau of Health Professions? 

Ms. GRUBBS. In the Bureau of Health Professions? 

Mr. BOOZMAN. Yes, ma’am. 

Ms. GRUBBS. I’m not sure of the exact number, but there are six 

different divisions and two offices, so the Bureau has somewhere 

around 300 people. The Division of Practitioner Data Banks, which 

runs the National Practitioner Data Bank and the Health Care and 

Integrity Protection Data Bank has a staff of around 22. 

Mr. BOOZMAN. Okay. And Health Resources and Services Administration? 

Ms. GRUBBS. How many are employed there? 

Mr. BOOZMAN. Yes, ma’am. 

Ms. GRUBBS. I’m sorry, sir. I would have to get back to you with 

that answer. 

(The information follows:) 

The Health Resources and Services Administration employs 1,852 people, in partnership with States and local communities, to perform the varied tasks necessary 

to provided medical care and social services to millions of low-income Americans, 

many of whom lack health insurance and live in remote rural communities and 

inner-city areas where health care services are scarce. 

Mr. BOOZMAN. The National Practitioner Data Bank has been in 

place since I think 1986. Hospitals are required to submit queries 

regarding staff practitioners every 2 years. Does that make the VA 

compliant on the biannual requirement? 

Ms. GRUBBS. The legislation that authorized the National Practitioner Data Bank was in 1986. It actually opened in 1990, and the 

VA is compliant. They do query, based on the numbers, they have 

queried from all of their facilities. 

Mr. BOOZMAN. VA, can you comment on that? 

Dr. MURPHY. We comply with query to the National Practitioner 

Data Bank on all physicians and dentists. 

Mr. BOOZMAN. Okay. The Health Care Integrity and Protection 

Data Bank created as part of the HIPPA of 1996 commenced operations in late 1999. I’m curious as to why both these important 

databanks aren’t combined. 

Dr. GRUBBS. They basically are combined. It is one electronic system. So if a private hospital or the VA facilities submit a query and 

choose to query both databanks, it’s done at one time and they receive the reports electronically from both databanks at the same 

time. And it generally takes about 45 minutes to receive a response. 

Mr. BOOZMAN. Okay. So how does it work with the fugitive felon 

program? 

Dr. GRUBBS. We have nothing to do with the fugitive felon 

program. 

Mr. BOOZMAN. So there’s no interface of the databanks? 

Dr. GRUBBS. No, sir. 
19

Mr. BOOZMAN. Okay. Ms. Bascetta, we’ve heard your testimony. 

I’ve heard the VA’s testimony and I’ve heard the HHS testimony. 

My question to you is, could another Dr. Swango situation occur 

today in light of the VA’s current credentialing procedures? Do you 

feel like the measures that have been enacted in the last several 

months would prevent another incident like this from happening? 

Ms. BASCETTA. The most important way to have prevented him 

would have been to have fingerprinted residents, which they’re not 

doing yet, but they indicate that they are planning to do. That 

would have caught him. 

I might point out also that applicants simply knowing that they’ll 

have to undergo a background investigation or fingerprinting could 

be deterred from trying to enter VA or another health care system. 

Mr. BOOZMAN. Okay. 

Mr. BUYER. Mr. Udall. 

Mr. UDALL. Thank you, Mr. Chairman. Ms. Bascetta, you say 

they aren’t currently fingerprinting residents. And my understanding of why that’s a problem, at least from the way I understand my teaching hospital in Albuquerque, New Mexico, is when 

you have residents—and interrupt me if I’m not explaining this, 

this relationship between VAs and teaching hospitals. But in a 

teaching hospital, they frequently have their residents serve over 

in the Veterans Administration hospital. So the residents are moving back and forth. They’re doing duty at the VA hospital. They’re 

also over at the teaching hospital and doing their residency over 

there. 

And when you’re saying the way you pick this up is you have to 

have fingerprinting for residents, then it’s because the large volume of people moving back and forth, the health care people and 

the docs that are doing that. Is that what you’re—that’s how you 

pick up this kind of situation? 

Ms. BASCETTA. Yes. that’s certainly part of it. Let me add some 

information that wasn’t discussed in our report but that we have 

in our workpapers. 

Several states require fingerprinting of residents, and your state, 

New Mexico, does. They require a state-only check, which means 

they would basically check with the police in your state, and they 

also require federal background checks for selected residents. I 

don’t know what their criteria are. 

But basically, 19 states do require background checks for medical 

residents. Seven of those states require a state-only check, and 12 

require a state or federal check. But one of the reasons that we feel 

so strongly that VA implement this check within their own system 

is that they wouldn’t necessarily have access to the results of these 

background investigations in the states. It’s so inexpensive to do a 

fingerprint check only, and as I’ve said, they’re already planning to 

do that. 

But it is very complicated, and the fact that these states already 

have this requirement indicates to us that there is acknowledgement of this problem in the health care system at large. 

Mr. UDALL. Dr. Murphy, you aren’t currently doing 

fingerprinting now, but you intend to? 

Dr. MURPHY. The issue of fingerprinting residents is actually a 

broader problem than in VA. As Ms. Bascetta has indicated, there 
20

are some states that currently require fingerprinting of residents, 

and we have actually been fingerprinting residents in Network 20 

at the Seattle facility and in Network 3 in New York/New Jersey. 

We’ve also addressed that issue from a national policy standpoint. And as previously noted at our March meeting of the National Leadership Board, we approved a policy that we will begin 

electronic fingerprinting, and we’ve funded that program. 

We will get that program up and running as quickly as we can, 

purchasing the equipment and putting the policies and staff in 

place to actually accomplish that. So we believe the VA has acted 

on this proactively. 

We’ve also been working with our colleagues in the AAMC to 

make sure that they’re aware of what VA is doing, because it will 

have an impact on the universities that don’t universally implement fingerprinting of all residents across the country. 

