Nov. 11, 2013: Patients, families are in the dark over risky Minnesota nurses

Leslie Anderson had no reason to distrust the nurse she let into her home to care for her 4-year-old daughter, who requires around-the-clock medical attention for a rare disease that has left her a quadriplegic and unable to talk.

Five months later, Anderson caught the nurse, Kelli Ingalls, stealing her daughter's pain medication.

Anderson did not know until contacted by the Star Tribune that Ingalls had a drug history that included methamphetamine abuse and a county finding that Ingalls maltreated a child by allegedly operating a meth lab in her home.

"That's something that should obviously be in someone's background check," Anderson said.

It wasn't.

What happened to Anderson and her daughter reveals how gaps in the state's system for background checks prevent employers and patients from learning the full history of nurses who have committed crimes, neglect or maltreatment, a Star Tribune examination of Nursing Board and criminal records shows.

Nurses can practice for years before their past troubles catch up with them, because the responsibility for vetting caregivers is split between the Department of Human Services and the Minnesota Board of Nursing. Even when these nurses have lied about their backgrounds, the board typically takes disciplinary action only when they commit more misconduct.

As a result, patients and their families have little access to the records of the nurses caring for them.

"Obviously, had I known [about Ingalls], I would have never let her into my home," Anderson said.

State Sen. Kathy Sheran said she will examine whether the public should be able to learn more about the backgrounds of nurses as part of an investigation she is launching into the Nursing Board.

"The public has a right to have information so they can make good decisions about who they have as their caregivers," said Sheran, DFL-Mankato, and a former nurse. "That has to be the priority, over taking care of the license holder."

Licensing a criminal

Nearly all health care providers licensed by the state are required to conduct background checks on new hires who will provide direct care. Those checks are done by the Department of Human Services, which is obligated to disqualify caregivers from direct patient contact if they have committed certain serious crimes. But DHS concedes that the background checks fall short of catching all prior misconduct.

"We know that our current system of notifying us is not adequate," Jerry Kerber, DHS's inspector general, said last week.

The Nursing Board does not run criminal background checks. It asks license applicants about trouble in their past, but it does not inquire further if the applicants deny it.

Some nurses have taken advantage of the honor system.

Michael L. Allison obtained his Minnesota license in 2008 after writing "No" on his application when asked if he had ever committed a crime, despite convictions for deceptive practices and theft in Illinois, according to a Nursing Board report. By May 2011, allegations that he had stolen drugs from his workplaces had cost him nursing licenses in Illinois, Washington, D.C., and Wisconsin, according to reports from boards there.

In June 2011, Allison applied to renew his Minnesota license and wrote "No" if had ever violated controlled-substance laws or faced any other nursing board disciplinary action. When Allison's employers asked DHS to do a background check on him, that also failed to detect Allison's record.

DHS looks for out-of-state convictions only if that person has a conviction in Minnesota, which Allison didn't have.

"That's a gap in our system," Kerber said.

With a clean background check and license in Minnesota, Allison was able to get nursing jobs at facilities in Onamia, Minn., and Crosby, Minn. In February 2012, the Onamia facility found discrepancies in how he handled narcotics, including withdrawing them when he was off-duty, records show.

Two months later, the Nursing Board suspended Allison's license, revealing for the first time that it had learned about his background. He continued to practice in Crosby for two months, when that employer discovered he was withdrawing numerous doses of narcotics and administering only a few of them, according to the Nursing Board report. His license was revoked in December 2012.

'Will that behavior continue?'

After years of applicants covering up their past convictions, the Nursing Board will start running criminal background checks on new applicants next year. That will not affect active nurses, who are exempt from checks until 2017 at the latest. That's the deadline set by the Legislature for licensing boards to devise a plan to check all caregivers' backgrounds.

Records analyzed by the Star Tribune show the Nursing Board has licensed 294 nurses who have criminal convictions in Minnesota that would appear to disqualify them from providing direct care, ranging from assault to drug crimes to felony theft.

Last week, DHS said it will disqualify up to 107 of those nurses after it was presented with records by the Star Tribune. The agency said it was not aware of those nurses' crimes because of shortcomings in its background checks.

Records show that nurses who lie about their backgrounds do not always jeopardize their license. At least 67 nurses since 2010 have been allowed to continue to practice in Minnesota after the board discovered that they had made false statements to hide past misconduct.

"Yes, the individual provided false information, but that does not necessarily say that the individual will provide false information in every instance forward," said Shirley Brekken, the executive director of the Nursing Board. "The board ... has to look at what was the intent. What was the level of seriousness of the breach, that breach of ethics, and ... where is the individual now, today? Will that behavior continue?"

Maltreatment tolerated

Patients also have few ways to find out whether nurses have been found responsible for serious neglect or other maltreatment, misconduct that would prevent them from providing care to patients if they were not licensed professionals.

The state disqualifies nursing aides, personal care assistants and other unlicensed caregivers from patient contact if they have been deemed responsible for recurring or "serious" maltreatment. Serious maltreatment is defined by statute as sexual abuse or neglect that results in death or serious injury.

