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Doing a good job of conducting thorough reference checks and background investigations of job applicants has become increasingly important in healthcare in preventing personnel-related crime and the legal consequences of negligence in hiring people who commit such crimes. However, there are many obstacles to obtaining information on applicants. In this report, we'll explore in depth the current state of background checking as described by an official of a company which provides background checking services, as well as the latest in legal practices from a leading attorney in the field.

Fraud examiners and investigators say that employee theft is out of control, citing recent U.S. Chamber of Commerce figures that employees steal approximately $400 billion from businesses each year and an Ernst & Young survey showing that nearly 90% of organizations countrywide experienced some type of fraud in the 12 months prior to the survey. An additional undetermined amount is being reported lost because of external fraud committed by customers, vendors, and others having contact with a company or institution. Fraud experts interviewed for this report note that all sectors are targets--including retailers, hospitals and healthcare, the hotel industry, schools, and college campuses. In this report, we'll present the how's and whys of this development and also describe what one medical center is doing to stop thefts of medical equipment and computers.

Growing legal and regulatory pressures are being applied to healthcare institutions to do a better job of screening job applicants--whether they are physicians, nurses, housekeepers, or security officers. In the past, the hiring of employees who turn out to have criminal pasts has sometimes proven both costly and embarrassing to hospitals, as this report reveals. However, while there are now many resources available to uncover an applicant's criminal record, there are pitfalls to be aware of when conducting or hiring an outside firm to conduct background checks.

Seattle, WA, hospitals are among the many seeking to attract foreign patients. Seattle is conveniently located, relatively speaking to dozens of Pacific Rim countries with residents who have economic means to seek out first-class health care when they need it. Patients at Seattle hospitals now include Russians in large numbers, as well as significant numbers from Korea, Hong Kong, Japan, the Philippines, Vietnam. Cambodia, Saudi Arabia, and neighboring North African nations. Treating foreign VIPs, however, can bring new challenges to hospital security departments. Many patients, along with their families and entourages, frequently have cultural expectations that differ from those held by many Americans. In one "worstcase" scenario, a hospital official cites behavior of some people who come from places "where it is all right to goose a woman or to pursue her openly." That kind of situation can escalate quickly, the official says. However, "we've had very good success sitting someone down and explaining in a good way that it is not OK to do that here and you can't do it again. Usually we have really good results, but if you go in like gangbusters, it could be a disaster." In this report, we'll describe some other security problems that can come with foreign patients and give details on how Seattle hospitals are meeting them.

In the December 1994 issue, we warned of the need to conduct adequate background checks of physicians, nurses, administrators, and other types of employees. A number of examples were presented in which hospitals put themselves at risk by hiring: an administrator with a phony doctorate and master's degrees; a nurse who had been found guilty of stealing drugs when she worked at a nursing home; a male nurse who had been arrested for raping patients under anesthesia (he had previously had his teaching license revoked for sexual misconduct with a student); a nursing aide arrested for fondling a 73-year-old woman in her bed who had been convicted of a similar attack at a nearby medical center three years earlier; and a doctor who had served jail time for attempted murder, who was hired by a leading hospital as a psychiatric resident. As was pointed out in the December article, conducting adequate background checks is not always an easy matter, even if your hospital has such a policy. However, a number of firms have emerged to provide improved services in this area. In this report, we will bring you up to date on a firm that specializes in background checks for health care industry job applicants, another firm that maintains a database of work histories of thousands of officers, and a firm that claims its integrity test can spot potential thieves.

Once considered a disease of the past, tuberculosis (TB) is spreading rapidly throughout the United States, with a particular concentration in hospitals located in major urban centers. Of special concern to health care professionals are the growing number of cases of employees and patients who have become infected with hospital-based TB in the last year. Even more alarming is the appearance of a new, deadly, multidrug-resistant (MDR) strain of the disease. In this report, directed at hospital safety and risk managers, we will cover how tuberculosis is spread throughout hospitals; who is susceptible; and what infection control procedures, safety equipment, and inservice education are recommended by experts. We'll also detail the infection control methods in use at the National Jewish Center for Immunology and Respiratory Medicine, Denver, CO--the hospital considered to have the highest standard in the nation of tuberculosis treatment and control.