Mr. UDALL. So you named a couple of facilities. I assume all the 

rest of the facilities you’re not doing fingerprinting in? 

Dr. MURPHY. We’ve not been routinely fingerprinting in all VA 

facilities, but we’ve changed our policy and will begin to do that. 

We’re also compliant in the states where the universities are required to do that. 

Mr. UDALL. And when you say you’re going to begin, how soon 

are we talking about? 

Dr. MURPHY. We believe that we’ll be able to get the program in 

place in 2005. 

Mr. UDALL. Ms. Bascetta, is the reason fingerprinting is so important is that you have an individual who has a felony conviction, 

let’s assume, like Dr. Swango, and you get the fingerprint as a part 

of that process. And then if that individual tries to move anyplace 

in the system, if you have fingerprinting, the individual that comes 

in, that applies, submits a fingerprint in their application, and 

you’re able then to make a comparison with the databases and determine that here is an individual that has in fact had a conviction. 

Is that what we’re talking about? 

Ms. BASCETTA. Yes. That’s exactly right. 

Mr. UDALL. My time has run out here, so I’ll go ahead and yield 

back, Mr. Chairman. 

Mr. BOOZMAN. Ms. Bascetta, can we get a copy of the OPM background check on the nursing assistant that was allegedly fired a 

year previously for patient abuse? The GAO in DC seem to disagree on the facts. 

Ms. BASCETTA. I don’t know if we have that in our possession. 

I know that we would have part of her paperwork, but background 

investigations are considered private documents. They’re not allowed to keep them in their official personnel files. They’re also allowed to, by OPM regulations, actually encouraged to destroy those 

documents. 

I can tell you that we, for our own quality assurance purposes, 

have two analysts review every personnel file that we look at, and 

that all of the workpapers have been signed off, of course, by a supervisor. I will get you what documentation we do have on that 

particular case. 
21

When we followed up with the facility, we didn’t have documentation that they terminated this person. This was what they 

told us based on our initial concerns about her employment. 

Mr. BOOZMAN. Ms. Murphy, how many VA employees and VA 

contractors have been matched with individuals on the Department 

of Health and Human Services Office of Inspector General’s list of 

excluded individuals and entities since 1999, the year that this became available? 

Dr. MURPHY. I don’t know that I have the exclusions list data 

back that far. What I do have is that since November of 2002, 24 

individuals were identified as potential matches with individuals 

on that list, and of these, 15 have been terminated. Two were not 

confirmed to be VA employees. Two resigned. Three were reinstated. That is, they resolved the issue with HHS and were taken 

off the list. And two are in the process of being terminated by the 

employing facility. 

Mr. BOOZMAN. Okay. So is that when the VA started to query the 

list? 2003? Is that when they started to query the list? When did 

they start to——

Dr. MURPHY. It was, Barbara, in 1999? 

Ms. PANTHER. Yes. Ninety-nine. 

Dr. MURPHY. We began the query in 1999, but unfortunately, the 

information I have with me today only goes back to 2002. We’d be 

happy to provide the data back to 1999 for the record. 

Mr. BOOZMAN. How often do we query the list? How does that 

work? 

Dr. MURPHY. On a monthly basis. 

Mr. BOOZMAN. Monthly? Okay. When will the VA have a plan developed to address the four recommendations in the GAO’s report? 

Dr. MURPHY. For some of the recommendations we will implement changes within the next month. Others are more complex and 

will require us to set up a task force to make sure that we’ve got 

the most effective solution in place, and that we’ve identified the 

appropriate resources to implement a standardized system that 

will give us the consistent reporting and policy that we want to put 

in place. 

We believe that one of the key features is to have a systematic 

approach that allows people to do the right thing and keeps them 

from not doing the right thing. And that’s really what our webbased program, VetPro, allows us to do. It’s a standardized, systematic approach that gives staff the tools to do the job and does 

not allow them to appoint a person if they’ve not gotten all the appropriate information prior to the appointment. 

We’d like to have that kind of standardized approach for employees in Categories B and C, and for the excluded employees who 

have direct patient care responsibilities. 

Mr. BOOZMAN. How many staff are assigned to the VA’s Office 

of Human Resources, Oversight and Effectiveness? 

Dr. MURPHY. Seven. 

Mr. BOOZMAN. Seven. What does the—what has that particular 

office accomplished? Have they done any investigations or? 

Dr. MURPHY. We have individuals here from that office. They 

have not done any for cause investigations at this point. 
22

Mr. BOOZMAN. Okay. In regard to the other question, you know, 

you said that you’d have some of the four implemented almost immediately. Could you give us, you know, maybe in writing, kind of 

a timeframe as to how as you discuss, you know, the process, could 

you give us some sort of a timeframe as to when you think the entire thing will get done? 

Dr. MURPHY. Let me point out some of the key pieces that we 

believe we need to put in place. We’ve agreed that we need to check 

all of the Category B and C employees against the HIPDB database. We believe that we’ll be able to do that for applicants next 

month. As of May of 2004, that should be in place. And we should 

be able, after notification to the employee bargaining units, to put 

that same process in place for reappointment of our current 

employees. 

In addition, we will purchase and begin fingerprinting employees—without-compensation staff and volunteers and trainees—we 

believe by the first quarter of 2005. 

We’ve asked for the background checks, the security checks and 

suitability adjudications to be looked at immediately and a report 

on the status at each medical center to be forwarded to us by April 

15. We will require periodic reporting until all of those adjudications have been cleared. 

Going forward, prospectively, we expect that facilities will be 

timely in complying with OPM policy, which is to do background 

checks within 14 days; upon receiving the results, to review the results of the background check within 10 working days; and to adjudicate and respond to OPM within 90 days. 

Mr. BOOZMAN. Okay. Thank you. Mr. Udall? 

