Purpose

To determine if the State Education Department (the Department): independently verifies information submitted by nursing license applicants; monitors nurses once they are licensed utilizing available criminal and misconduct data; and investigates complaints against nurses in accordance with its policies and procedures in a timely manner. The audit covered the period April 1, 2014 to April 18, 2017.

Background

The Department oversees the licensure and practice of the professions, as outlined in Title VIII of the New York State Education Law (Education Law). Its regulatory responsibilities encompass 54 professions, including nursing. From April 1, 2014 to October 31, 2016, there were about 450,000 active professional nursing licenses – in the titles of licensed practical nurse, registered professional nurse, clinical nurse specialist, and nurse practitioner – in New York State.

To qualify for a nursing license, applicants must meet certain standards, including education, examination, and moral character requirements (such as no involvement in certain crimes or offenses), as established under the Education Law. The Department is responsible for ensuring that applicants seeking a license meet these State standards. The Department also is responsible for investigating complaints and prosecuting professional misconduct (e.g., gross negligence, physical or sexual abuse, practicing under the influence of drugs or alcohol, conviction of a crime). The Department has established a risk-based system for prioritizing investigations as well as time frame goals and benchmarks to ensure they are completed timely. For example:

• Priority 1 investigations (involving complaints that pose a substantial danger to public health and safety) should be completed within six weeks.
• All investigations, regardless of priority, should be completed within 180 days.
• Any investigations that remain open after 360 days are upgraded to a Priority 1 status.

Annually, the Department receives about 6,000 complaints against licensed professionals, including nurses. The final disposition of all disciplinary matters can include the revoking, annulment, or suspension of licenses.

Key Findings

We identified several issues that, left unaddressed, can increase the risk that nurses who are threats to the public’s health and safety are able to continue practicing in New York.

• Despite clear policies and procedures for investigating complaints, the Department is challenged to ensure investigations, particularly Priority 1 complaints, are completed timely. Timely completion of investigations helps ensure the public’s safety. As well, it affords timely due process to those nurses subsequently exonerated. Of 8,202 investigations (including 215 Priority 1 and 7,987 Priority 2–4) that were open at some point from April 1, 2014 to February 28, 2017:
  • 179 (83 percent) Priority 1 investigations were not completed within the Department’s established six-week time frame; on average, they were open over seven months.
  • 482 lower-priority (Priority 2–4) investigations that exceeded the 360-day benchmark were not reclassified as Priority 1.
  • 327 investigations, including 43 designated as Priority 1, were open more than 402 days.
• Citing confidentiality provisions in Section 6510(8) of the Education Law, the Department denied us access to its investigation files. Lacking this information, we were unable to draw conclusions about factors contributing to the noncompliance, nor were we able to assess the Department’s compliance with any of its other investigation procedures and benchmarks. (The Education Law effectively prevents independent audit oversight of the complaint investigation process.)
• The Department independently verifies education requirements, exam results, and out-of-state licenses, but does not take similar proactive steps to check applicants’ background in relation to the moral character requirement. Instead, the Department relies solely on applicants to fully and truthfully disclose past misconduct and criminal convictions. While New York does not require fingerprinting or background checks as a condition for obtaining a nursing license, the Department does not take advantage of other available resources that could help minimize the risk that applicants do not submit full disclosures.
• Once nurses are licensed, the Department does not actively monitor them to identify incidents of professional misconduct or criminal convictions. Furthermore, nurses are only required to disclose this information every three years upon reregistration. As such, the Department cannot be assured that episodes of misconduct are identified properly and in a timely manner, and that nurses who pose a threat to the public’s health and safety are prevented from practicing in New York State.
• Department officials stated resources have not kept pace with increased expectations. Officials stated their computer system is out of date and staffing has been reduced, which has led to investigation backlogs and difficulties using available data to monitor and manage investigations. 

Key Recommendations

• Ensure management more closely tracks investigations, particularly those classified as Priority 1, to help ensure they meet established time frames for completion.
• Reevaluate existing resources and procedures to identify opportunities for streamlining investigations.
• Take steps to strengthen oversight of nurse licensing. This should include:
  • Taking steps to strengthen controls over moral character requirements.
  • Researching other states’ nurse licensing and monitoring procedures to determine best practices for enhanced oversight.

Other Related Audit/Report of Interest

Department of Health: Office of Professional Medical Conduct Complaints and Investigations Process (2005-S-21)