Anyone in the management field knows the basic processes of performing background checks on prospective employees.  Depending on who you speak with, it is either an easy process or complicated.  Easy in the sense that they contract out the service and depend on a vendor to do a criminal history check, while the employer will likely do the reference checks and employment history verification.  Complicated in the sense that trying to get a complete criminal and work history on a person is often up against a corporate concern to release information due to possible civil litigation.  So let’s look at the processes, doing the background checks internally and hiring out that part of the pre-employment hiring process.

Pre-Employment Background Checks

Depending on the size of the organization, the hiring process may be wholly or partially conducted in-house.  Healthcare organizations have their Human Resource department in most cases initiate the background checks, but you will still find them out-sourcing major parts of the background checks.  Why?  Because hospitals normally do not subscribe to online databases that scour the criminal justice system records for criminal history checks, thus they contract that part out to another company.  In the past when I asked Human Resource staff how thorough their criminal history checks are; they commented that they are complete.  However, there are still cases where not all court records have been placed online.

Criminal History Background Checks

In those cases you will find that companies that perform criminal history verification checks will state that they have investigators in all states that will perform an in-person check of county court records as needed.  What they mean in many cases is that they have private investigators that have agreed to perform courthouse checks on demand.  Now even though background companies may claim they will search all records, there are still reported cases where some criminal records were not discovered.  The breakdown in the system is largely due to the vast number of places that criminal records may be stored, and the fact like anything else online data entry errors do happen.  Actual court records may be complete, but it is the process of putting them online or errors are made when someone does an online check.

The errors that can happen while doing online checks can include such things as inserting the wrong name, D.O.B. or social security number, thus garbage in garbage out.  Data entry errors could be as simple as typing in the same information in correctly, or missing it altogether.  Look at it this way, law enforcement agencies do some of the most detailed backgrounds checks on prospective police officers, and they even send investigators across the country to conduct in person reference checks and they at times still miss crucial information.  Criminal history checks for them are easy because they have NCIC and other law enforcement records that they can view.  However, when it comes to hospitals their choices are limited.

Pre-Employment Reference Checks

One of their means of gathering information is by doing personal reference checks.  But think about that for a moment, is that reliable?  Would a candidate for a job ever write down a reference that would give them a bad review?  Of course not, we all know that those names that are provided with applications are people that the person knows will say good things, even if the person has a history.  So how could a Human Resource person get past that issue?  One simple way is to call and interview that reference and when they are done ask them for the names and phone numbers of 2-3 additional people that know the candidate.  Law enforcement uses this tactic in many cases, as it is very helpful in getting past the pre-determined references.

Background Check Missed Opportunity

Another way is to ask applicants to provide both employment and residential information of the last 10 years.  Why you may ask?  Simple, most applications ask for the last 4-5 positions that you held, and in some cases that means the last 1-2 years for some people.  If that is the case, you have to ask for additional information, and I have found that sometimes HR forgets to do that.  Also, with our population moving around as much as it does, most applicants will not always disclose all the locations that they have lived in the last 10+ years.  Because of that you may never know that an applicant worked in another state and left that employment with a demand to quit or be fired.

Case is point; I worked a case at a hospital in the Midwest where an employee, a home health aide, was accused of inappropriate contact with an adolescent patient during home visits.  When interviewed the employee admitted that it “may” have happened but not intentional.  Further in her comments it was learned that she left her employer in another state after being accused of the same thing.  When the Human Resource person present was asked if this came up in the background, I was advised no.  There was no criminal record and the references all checked out.  So how did this happen?

Well like a lot of other people, this employee left her job off of her application, and the fact that she even worked and lived in that other state.  Since there were never any criminal charges brought against her in that case there was no criminal record.  And since the employment was not listed, or even a reference to living in that state, HR stated that they had no reason to pursue it any further.  The real question is how many times has this happened?  How many other victims are out there?

A more widely know case is that of the “Angel of Death,” Mr. Charles Cullen.  Cullen, a critical care nurse, murdered 40 people over a 16 year period and in seven different hospitals.  According to news reports there were plenty of suspicions around Mr. Cullen, but for many years he was never charged. So if there were suspicions surrounding him, how was he able to get jobs at seven different hospitals?

Another case is that of David Kwiatkowski, a technician at a hospital who was accused of diverting medications for personal use and then using the same needle to inject saline into his patients, resulting in those patients not only not receiving their meds, but also contracting hepatitis C as a result.  The similar factors in this case, to the one stated above, was the fact that there were also suspicions of Mr. Kwiatkowski at ten hospitals in several different states.  Mr. Kwiatkowski was a traveler and had access to many patients over his career.