Mr. UDALL. Thank you, Mr. Chairman. Is one of the issues—for 

any of the panelists here—one of the issues with fingerprinting, because I seem to get that in the last question is that—do you all 

have the authority at the federal level to require the fingerprinting, 

or is that normally done at the state level through the states? 

Dr. MURPHY. We believe that we have the authority and have 

made it our policy and a requirement from this time forward. 

Mr. UDALL. So even states that don’t have—my state and several 

others that she’s mentioned actually have it right now in place. 

Even if those states don’t have it in their teaching hospitals and 

that kind of thing, you’re still able to require it, Dr. Murphy, is 

that right? 

Dr. MURPHY. Yes. We will have a national VHA policy. 

Mr. UDALL. A national policy? Okay. Ms. Bascetta, on the issue 

of databases, you said one of the things that is important is the 

database is only as good as the information that’s in them. Why is 

that a problem vis-a ́-vis the kind of Dr. Swango situation? 

Ms. BASCETTA. Well, it wouldn’t have been with Swango because 

of the criminal conviction which would have been in the database. 

But in other cases that aren’t as black and white, where perhaps 

something is under investigation—and a lot of these things take a 

long time to investigate—if there’s reluctance on the part of the facility that is to do the reporting to admit that they’ve had a problem with a practitioner in one of their facilities, these people can 

fall through the cracks. They can move from jurisdiction to jurisdiction, for example, while something is being investigated. And un-
23

less someone is willing to tell a prospective employer about a problem, they may not know. 

That’s why, in addition to checking the databases, the primary 

source verification, the contacting of the state licensing boards or 

the national certifying organizations is so important. Because that’s 

really your first line of defense. These databases are double checks. 

There are other ways to find out about incidents that may not have 

been disclosed. But your first line of defense is that primary source 

verification. 

Mr. UDALL. And the primary source verification, that institution 

is allowed to give that information out? So if a VA hospital contacts 

the New Mexico licensing board and says we have this particular 

doctor by this name, and he claims to have these certificates from 

you, can you verify that this is in fact true? 

Dr. MURPHY. Yes, we can and we will. 

Mr. UDALL. Now that doesn’t deal with the issue of is it the identical person that there’s in front of you, I guess? You’d do away 

with that with fingerprinting, but you could always have a situation I guess where somebody is representing to be someone that’s 

there. How do you all deal with that in your whole screening effort? 

Dr. MURPHY. For VA employees, we currently require not only 

the credentials check, but a background check. And in the process 

of doing the background check, fingerprinting will be done so identity can be verified. 

Mr. UDALL. Through the fingerprinting? 

Dr. MURPHY. Yes. 

Mr. UDALL. Dr. Murphy, are you familiar with an individual by 

the name of Christine Gilbert? This is a nurse that was at the VA 

facility, VA Medical Center, 1989 to 1996, and she has 63 deaths 

I think as a result of—from patients occurring on the ward. Are 

you familiar with that or heard—— Dr. MURPHY. Sir, I recognize——

Mr. UDALL. This is Northampton, Massachusetts. It’s the medical 

center up there. 

Dr. MURPHY. I recognize the name, but I don’t have the details 

of that case. 

Mr. UDALL. Okay. One of the things that I think is—that we 

need to talk about in this hearing, is this is a nurse that—I 

thought you might be familiar with it—but walked into the system, 

had no problems in her background, was a legitimate registered 

nurse. And then because of these bizarre situations with her boyfriend and faking emergencies to put people in an emergency situation and to show that she could save them, and in fact many of 

them died, you had this tragedy. 

How do you pick up those kinds of individuals that make it— they don’t have problems, but they make it into the system, and 

then they go bad within the system? I mean, how do you pick that 

up? What’s your approach to that? 

Dr. MURPHY. One of the approaches that we take in VA involves 

our very robust patient safety system, and we do a root cause analysis on either near misses or adverse events. In doing a root cause 

analysis on either a single case or a series of cases, we believe that 

we have the ability to at least begin to question whether any 

wrongdoing or pattern of wrongdoing has occurred. 
24

It’s a system that is relatively unique to VA and really has been 

viewed as a best practice in an area where VA leads the country. 

Mr. UDALL. And so the kinds of things that you look at are if you 

start having a series of incidents in a particular ward that seem 

unusual, you immediately get into that and investigate it? Is that 

what you’re talking about? 

Dr. MURPHY. The way the patient safety system is set up, even 

if a near miss or an adverse event almost occurs, it can trigger a 

patient safety root cause analysis. And a team would be put together to analyze that single near miss or adverse event, and try 

to determine what the cause was. 

By providing that level of scrutiny and oversight for serious 

events, we have an ability to pick up some of these cases. 

There is no way to be 100 percent sure that you are going to 

identify people who have ill intent or who are not following what 

we consider appropriate standards of care. But within VA, our patient safety system certainly gives us a greater ability to address 

these issues than many medical centers in this country, whether 

the public or the private sector. It is one of the aspects of VA’s 

health care system that has been identified as a model to be adopted by other medical facilities in this country. 

Mr. UDALL. Thank you, Dr. Murphy. Thank you, Mr. Chairman. 

Mr. BOOZMAN. Dr. Murphy, what’s the rationale for only checking one state license for some practitioners, such as nurses who 

currently work in the VA, and not verifying all of the licenses held 

by the practitioner? 

Dr. MURPHY. Having a single state license or certification is a 

condition of employment, and because that was the condition of employment we had in the past only required verification of that single credential. 

We agree that this is a potential problem, and we have already 

made a commitment to set up a system so that we will verify all 

licenses or certificates for the Categories B and C non-independent 

providers in our system, and that we will contact the issuing organization directly in the future. It is a change based on the recommendations from the GAO. 

Mr. BOOZMAN. Good. Again, that does seem like that makes 

sense. Have all the VA facilities, do they have a database of the 

diploma mills? 

