State auditor to hunt for ways to protect patients from harm

At the request of Gov. Christine Gregoire, the Washington State Auditor's Office is launching an unprecedented review of the state Department of Health and will recommend ways to strengthen sexual-misconduct investigations and protect patients.

"We've never had this kind of request before," State Auditor Brian Sonntag said. "But this is a great way for us to broaden our scope beyond auditing finances."

Gregoire said Thursday that a performance audit is necessary because of the "gravity of the situation." She cited a Seattle Times investigation, "License to Harm," which last week highlighted what Gregoire called "sad and tragic cases" involving sexual misconduct by health-care practitioners.

In the past decade, the state dismissed one-third of all sexual-misconduct complaints without any investigation, The Times found. When it did act, the state often returned offenders to work without therapy or under dubious safeguards, such as allowing them to treat female patients only if they were older than 50.

Gregoire's request for the audit comes after she announced Sunday that she wanted the state to begin screening applicants for previous discipline in other states; to draft consistent definitions of sexual misconduct; and to develop consistent guidelines for investigations.

On Thursday, she also asked the auditor to recommend ways to conduct national criminal-background checks on health-care license applicants and existing practitioners — a move that she earlier had said might not be practical.

The audit will incorporate a top-to-bottom review of Health Department policies and performance, marking the first time the state auditor has been given a direct hand in recommending policy changes. Gregoire could make many changes through executive order.

The audit also will be the first time an outside agency has been allowed unfettered access to the Health Department's disciplinary system, which has been besieged for years by complaints from lawmakers and the public that it is too lenient.

Health Department Secretary Mary Selecky said she welcomes the audit.

Projections show that a rising number of licensed health-care practitioners, along with marked increases in the number of disciplinary cases, will "outstrip our resources and our capacity," Selecky said Thursday.

An overburdened system is one reason the Health Department seeks to settle most disciplinary charges, health officials acknowledge. At least 90 percent of cases are settled in confidential meetings, The Times found. Often, suspects have been allowed to edit their own disciplinary orders and remove embarrassing details.

Selecky said she and Sonntag's staff have already begun talking about details of the audit. Officials said they don't know how long the audit will take.

The audit's primary mission is to reconcile a fragmented disciplinary system that is split among the state and 16 independent boards and commissions, which oversee 57 health-care professions and about 300,000 practitioners.

The state sets standards for 22 professions, including nursing assistants and registered counselors. The remainder — including doctors and registered nurses — are overseen by boards and commissions, which may adopt their own standards.

Disciplinary sanctions for the same kind of offenses vary wildly among professions, state records show.

Gregoire said her goal is to have uniform sanctioning guidelines adopted for all professions.

However, a first step must be to define sexual misconduct, she said.

Generally, it is defined as any sexual or romantic behavior, physical or verbal, between a health-care practitioner and a patient, or a patient's representative. It can occur inside or outside the professional setting.

However, about half of the boards and commissions have yet to agree on a legal definition, which is important if a disciplinary decision is appealed to Superior Court. In the past decade, citing the lack of a concrete definition, scores of practitioners charged with sexual misconduct have successfully petitioned to keep their licenses.

Gregoire ordered Thursday that all regulators must adopt definitions by Sept. 1.

She is joined by a group of state lawmakers who want to overhaul the granting of credentials to registered counselors and require all practitioners to undergo extensive criminal-background checks. Those recommendations would require legislative approval.

A task force will be created this month to study the qualifications required of registered counselors and to recommend possible changes.

Currently, the only qualifications required to become a registered counselor are a $40 registration fee and a four-hour class on AIDS awareness. No education or experience is required, not even a high-school diploma. There are about 17,000 registered counselors in the state, more than four times the number of licensed mental-health counselors.

Gregoire said most people may not understand the differences among counseling professions. For example, licensed mental-health counselors must have a master's degree and a minimum of 36 months full-time counseling experience or 3,000 hours of supervised, post-graduate counseling.

The audit will include recommendations to implement national criminal-background checks for new applicants and current license holders.

Currently, the state conducts only in-state criminal checks for new applicants. The Times profiled a convicted sex felon from Oregon who used that loophole to get a Washington nursing-assistant license. Additionally, the Times found 55 practitioners with active licenses who had previous sex-crime convictions.

Michael J. Berens: 206-464-2288 or mberens@seattletimes.com