Did you know that in some states the fact that a person diverted medications for personal use cannot be disclosed, and that a licensing authority cannot revoke a license if the person goes into a diversion program for rehabilitation?  And like many other cases of workplace issues, that even though there are warning signs of potential risks, and possibly criminal acts, that employees will often not say anything for fear of being a witness against their peers because for some reason the situation turns out to be unfounded?  It is that way in our society where people may see a crime occur but will not come forward because they do not want to be involved for a number of reasons.

So let’s look at how these and similar cases fell through the cracks and this information was not found during pre-employment background checks.

Background Check Concerns

Many employers do not press charges against employees that violate the law for fear of bad press, and the resulting lack of confidence that patients will have.  I have had Human Resource vice presidents tell me those words.  Although that is not the rule, it does happen more often than most people realize.  So often an employee is advised that they can quit or be terminated, and if they quit they avoid any termination on their record and the hospitals avoids possible civil action being brought by that employee.  So in effect, a “Win-Win” for both parties right?  Not hardly!  Although the employee is not fired or charged with a crime, and the hospital avoids any possible litigation and bad press, there are still plenty of victims out there.  Not to mention the next employer that might hire this person.

So what happens these days when an employer runs an employment verification check on an applicant?  Often they only receive the person’s job title, rate of pay, and dates of employment.  Many employers only provide that much information, and when pressed for the reason why the employee left, or if they are eligible for re-hire they are often told we do not give out that information.  I had one former employer tell me that they wish that other employers gave out more information so that they could get a better feel for an applicant, yet in the same conversation they stated that they only give out the limited information noted above because they are trying to avoid getting sued.  Really? Getting sued for the telling the truth?  Yes, that is often the case in today’s world.  As one hiring manager stated, “I would rather just give them the basic information and be done with it, then tell them the truth and risk litigation!”  I have also heard people say, “if I tell them the truth they will not hire the guy and we will be stuck with him.”

So let’s look at the internal process of conducting background investigations.   First, I have worked with many outstanding Human Resource department staff, and yet not one of them has ever completed a course of any kind in conducting an investigation.  However, in most businesses these people are responsible for conducting the investigation.  I have also worked with my previous employers and my clients to deal with the results of a “Bad Hire.”

When asking questions to find the root cause of this bad hire, it was almost always the pre-employment screening process that had some type of issue.  I have found that Human Resource personnel are often pressured to get someone hired, and even though they say that they will wait to get the information that they need, I have seen them numerous times only wait long enough to get some type of positive information and then proceed with the hire.  Often the “positive information” is nothing more than no negative information, meaning that they found nothing bad so they moved on.  But think of it this way, finding nothing bad does not mean there is not something in that applicants background that you need to know about.  It only means that they did to find anything.  So does this mean that Human Resources are the wrong department to do this job?  Should security do all backgrounds?  It is not that simple.  In the average sized healthcare security department they do not have a dedicated staff person to conduct background checks.  And in those cases where they have enough staff, often times they do not have anyone that has the proper training.  However, I have found that in larger medical centers and many other corporate settings security will in-fact have a role in background investigations.

Another issue with the applicant screening process is that those applicants will leave information off of their applications intentionally, and when their information is being reviewed by a potential employer no one fact-checks it for completeness and validity.  To explain this, consider an applicant that resides in Missouri their entire life and is applying to work at a medical center in Missouri.  They have never attended school in another state, never been in the military, and there is no indication that they have ever been outside the state.  So in many cases the background investigation will be limited to that state.  Years ago speaking to a hiring manager I asked if they would still do criminal history checks for the entire United States or just Missouri, and I was advised it costs them money for each state, so since they do not have any indication that the applicant has lived anywhere else, they would not do a nationwide check.  Really?

Risk Mitigation in Background Screening

So it really comes down to knowing everything possible about an applicant and then fact-checking that information and not relying on their information to be complete and accurate.  Is it good business to conduct a nationwide check and spend the extra money now, verses dealing with a much larger payout in litigation later?  Of course it is, so there is no reason to skimp in the hiring phase yet it happens.  It always seems to amaze me when I find a medical center that is involved with litigation for negligence hiring or retention and they had many warning signs or indications of missing information in the hiring process of that employee.

Until such time that employers start providing honest and full information to other employers, and they start prosecuting employees that commit criminal acts, there is always going to be the risk that your new hire has a history of something that you will regret.  Look at your employment applications and see how many years of work history it asks for; how many residences it asks about (including all states that the person has worked or resided in); consider asking references for additional references; and work with your Human Resources and legal departments to prosecute all criminal behavior so that your organization is just not kicking the can down the road to the next unsuspecting employer.