Dr. MURPHY. It’s very difficult to keep a diploma mill list up to 

date, and what’s recommended at this time is that we check to 

make sure that the degrees and the educational credentials of our 

applicants and our employees are from awarded by accredited institutions. So we check a list of accredited programs and make sure 

that we only hire individuals who have degrees that are required 

for their position that are from accredited institutions. 

Mr. BOOZMAN. Going back to the other question, it does seem 

like, you know, we do have situations where an individual is in 

good standing with the current state, but because they didn’t do a 

good job of looking back, that, you know, that you might have an 

individual that had problems, you know, in another state, moved, 

you got—you see what I’m saying? I mean, that does seem like that 

that really is very important to get fixed. 
25

Dr. MURPHY. We check with the Federation of State Medical 

Boards for licensed providers and therefore can check all state licenses that way. In the future, we will also do that for individuals 

who are not in the independent provider category—nurses, therapists, et cetera. We will check all licenses and we will check all 

certificates. 

Mr. BOOZMAN. Very good. Okay. 

Mr. BUYER. Mr. Udall? 

Mr. UDALL. Thank you. Dr. Murphy, VA Directive 2002-075 involves security and access requirements for VA’s research laboratories. Could you explain the approval and vetting process for individuals granted access to Level 3 laboratories? 

Dr. MURPHY. I can’t give you a complete explanation of that, but 

we do have individuals from the Research Service here who would 

be happy to explain the process to you. 

Mr. UDALL. Would you like to start, or would you just want to 

defer to them? 

Dr. MURPHY. We require credentials checks and background 

checks for VA employees who are in those positions. We comply 

with the CDC recommendations in those areas, and we have recently done a verification of compliance in the VA’s the BSL–3. 

This was done to ensure that they were aware of the regulation 

that they had been appropriately trained, that the credentials 

checks were in place, and that the required security procedures 

were being complied with. 

Our VA IG’s office has done an audit of those lab facilities. I understand that that report is still a draft at this point, so I don’t 

have results for you. 

Mr. UDALL. What I’m trying to focus in on is some of the labs 

grant access to research assistants who may be attending an affiliated university, and some of these research assistants may not be 

U.S. citizens. So how does the VA screen non-citizens for access to 

the labs? And if you want to have the individual come up, that 

would be fine. 

Dr. MURPHY. We will provide that information for the record. 

There is a process in place, and that was a specific focus of the IG 

audit. The credentials and the background checks are being done. 

Again, we believe we are in compliance with the CDC recommendations for the BLS labs. 

Mr. UDALL. Do you see this as a possible weak point in terms 

of having somebody that isn’t a citizen that may be at a university 

that has access to the lab, or is that taken into consideration in 

your recent regulation or directive? 

Dr. MURPHY. I believe the directive addresses the issue of background checks and credentials checks for not only VA full time and 

part time staff, but for WOC employees. Again, that’s not a program that’s in my area of either expertise or in my current portfolio, so I’d like to provide more detailed information to you for the 

record. I don’t want to give you an inaccurate answer, sir. 

Mr. UDALL. Thank you very much, Dr. Murphy. Ms. Bascetta, do 

you have any comment on access to these labs? 

Ms. BASCETTA. Only that as I mentioned earlier, I am aware that 

the IG in VA as well as their counterparts in other federal agencies 
26

are reviewing both the requirements as well as compliance with 

those requirements. 

Mr. UDALL. Thank you. Ms. Bascetta, you outlined a couple of 

the reasons or a couple of the areas that you thought should be 

looked into—the fingerprinting, the database is only as good as the 

info in it. 

And I think you said, your third one is with you have to get the 

right information to the people that are making the judgments and 

making the decisions. Could you explain that a little more of exactly what you mean there and what’s the possible problem with 

the system? 

Ms. BASCETTA. I was simply making the point that it’s conceivable that a hiring official even when faced with information about 

a problem in a person’s work history, you know, could for whatever 

reason decide to hire the person anyway. So that even having the 

requirement doesn’t preclude that somebody uses poor judgment. 

Mr. UDALL. And so what you’re talking about there may be a situation where they so desperately need an employee, a doctor or a 

nurse or someone along that line, they feel an urgency to get the 

hire done, and they may have an indication that there’s something 

wrong, but they don’t further check it out, they just hire the individual. 

So the message you’re really sending is, if there’s anything out 

there that looks like that it’s a problem, it should be thoroughly investigated and put to rest before you put the employee on, the 

health care professional on, and have them have contacts with patients and veterans in that kind of situation? 

Ms. BASCETTA. That’s correct. 

Mr. UDALL. Thank you. Thank you, Mr. Chairman. 

Mr. BUYER. Thank you, Mr. Udall. Dr. Murphy, on page 9 of the 

GAO’s testimony, it states that VA facility officials are not required 

to check state licenses disclosed by a practitioner such as respiratory therapists, and are only required to physically inspect the 

national certificate. 

Is that a written policy? 

Dr. MURPHY. I believe the personnel policies at this time require 

that we check the licenses as a condition of employment, and it’s 

a single license or certificate for reappointments they’re currently 

looking at. But as I said in my testimony, we will begin to check 

all state licenses, certifications and to do verification with the 

issuing organization. 

Mr. BUYER. So with what you have just outlined, is proper authentication possible? 

Dr. MURPHY. Please clarify; I don’t want to give you an incorrect 

answer. Are you talking about the current policy? 

Mr. BUYER. I’ll let you answer the question. 

Dr. MURPHY. All right. We believe that our current policy allows 

us to verify that an individual has the appropriate credentials and 

state licensure or certificate to practice under that state license or 

certificate. 

However, we do agree with GAO that, in some circumstances, it 

might not allow us to have a complete verification. There may be 

a state licensure in another state that has been restricted, and we 

agree that we want to know that information so that we can appro-
27

priately make judgments about the quality of that provider and 

whether they should be hired or continue to practice in the VA. 

Mr. BUYER. The approximate effective date of the policies for 

which you’ve just expressed—when? 

