In Wisconsin, healthcare systems are working under a new set of rules.
A state law went into effect last month that requires criminal background checks on virtually every prospective and current employee at hospitals, nursing homes and home health agencies in the state.
Besides mandating background checks, the law lists crimes that bar employment in the facilities and those that require candidates to get a special dispensation from the state.
"The intent of the law is to protect the most frail and vulnerable," says state Rep. Peggy Krusick, a Democrat from Milwaukee and a sponsor of the bill.
The measure resulted from a Milwaukee newspaper's coverage of nursing home employees with criminal histories.
Despite the law's good intentions, some healthcare officials are concerned that enforcement may be a logistical nightmare and keep people out of work even after they've turned their lives around.
The law has a broad reach: It applies to facilities licensed or regulated by Wisconsin's Department of Health and Family Services, including healthcare, child-care and long-term-care facilities.
Background checks must be done not only on doctors, nurses and other employees who work directly with patients but also on employees and independent contractors who have patient access. That includes noncaregivers such as maintenance crews and housekeeping staff.
Tim Hartin, general counsel for the Wisconsin Health and Hospital Association, says healthcare systems will feel the sheer volume of those background checks. For example, one large system plans to order as many as 18,000 employee background checks during the next 11 months, he says.
For each background check, the Wisconsin Department of Justice charges $2 for not-for-profits, $5 for government organizations and $13 for everyone else.
The law set an Oct. 1 deadline for beginning the process of criminal background checks on prospective employees and an October 1999 deadline for checking current employees. The checks must be repeated every four years.
Employees and candidates must fill out disclosure forms as part of the checks.
Hartin says he's concerned the new law could undermine the state's welfare reform by eliminating many job opportunities for people with criminal records. In some areas, he points out, hospitals are the largest employers.
"This is the land of second chances," Hartin says.
The list of criminal offenses that bar employment is being refined and narrowed, says Linda Dawson, deputy chief legal counsel for the DHFS.
Emergency rules for implementing the law are in place now, but final ones likely won't be enacted until January, after public hearings are held next month.
Early drafts of the list of crimes that would permanently bar employment have included robbery with a dangerous weapon. But robbery is being moved to the category of crimes that allow people to work if they show they've been rehabilitated and get permission from a DHFS panel, Dawson says.
"I think we are trying to be fair," she says.
Dawson cites a former drug addict who was convicted of robbery while trying to support his drug habit. He now counsels young people. If robbery permanently barred someone's employment, he would be out of his job.
Dawson says other crimes will likely be moved from the permanently barred list, which includes kidnapping, stalking, arson and mayhem, as well as homicide and sexual assaults.
Dawson says she expects the state to be swamped with rehabilitation review requests as providers scramble to meet the October 1999 deadline.
"Our job is to ensure the protection of vulnerable clients," Dawson says. "And so far, not all employers have done that."
Bob Reed, director of reimbursement and compliance at Milwaukee-based Ministry Health Care, a 10-hospital system, says that while the system hasn't been checking the backgrounds of every new employee, it has screened candidates by asking about criminal convictions.
The problem, Reed says, will be when otherwise good employees, who have turned their lives around, have to be fired for crimes they committed years earlier that are unrelated to their current jobs.
"The law doesn't give us any room," Reed says. "We have to terminate those individuals."
Bob Weiss, vice president of human resources for Milwaukee-based Covenant Healthcare, a five-hospital system, says his system checks backgrounds on candidates.
"What they've done is impose on all organizations something that was maybe needed by a small number," Weiss says.
Under the law, Covenant will have to run about 10,000 criminal background checks on its current employees. "It's a labor-intensive project," Weiss says.