BALTIMORE — A new state audit reveals a troubling pattern within Maryland's Department of Health.
Auditors raised specific concerns about the Board of Nursing's lack of investigative efforts into hundreds of nurses who may have used fraudulent credentials to obtain a state license.
"Our review disclosed that the Board of Nursing could not document that it had investigated 259 of the 287 who still held active Maryland licenses as of February 2024," the audit states. "We determined that at least 131 of these 259 individuals were employed by a Maryland medical facility as of December 2023 including six employed at one State-owned facility."
In response, the Board of Nursing said they've since processed 205 of the 259 individuals in question, all of whom obtained their credentials legitimately.
"Maryland has no cause to take disciplinary action against 205 of the individuals because the Maryland LPN or RN license was obtained with legitimate credentials, or, the Maryland Board of Nursing does not have jurisdiction because the individual does not have a Maryland RN or LPN license, a pending RN or LPN application, or a privilege to practice nursing in Maryland pursuant to a multistate RN or LPN license."
As for the 54 remaining cases, the Board of Nursing provided this update:
"Of these, 12 cases were closed after the applicant withdrew the application for RN licensure, 3 were closed by voluntary surrender of the RN license, and 3 were closed by revocation of the privilege to practice in Maryland. The Board has voted to issue charges in 7 of the cases and those cases have been transferred to the Office of the Attorney General for prosecution. Three cases were disposed of by a vote of take no action by the Board."
That leaves 26 other cases, which the Board of Nursing expects to complete investigations on by July 31.
The report goes onto accuse the Boards of Nursing and Professional Counselors of not investigating these issues in a timely manner.
"As of February 2024 — 3,594 of the 4,916 open complaints (or approximately 73 percent) have not been completed timely, including 3,051 (or 62 percent) that had been open for at least 2 years," auditors wrote.
The Board of Nursing said they've drastically decreased the number of open cases, to 1,303.
"796 of these cases have been open for more than 540 days. Both case load and complexity of cases contribute to prolonged investigation time frames," the Nursing Board wrote in response. "The Board estimates that reducing each investigator’s caseload to a maximum of 25 cases per investigator would assist with clearing the backlog and allow cases to be investigated timely."
Vacant investigative positions on the board are expected to be filled by December 31, they say.
The issue of fraudulent nursing licenses came to light in January 2023, when the FBI busted a diploma scheme out of Florida called Operation Nightingale.
In October 2023 the Maryland Board of Nursing released a list of names tied to the investigation.
Another audit finding suggests the Office of Health Care Quality (OHCQ) failed to conduct annual inspections of assisted living and long-term-care facilities, as required by state law.
"State law requires OHCQ to conduct inspections at least annually to ensure compliance with State and federal regulations regarding patient care and safety," the audit states. "During fiscal year 2023, OHCQ only inspected 42 of the 255 Long-Term-Care Facilities."
Similar problems were documented in prior audits, some of which date back more than 20 years.
"OHCQ not completing required inspections have been commented upon in MDH audit reports dating back to 2004," auditors wrote.
In response OHCQ blamed most of the issues on staffing shortages, but laid out time lines of when inspections should be completed.
"For assisted living facilities (ALF), there are currently seven full-time nurse surveyors and one administrative officer conducting annual inspections statewide. Additionally, eight full-time nurse surveyors are currently in training, which will enhance our capacity to manage and complete annual inspections promptly and efficiently moving forward. We anticipate being in compliance with annual inspections for ALFs by November 2025," OHCQ said. "We anticipate achieving full compliance for long-term care facilities by 10/30/2026."
Finally, state auditors expressed some concern about the background process to obtain a license.
To clarify, Maryland State law requires certain Health Professional Boards and Commissions (HPBCs) to check an applicant's criminal history before issuing a license.
Some, however, don't require background checks.
According to the audit, there are 10 such HPBCs who don't require criminal background checks of applicants.
Auditors said they fear this increases the risk of applicants with criminal records getting a license.
"We matched this data to licensed Dental and Pharmacy health professionals as of February 2024 and identified 16 licensed dental professionals and 14 licensed pharmacy professionals who were convicted of crimes including possession of controlled dangerous substances, assault, and theft. State regulations provide for disciplinary action ranging from probation to license revocation based on the severity of the crime. For example, 2 of the aforementioned licensed dental professionals were convicted of assault, which should have resulted in these licenses being suspended for at least 1 year."
Here is how the Board of Pharmacy responded to the audit's background check findings.
"Board of Pharmacy does not have statutory authority to run criminal background checks on all license applications.
The Board of Pharmacy is currently required to conduct criminal background checks on Pharmacy Technicians only through our legislation. Any criminal background information about a technician is presented to the board to approve or deny the application. Since our regulations do not require us to do criminal background checks on all licensees, we can not conduct them."
The Maryland State Board of Dental Examiners had this to say.
"The Board utilizes character and fitness questions on both the initial and renewal applications. If there are any yes answers to these questions, the Board will then investigate the incident that has been reported by the applicant. The Board receives alerts from the National Practitioners Data Bank when activity is reported. This information is used to assist with the investigation."
A full copy of the audit can be read below.