Dr. MURPHY. We’ve already established a task force. They are to 

give us their recommendations no later than October 2004. We 

hope that they will be able to quickly give us recommendations 

that we can implement in 2005 or as early as possible. 

Mr. BUYER. So your testimony is prospective? 

Dr. MURPHY. Pardon me? 

Mr. BUYER. Your testimony is prospective. It’s over the horizon 

as opposed to what it is today? 

Dr. MURPHY. Absolutely. The solutions are prospective solutions 

that will improve the VA health care system in the future. 

Mr. BUYER. Under the current policy, if a health care practitioner 

has a license in any state, that individual may work in any VA facility in the Nation. Is that a good policy or not? 

Dr. MURPHY. I think it is a good policy. We require that physicians and other providers have a valid state license and they practice under the scope of practice of that license. 

Our physicians often move from facility to facility, and we believe 

that such a state license allows them to have the credentials to provide the level of quality care that our veterans deserve. 

Mr. BUYER. What’s the rationale for asking medical practitioners 

who are not required to have a license to work in the VA to disclose 

all state licenses held but then not verifying that all are in good 

standing? 

Dr. MURPHY. We’ve already responded, Mr. Chairman, that we 

believe that that is a gap in our current practices, and we intend 

to correct that by verifying all state licenses, certificates, and national certificates. 

Mr. BUYER. How do the facilities know which databases to query? 

How do they know which ones to go to? I’m going to go to the directors here in just a second, but I just wanted to ask you. 

Dr. MURPHY. For independent providers, the process is actually 

standardized through the VetPro and credentialing process. There 

are VA policies that prescribe the process for the other provider 

categories. As has been previously mentioned, those are not as 

standardized, and we don’t have computerized tools to ensure that 

that process is uniformly and consistently implemented across the 

country at this point. And that is one of the issues that the task 

force has been asked to address and to provide us recommendations 

on how we can improve the tools that we give our give our facilities 

so that they can actually accomplish the work that’s prescribed in 

VA policy. 

Mr. BUYER. Why—and I’m going to open this up to all three of 

you—why was the Federal Credentialing Program dismantled? 

Dr. MURPHY. I think probably HHS is best able to answer that. 

Ms. GRUBBS. One of the reasons was, or the most prevalent reason is because the participants that we did have were consumed by 

the Homeland Security, Department of Homeland Security. And 

once they went over to that new department, those groups were basically dismantled and put into new groups. And because they had 
28

a different focus and a different priority at that time, we couldn’t 

keep the Federal Credentialing Program alive economically. 

Dr. MURPHY. Could I add to that? 

Mr. BUYER. Sure. 

Dr. MURPHY. From a VA perspective, the important components 

to our system have not been dismantled. We have adopted the 

VetPro software. We continue to use that in exactly the same way 

that we did under the Federal Credentialing Program. 

That benefit, however, is not being applied to the other partners 

who were previously using the credentialing program. And so if 

you’re concerned that the dismantling of the Federal Credentialing 

Program has had a negative impact on VA, it has not. We have 

continued just as strong a commitment and have continued to use 

the software in exactly the same way. 

Mr. BUYER. All right. I’d like to receive testimony from the directors of the four hospitals. Have you had an opportunity to review 

the GAO report, all four of you? All four nod their head in the affirmative. 

With regard to the GAO’s criticisms, constructive, and with regard to how they’ve charted to indicate compliance and noncompliance, I would like to give each of you the opportunity to discuss the 

findings of the GAO report and what actions, if any, have you 

taken subsequent at their visit. This is your opportunity to, I view, 

rehabilitate yourself. So we’ll start with Seattle first. 

We’ll slide the chair up one at a time. 

Mr. WILLIAMS. Excuse me. Tim Williams from Seattle. The criticisms from the GAO, one of the areas that they identified that we 

were lacking in was looking at applicants for—doing a thorough review of applicants. What we think is that if you look at the definition of that, I think it’s a definitional issue. But as we have serious 

applicants for positions, we are doing complete background checks 

on that. 

If we were to go to doing security checks on and full background 

checks on all applicants, we hire one out of every 30 applicants. For 

instance, police officers. We may get 100 applicants for a single job. 

So I think that by doing the full background check on those people 

prior to—those that are serious applicants—prior to the hiring, 

we’re actually in compliance with the intent of the screening all applicants. So I think that we’re there for that. 

The other area on the table that we didn’t come up to the 90 percent on had to do with looking at the license problems. And my 

human resources, along with my people in the medical service office have created that hole as a result of that and are filing those 

more rapidly. So. 

Mr. BUYER. You should, in the area of transparency, sir, you 

should know that GAO felt that you were very responsive at the 

Seattle facility. So I want to thank you for that. 

Mr. WILLIAMS. Thank you. 

Mr. BUYER. Next? DC? 

Mr. WILLIAMS. Dr. Murphy has asked that I just say a few words 

about our fingerprinting program that we have. 

Mr. BUYER. All right. 

Mr. WILLIAMS. Because we are fingerprinting everyone —all of 

the residents, all of the medical students, all of the volunteers, ev-
29

erybody that comes into our facility that isn’t a patient, to do the $21 background check that gives us a criminal background check 

on all of those people. 

Because the digital equipment is portable, we’re able to take it 

over to the university, and that’s what we do is take it over to the 

university. And a question came earlier about the number of residents that we do have rotating through the facility, and on an annual basis, I have 500 medical residents that rotate through the facility, and we go over to the university and get them prior to their 

rotations through our facility and do the background checks in advance of their coming to our facility. 

Mr. BUYER. How long have you been doing that? 

Mr. WILLIAMS. I beg your pardon? 

Mr. BUYER. How long have you been doing this? 

Mr. WILLIAMS. We’ve been doing that for about a year. It has 

now been adopted for our VISN, our complete Veterans Integrated 

Service Network, has embraced this, and we have bought the 

equipment. And by October, all of the facilities in the VISN will be 

fully utilizing this program. 