If the caregiver found responsible for maltreatment has a license from a health board, DHS cannot disqualify them. Instead, state law directs the agency to refer those cases to the appropriate board for action.

From July 2012 through June 2013, DHS sent 18 such cases to the Nursing Board. The public cannot learn the names of those nurses, because state law shields the identities of nearly all caregivers found responsible for maltreatment or neglect.

Records show that since 2010, only two nurses lost their licenses after being found responsible for serious or repeated maltreatment. Eight are still able to practice.

Nine were allowed to continue to practice until they retired or lost their license following more misconduct. One of them was Kara Wenger, who was twice found responsible for child maltreatment in 2007 and 2009 after being accused of using drugs in front of her child and abandoning the minor in a gas station parking lot for 15 minutes, according to a Nursing Board report.

That recurring maltreatment would have disqualified an unlicensed caregiver from direct care, Kerber said. However, DHS forwarded her case to the Nursing Board, which took no action against her at the time.

Wenger began working at a Winona senior living facility in October 2010. Her maltreatment would not have shown up on her employer's background check. The Department of Human Services reports only maltreatment that results in disqualification, Kerber said.

Nine days after she was hired, Wenger was fired due to concerns over her professional conduct, the Nursing Board report said. When the facility suspected Wenger had stolen hydrocodone tablets, the Nursing Board asked to meet with her three times in January and February 2011, the board report said. Wenger failed to attend any of those meetings and was suspended in April 2012.

Stealing from a child

Kelli Ingalls obtained a nursing license and landed a job without anyone asking about her drug history.

In 2008, Morrison County social workers found Ingalls was responsible for maltreatment, three years after she was accused of making meth in her basement while her child was home. During the investigation, Ingalls tested positive for meth and said she used marijuana two to three times a week, according to a Nursing Board report.

Ingalls, 48, of Deerwood, Minn., told the Star Tribune that she did not make meth but acknowledged the finding of maltreatment and that she used drugs in the past.

But when Ingalls applied for a nursing license in August 2010, she wrote "No" to questions asking whether she had ever violated a drug law or abused drugs or alcohol.

Ingalls said she was not trying to mislead the board but believed, wrongly, that the board would check her background.

"I assumed if they had a question about it, they would call me," she said.

Ingalls did not mention the maltreatment on a job application with Good Neighbor Home Health Care, either, and the company never asked her about it, she said.

Kerber, the inspector general of DHS, said nothing would have shown up on a background check of Ingalls. Kerber said DHS can report maltreatment to employers only if it means a job applicant cannot provide direct care.

But the inquiry by Good Neighbor alerted DHS that Ingalls was now a licensed nurse, so the agency informed the Nursing Board about the maltreatment finding.

Anderson, who lives a half-hour west of Brainerd, Minn., said she had no reason to worry about Ingalls. She had already used Good Neighbor without problems since her daughter Addison first started requiring 24-hour care in June 2010.

As a toddler, Addison was diagnosed with a stroke caused by Moyamoya disease, a rare disorder caused by blocked arteries at the base of the brain. She depends on caregivers for feeding, dressing and bathing, as well as for administering medications and monitoring her condition. Addison can smile and sometimes tracks people with her eyes.

When Ingalls arrived at her home in December 2010, Anderson said she initially found the nurse to be friendly and attentive to her daughter.

In April 2011, Ingalls got a letter from the Nursing Board. The board was inquiring for the first time about the maltreatment finding and requested her response. Ingalls said she was going to respond but then, "I did the other thing."

Ingalls was referring to what happened at the Anderson house. In the spring of 2011, Anderson noticed strange behavior by her daughter's nurse. Ingalls became manic and spent an unusual amount of time in the bathroom with her purse, Anderson said. Then her daughter's oxycodone started disappearing.

Anderson suspected the nurse. She called Good Neighbor. They agreed to put out a fake bottle of prescription medication, which soon went missing during Ingalls' shift. Ingalls confessed to her boss, then to police.

Ingalls said that when she was caught, she was struggling with back pain and ran out of medication.

"I borrowed some from my client," she said. "It was just a stupid ass thing to do."

Good Neighbor Home Health Care did not respond to requests for comment. When told that the state was forbidden from telling the home health care company about the maltreatment, Anderson said, "That is the most ridiculous thing I have ever heard."

Ingalls pleaded guilty to one count of felony theft in September 2011. The Nursing Board suspended her license in June 2012, after she missed two scheduled meetings.

Ingalls said she could have gotten another job before she was suspended but didn't because she had back surgery. In September 2013, she pleaded guilty to a new charge of felony drug possession.

Ingalls said she hopes to get her nursing license reinstated, for which she can petition the board after she is able to show two years of sobriety. But that's been difficult, she said. She said she has become addicted to painkillers due to the back injury and is going through methadone treatment.

Data editor Glenn Howatt contributed to this report.

Brandon Stahl • 612-673-4626