This series focuses on the dysfunctional professional licensing system in New York State. The system, administered by a division of the NYS Department of Education called the Office of Professional Discipline (OPD), licenses professionals in some 50 areas. The story we are telling involves any of these professional credentials, though today we focus on nurses.
Establishing identity should be at the heart of any system of verifying credentials. It's a simple thing really, one that the DMV does routinely. A driver candidate proves they are who they say they are even before establishing driving competency. For candidates for licensing in nursing, it should be just as easy, right? Wrong.
Let's start with the simple fact that in 2005 the OPD (the Office of Professional Discipline, the licensing division of the NY State Department of Education) eliminated a requirement for applicant photos. Officially, the photos are not required as the OPD says it can obtain an applicant's photo from DMV; an interesting assertion since investigators at OPD don't have any means of accessing the DMV database and there is no official means of requesting a photo across agencies. The bottom line is that you must have a photo to drive a car in NYS but not to work as a nurse. Is this a problem? Consider the case of Sharon Kimberly Phillip.
In March of 2005, the Department of Investigation in NYC announced with great fanfare the conviction of Sharon Kimberly Phillip. Ms. Phillip had run a home care agency in Brooklyn, dispatching home care attendants to assist elderly patients, under the terms of a $1.7 million contract with NYC HRA. The agency, with Ms. Phillip as its head, had been charged with "theft, or bribery concerned with receiving public funds, embezzling public money, theft or embezzlement in connection with health care, health care fraud and money laundering." During the course of her directorship at the agency, Ms. Phillip had often visited patients for assessments, representing herself as a nurse. After her arrest, a probation officer found that Ms. Phillip did not actually have a license; yet she had worked for ten years as a nurse.
Speaking at a press conference, HRA Commissioner Eggleston stated that "although HRA has suffered from this scheme, fortunately none of the elderly clients were at risk or affected by this wrongdoing." Nevertheless no one at OPD followed up to determine how Phillip obtained her license or if there were any other potential malpractice or criminal issues related to her nursing "career."
Might this have been case of impersonation have been prevented? There is no way to know for sure, yet it is perhaps telling to note that while Sharon Phillip was a large woman of Caribbean descent who lived in Brooklyn; the actual holder of the nursing license credential lived in Buffalo, NY and was white. Had a photo been part of the file, Phillip would have had a harder time obtaining a phony license and any potential employer would have been able to more easily verify her identity.
What is perhaps worse is that there have been a quite a number of documented cases of fraud and criminal impersonation that have come to the attention of OPD investigators. No effort has ever been made to determine how widespread the problem may be, or whether internal corruption may be involved. Worst still, there are systemic vulnerabilities that open the door to more cases of impersonation in the future.
Take for example a requirement that a professional in NYS should be a US Citizen or a Legal Permanent Resident, as 13 licenses do, including the nursing license. There is also the requirement that an applicant provide a Social Security number, another means of uniquely tracking identity. Yet an applicant for a nursing license need not have a Social Security number to apply. If they don't have one, a random number is generated for purposes of the license application. One can only wonder who would be applying for a nurse's license for New York, intending to work in the state and not have a Social Security number.
Parallel licensing streams are an equally large vulnerability in the system. A person who earns a license as a Licensed Practical Nurse, or LPN, is not required to relinquish that license when they earn a higher credential, such as an RN. The theory is that the nurse would no longer be working under the lower level license. Yet there is nothing that would prevent someone with knowledge of the existence of the original LPN license to have it renewed, even sent to a new address. Since the databases are not cross-referenced with each other, an imposter could then work under the lower license.
Perhaps the largest and most frightening system vulnerability, however, is the lack of file security at OPD offices. For years investigators have reported to OPD security managers that investigators were ordered to leave files out in the open or in unlocked file cabinets. Unvetted contract cleaning crews are allowed unsupervised access to secure areas, working after OPD staff has left for the day. This despite a history of reported thefts in the offices. Investigative files may contain confidential information, as well as all the particulars related to identity. Access to these files could lead to identity theft, impersonation or other criminal conduct.
Identity theft is a huge social problem but the idea that a professional identity could be compromised is perhaps even worse. Many professionals, especially nurses and other health care workers, provide care to vulnerable populations in unguarded moments. The health, well-being and even financial welfare of these populations can be at risk. If the integrity of the system is not safeguarded at the outset, how can we ever feel safe?
Next: Criminal Misconduct