Mr. BUYER. All right. Thank you. 

Mr. WILLIAMS. You’re welcome. 

Mr. BUYER. DC, please reidentify yourself and your facility. 

Mr. GARFUNKEL. Sorry, sir? Reidentify myself? I’m Sandy 

Garfunkel, Director of the VA hospital here in DC. I think—I guess 

in answer to your first question, I think the recommendations in 

the report are good recommendations that will help us. 

I’ve already, I think—I hope—mentioned that we had fallen behind in our background investigations. I want to tell you as of now, 

we have fingerprinted all of our employees and begun background 

investigations. So we’re in complete compliance there. 

We have not yet started to do our medical residents, and we’ve 

discussed how we will go about that. We have three medical 

schools. We’re the only VA affiliated with three medical schools, so 

it’s a complex issue for us, but we’re going to find a way to do that. 

We do have the electronic equipment, and we’ll probably need more 

of it to begin to do that. 

The list of exclusionary individuals, I sent an individual yesterday into HR to take a look at the last 30 hires we had, and we 

were in 100 percent compliance at this point with the list of excluded individuals. So corrective action has been taken on both of 

the deficiencies that were found. 

Mr. BUYER. Did you find any employees working at the VA who 

should not be there employed because of your background checks? 

Mr. GARFUNKEL. We did. I did in fact terminate an employee recently because of a problem that was found on the background 

check, but surprisingly few——

Mr. BUYER. What was it? 

Mr. GARFUNKEL. I honestly can’t recall exactly what it was, sir. 

I can get you that information if you’d like. But surprisingly few. 

Mr. BUYER. Go ahead and remain in your seat. With regard to 

Seattle, when you went back—you were in compliance weren’t you? 

Now when you went back and looked in Seattle, did you find 

anyone that was noncompliant or should not be employed in the 

VA? 
30

Mr. WILLIAMS. No, we did not. We found some volunteers, but we 

did not find employees. 

Mr. BUYER. Some volunteers? 

Mr. WILLIAMS. Yes. 

Mr. COX. I’m William Cox, Acting Director of Big Spring VA 

Medical Center. 

Mr. BUYER. Wait. Time out. Volunteers. What were these individuals doing at the VA who are volunteers of whom you found should 

not have been there with regard to your background check? 

Mr. WILLIAMS. These are volunteers who escort patients from one 

clinic to another or, you know, move—read to patients, provide coffee, that sort of thing. 

Mr. BUYER. All right. 

Mr. WILLIAMS. They’re not providing medical care. 

Mr. BUYER. Right. 

Mr. WILLIAMS. Nobody who was providing medical care. 

Mr. BUYER. But these individuals, I mean, you’re not going to 

shock me here all of a sudden? These were individuals who were 

abusive to people or had been arrested for battery and are now caring for our veterans? 

Mr. WILLIAMS. No. No, they’re not. 

Mr. BUYER. All right. Thank you. I don’t need to get into the details of it. I just don’t want to be shocked. Thank you, sir. 

Mr. COX. William Cox, Acting Director of the Big Spring VA 

Medical Center. With regards to the audit and study itself, I think 

it was positive in the fact that it has identified some gaps and opportunities for us to improve our processes. 

At Big Spring, I know we’ve taken the information and have 

looked at opportunities on how we can improve from this. One area 

is in the area is staying current with the background checks and 

looking at fingerprinting of volunteers that have access to patient 

care information. 

So we’re looking at the study as an opportunity to improve our 

processes. 

Mr. BUYER. Now you’ve not been in this position all that long, 

correct? 

Mr. COX. That’s correct. I’ve been there 31⁄2 months. 

Mr. BUYER. I will exercise self-restraint because of the—well, I’m 

going to exercise self-restraint. You’re a new medical director. My 

criticisms would be lobbed at those of whom came before you, and 

some of these individuals of whom are still there, which means you 

have to exercise some pretty stern leadership, and for that, we give 

you the opportunity. 

Mr. COX. Thank you. 

Mr. BUYER. All right. Next? 

Dr. ROSENFELD. Mr. Chairman, I’m Dr. Paul Rosenfeld. I’m the 

Chief of Staff at the VA Medical Center in New Orleans. I’m here 

for my Medical Center director, who is ill. 

At the New Orleans Medical Center, we actively use the list of 

exclusionary individuals for all our licensed independent practitioners, and that was pointed out to us as a best practice by the 

GAO. 

We did have problems in the audit with background checks being 

completed on time. I can now report to you that all those back-
31

ground checks have been done and have been completed and are 

up to date at this time. 

Mr. BUYER. Did you find anything shocking? 

Dr. ROSENFELD. No we did not, sir. We found a few things, but 

nothing that would be—nothing in any practitioners. 

Mr. BUYER. Good. Not to be redundant, it’s very unusual that 

this subcommittee bring the medical directors, or you in particular, 

sir, the chief of staff here to Washington, DC to testify. 

Too often in this subcommittee what we find is, is we bring in 

the hierarchy of the VA and we question them and they answer. 

They’re very responsive. We turn to the GAO, they jump into the 

high weeds, come back and give us the reports. But here in particular, while the criticisms are easy to say that there’s been lack 

of oversight at the headquarters of the VA, it all goes back—it goes 

down to somebody, and it is the medical directors. 

We’re not picking on you here today. We’ve invited you here because the GAO found some of these noncompliant issues for we 

take very seriously, and I know you do, too, and there’s a lot of 

things that you’re working on, and you’ve got a pretty broad—the 

waterfront is very broad. 

But I want you to know, these are very important to us. And the 

fact that we’ve brought you here, we also recognize will send a tremendous signal across the spectrum of the VA facilities. 

