Criminal checks increasingly a fact of life for physicians

First came the fingerprinting. Then the criminal background check.

Rebecca J. Patchin, MD, submitted to both. Was she seeking high-level national security clearance? A job with the FBI?

No. Dr. Patchin, an AMA trustee, was simply applying to get a medical license in California.

She didn't mind the scrutiny for the sake of medicine.

"I remember that they said you had to do this to get a license. I wanted to get a license, so I jumped through the hoops," said Dr. Patchin, an anesthesiologist and pain management specialist in Riverside, Calif., who received her license in 1991.

Thousands of physicians across the nation have had a similar experience. That's because in the past decade, more states have adopted laws that allow state medical boards to conduct fingerprint and criminal background checks of medical license applicants.

California was among the frontrunners and has been conducting checks since at least the late 1970s. In 1997, Florida began requiring fingerprinting as part of the licensure process. In 1998, the Federation of State Medical Boards recommended that its members require criminal background checks on all applicants for licenses or permits.

Since then, several states have taken action. The FSMB knows of at least 12 states that have the legal authority to conduct national and criminal background checks. At least seven states are authorized to conduct state criminal checks. While some of the states routinely fingerprint and investigate all new applicants, others only conduct reviews when an application raises suspicion.

The trend continues. On Jan. 1, 2005, Iowa will begin requiring criminal checks on new applicants. Meanwhile, South Carolina legislators next year will consider a similar measure. And the Assn. of American Medical Colleges is weighing a proposal to begin background checks nationwide on students accepted to medical schools.

Some high-profile cases, such as the fatal poisoning of patients by medical resident Michael Swango in New York in the 1990s, have provided incentives for states to start fingerprinting and looking at criminal histories. Contributing factors are the patient safety movement and heightened concerns about security since the Sept. 11, 2001, terrorist attacks.

"There appears to be an increasing interest in performing criminal background checks," said James Thompson, MD, president and CEO of the Texas-based FSMB, which represents 70 medical boards in the United States and its territories. "What we've seen is a greater call from the public for accountability of the profession, and medical boards are responding to this to make sure the public is maximally protected."

Safety issue

Many physician leaders don't view the process as an indignity. Rather, they see it as a way to uphold the professionalism of medicine and to provide patient safety.

"It is important to protect our identity [from imposters] and the well-being of our patients," said Paul Handel, MD, member of the Texas Medical Assn.'s board of trustees.

The AMA has no policy on criminal checks for medical licenses, Dr. Patchin said. But several medical societies support the efforts. The Florida Medical Assn. said the practice can be good if applied appropriately. John Shaffer, spokesman for the Medical Society of New Jersey, said, "In the interest of public safety, we believe that most doctors would readily consent to a background check."

Timothy J. Kowalski, DO, chair of the South Carolina Board of Medical Examiners, said a legislative proposal to review criminal pasts of license applicants is likely to pass with no resistance from physicians. The South Carolina Medical Assn. sees the measure as a way to further protect the public.

"We're in favor of it," said association President John Evans, MD, a hand surgeon in Greenville, S.C. "[Criminal checks] are already being done by several hospitals in the state."

Others, however, criticize the practice and question why medical boards need to take physicians' criminal histories.

"It sounds pretty outrageous," said Jane Orient, MD, an internist and executive director of the Assn. of American Physicians and Surgeons, based in Tucson, Ariz.

"I can't see any justification for doing it. It just seems like another affront to the integrity of physicians. They have to prove they haven't committed a crime somewhere."

Keeping out problems

Several boards believe the requirements are helping to keep potential problems out of their states. The North Carolina Medical Board uses fingerprints on license applicants to conduct criminal reviews through the FBI and state bureau of investigation. Board officials say some doctors are scared off when they learn what they will face.

"It prevents people from applying who have some type of criminal conviction," said David Henderson, the board's executive director. "We don't want to be the state where people with a checkered background are coming because we're not doing a criminal background check."

One physician lied on his application and failed to disclose that he had served time for armed robbery. When the board found out about the conviction, members asked him about the crime. "He leapt up and ran out of the room," Henderson said.

But while criminal checks can be a deterrent, boards say they are only one tool used to measure a physician's competence and skill level before issuing a license. They say they don't judge an applicant on criminal history alone.

Serious crimes, not small infractions such as traffic tickets, are offenses that might keep a doctor from getting a license.

"You might be the best physician in the world, but you have a penchant for robbing banks. That is a character issue," Henderson said.

The Medical Board of California has refused licenses after criminal checks turned up problems. It happens probably fewer than a dozen times a year, board officials said. Typically, the rejection comes for failing to disclose a problem or misrepresenting it.

"Often it has been compounded by the fact that they have refused to disclose [criminal histories]. So we have an honesty issue, as well as some problem on their background check," board spokeswoman Candis Cohen said.

Most boards are unsure how many licenses they reject due to criminal pasts. One reason is that criminal histories are just one factor considered.

Licensing delays

Although board members say checks are a good patient safety weapon, they admit the process is time-consuming. Getting histories from state and federal law enforcement agencies can take weeks. That adds up when states process hundreds or thousands of applications.

California, for example, has issued about 5,000 new licenses in each of the last two years. Texas granted about 2,400 licenses last year.

Boards are not sure how much time background reviews add to the process.

The Florida Board of Medicine said expanding the staff since 1998 has helped keep licensing and other paperwork moving along.

Regardless of the time it takes, licensing officials say, the effort is worth it.

"We feel it's working. We generally find something [criminal] will point us in the direction of another problem," said Jaime Garanflo, director of customer affairs for the Texas State Board of Medical Examiners.