So I don’t want it to be that you were brought here for us to beat 

up on you. You were brought here for an opportunity to respond 

to the GAO’s findings, to tell us what you’re doing to bring yourself 

into compliance, at the same time sending the signal across the VA 

system. 

We won’t hesitate to bring in the medical directors, even to go 

to that particular level, not that we micromanage, but this subcommittee, being the oversight subcommittee, I think we’re tasked 

to do that, okay? And that’s the reason we brought you in here. 

So, Dr. Murphy, I don’t mean to go around you here today. I 

have tremendous respect for you over the years. But that’s the reason you’re here. 

Did any of the four of you—I know you talked about your compliance—any of the four of you have disagreements with regard to the 

analysis or findings from the GAO? None of you? All right. Very 

good. 

Mr. Udall, did you have any follow-up? Let me yield to Mr. Udall 

for any follow-up he may have. 

Mr. UDALL. On the GAO report, I’m first going to go to Ms. 

Bascetta and then to the directors here. If you look at your graph 

on I guess this is page 1 of your report where you have the chart 

and the black dots and the clear dots, it’s very, very clear that 

three out of four of these facilities verified credentials for practitioners they intended to hire, and three out of four of them did not, 

did not verify for people they intended to hire, and yet when you 

get to credentials verified for practitioners currently employed at 

the VA, you have 100 percent. 

And I’m wondering, what’s the difference there? Why are they 

able to verify 100 percent and do well for the people they have, and 

yet they fall down on the people they’re going to hire, that are 

going to be brought into the system? 
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Ms. BASCETTA. First let me just clarify that the black dots don’t 

mean 100 percent. They mean 90 percent or better. 

Mr. UDALL. Thank you. Thank you for that correction. Ninety 

percent or greater. 

Ms. BASCETTA. But part of the reason is that remember that our 

finding about this requirement is that it’s less stringent. They are 

not going back to the state licensing boards or the national certifying organizations. They are doing a visual inspection of the credential. So it’s an easier requirement to meet. 

Mr. UDALL. And then that’s the sole explanation of why these facilities all except for one don’t get a very good ranking here? 

Ms. BASCETTA. Well, that would be my explanation. I would be 

interested to hear what their views are about the difference between those two processes. 

Mr. UDALL. Could you tell us—the only facility that was able to 

verify for practitioners it intends to hire was the DC facility. Texas, 

New Orleans, Seattle, you’re listed as less than 90 percent. And I’d 

first ask Ms. Bascetta, you have—it’s less than 90 percent. Are 

there some of them that are down at 50 percent or 30 percent? I 

mean, is there a difference here? Are we talking about just below 

90? Is there a difference in these three facilities? 

Ms. BASCETTA. No, there was a pretty broad range, and many 

were well below the 90. In fact because of the way we did the statistical test, those who were close to 90 were bumped up into the 

compliant range. 

Mr. UDALL. Okay. Could Texas and New Orleans and Seattle tell 

me what the problem is there? 

Dr. ROSENFELD. Sir, I think again, the distinction between a 

licensed——

Mr. UDALL. Sir, you’re going to have to reidentify yourself so we 

can get the record clear. 

Dr. ROSENFELD. I’m sorry. Paul Rosenfeld, Chief of Staff in New 

Orleans. There is difference between licensed independent practitioners and other practitioners, the distinction between the various 

groups in the chart. 

For the Group A practitioners, the licensed independent practitioners, we do primary source verification on all people that we intend to bring on. 

For other practitioners, for the Group C practitioners, following 

the VA regulations, we only view the license. We agree that that’s 

a problem, and as Dr. Murphy has testified, in the future the plan 

is that we will do primary source on everyone. 

Mr. UDALL. And how soon are you going to do that in your 

facility? 

Dr. ROSENFELD. As soon as we can make it happen. So I can’t 

give you a time, but as soon as we can make it happen. 

Mr. UDALL. Okay. Thank you. 

Mr. WILLIAMS. Tim Williams, VA Puget Sound Health Care System. And I think that we’ve got two things. One is definitional. And 

we believe that for those that become selectees that we are doing 

greater than 90 percent. In fact, my human resources people tell 

me 100 percent of background checks on those people who get to 

the point where we are going to hire them. 
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But earlier in the process, we do not do a complete background 

check. 

Mr. UDALL. So you wouldn’t agree with how the GAO has listed 

you here? 

Mr. WILLIAMS. As I say, I think it’s a definition. The way they 

did it, it’s correct. We think that before they get to actually see patients, we have gotten 100 percent verification on that. 

Mr. UDALL. Ms. Bascetta, do you have any comment on that? 

Ms. BASCETTA. Well, we know that the requirement is not to do 

the background investigation until the employee is hired. I think 

that the open dot here for Seattle is actually in verifying the credential, not doing the background investigation. 

Mr. WILLIAMS. We do—well, we do check all of the—we use 

VetPro to verify credentials. We go back to the source, the universities. I’m not sure why it fell below 90 percent, but we believe 

we’ve got the processes in place and have as a result of the visit 

from the GAO, tightened the procedures that we have in place. 

I have three people in a credentialing office that this is their full 

time position. We actually have a police officer now, because that 

individual is able to look at issues a little differently and has 

stopped the hiring of some folks just because of the additional 

skills. 

So I think that we’ve got the personnel in place and the processes in place such that this will not happen. 

Mr. UDALL. Thank you. As of today? 

Mr. WILLIAMS. That’s correct. 

Mr. UDALL. Yes. Okay. And just to finish the last one. 

Mr. COX. William Cox, Acting Director of Big Spring VA Medical 

Center. It looked like we were about 75 percent compliant, which 

is not good enough, and we should be making improvements. 

I would like to take this data back and review the areas where 

we fell short. Like Mr. Williams, we have full time staff that are 

dedicated to this area, and obviously, we need to do a better job. 

So I will take the information, go back and verify where we fell 

short. 

Mr. UDALL. Thank you. Thank you, Mr. Chairman. 

Mr. BUYER. Thank you, Mr. Udall, for your contributions. Ms. 

Grubbs, thank you for coming, and your staff and helping you also 

prepare for today’s testimony. 

Dr. Murphy, as always, appreciate it, along with the medical directors for coming. I extend my appreciate to your staff, Ms. 

Bascetta, as always. Please extend also to your staff good job. Another well written report and a tremendous contribution. 

I note, Dr. Murphy, that you’ve extended some promises here in 

the April and May timeframe. What I will do, though, is I’d like 

to ask GAO to continue to monitor all of the remedies and these 

hard milestones to make sure that the VA fixes this problem. 

And obviously the bottom line here is no one, none of us I know 

in this endeavor want to re-live the hideous example with regard 

to Dr. Swango. And that is awful, that is cruel. And somewhere the 

system failed us, and we never want that to happen again. 

So thank you very much. This hearing is now concluded. 

[Whereupon, at 12:06 p.m., the subcommittee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF CHAIRMAN BUYER

Good Morning. The purpose of today’s hearing is to review the Department of Veterans Affairs’ current employment practices with regard to its procedures for personal background checks and credentialing of its health care practitioners. 

In the past the Oversight Subcommittee has touched upon this subject in several 

hearings, however because there have been repeated serious lapses in the system 

over the years, we believe this issue warrants further scrutiny. In fact, there are 

several high profile cases which illustrate why it’s so important to insure that VA 

has an effective policy in place. One of the most compelling examples involves a Dr. 

Michael Joseph Swango. In 1993, even though he had a criminal record, Dr. Swango 

was able to secure a medical residency at the VA facility in Northport, New York. 

Dr. Swango is currently in prison serving three consecutive life sentences for murdering three veterans at the Northport facility. The question is: At the present time, 

could someone like Dr. Swango avoid detection and be successful in gaining employment with the VA? 

I believe we all recognize that such lapses do not happen solely in the VA, but 

in my role of providing oversight over the Department of Veterans Affairs, issues 

affecting the safety of veterans are my major focus. 

Let’s look at what the VA’s Office of Inspector General was able to detect through 

its fugitive felon program that was initiated in 2001. Using the VA benefit system 

files, the IG was able to identify 9,700 matches for referrals to law enforcement 

agencies. In addition, over 6,500 fugitive felons identified in these matches have 

been referred to the Department for benefit suspension. Due to these identifications, 

35 VA employees were arrested. Twenty nine other employees were identified as fugitive felons, but were not arrested because they were non-extraditable. They have 

been referred to the Veterans Health Administration for possible administrative 

action. 

If any of us here today find ourselves in the position of having to seek medical 

care, we deserve to be treated by health care practitioners who have completed the 

necessary educational requirements, have passed the boards and are licensed to 

practice. Veterans deserve to have this same level of confidence when they enter a 

VA medical facility. 

Today’s hearing will show that the VA has been working diligently to improve its 

credentialing and background checks of applicants seeking employment with the 

VA. 

However, there are several issues that need some clarification. One such issue involves VA’s credentialing program called VetPro. For instance, I wonder if VetPro 

is working as envisioned. I also wonder why the Federal Credentialing Program initiated by VA and HHS, under whose auspices VetPro was developed and maintained, was dismantled last fall. While representatives of the VA have stated publicly that VetPro is an excellent tool for verifying credentials, I also wonder why the 

GAO was silent on VetPro in its report. I find it perplexing that such an omission 

would be made since this is one of chief mechanism used by VA to verify credentials 

of physicians and dentists. Hopefully, both VA and HHS will shed some light on 

this. 

The VA has several key screening requirements in place for verification of credentials and to investigate personal backgrounds of health care practitioners. These 

checks include querying the Federation of State Medical Boards (FSMB), the National Practitioner Data Bank (NPDB), the List of Excluded Individuals and Entities 

(LEIE), and, on a limited basis require finger printing and a background check, 

which is performed by the Office Personnel Management. 

Today’s witnesses include the Department of Veterans, the Department of Health 

and Human Services and the General Accounting Office. When I spoke with the 
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American Medical Association yesterday about its decision not to testify, I was assured that the AMA will send a representative to hear our concerns. I have also 

asked them to provide a written statement and respond to post hearing questions, 

which will be made part of the official record. It would have benefited this Subcommittee to hear AMA’s position on physician credentialing and its interaction 

with the federal and private health care sectors during the hearing.
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PREPARED STATEMENT OF CONGRESSMAN EVANS

Thank you, Mr. Chairman. Cases in the VA and in the private sector highlight 

what can go wrong when an individual’s health care credentials are not checked 

carefully, and background checks are not performed with rigor. 

Thorough background checks may have prohibited the harmful and criminal acts 

of Dr. Swango that are mentioned in the GAO testimony. Identifying ‘‘bad apples’’

and screening them out will help build a more responsible VA health care system. 

It will help keep veterans secure from harmful or careless actions. 

Additionally, we must strengthen vigilance by those within the VA health care 

system with access to veteran patients. It is possible for those who enter the system 

with good credentials and clean backgrounds to just go bad. They try to inflict harm 

on those in their charge. The system must be responsive to detect such occurrences. 

For example, effective screening may not have detected the problems Kristen Gilbert, RN was to cause in the Northhampton, Massachusetts, VA acute care medical 

unit. Ultimately, she was convicted of three counts of first degree murder, one count 

of second degree murder and a host of other charges. She was sentenced to four consecutive life sentences without the possibility of parole. 

The point is that screening and credentialing are important, but solutions to the 

problem do not stop at that point. Thank you, Mr. Chairman, I look forward to hearing from the witnesses this morning.
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WRITTEN COMMITTEE QUESTIONS AND THEIR RESPONSES 

CONGRESSMAN BOOZMAN TO DEPARTMENT OF VETERANS AFFAIRS
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