Considering the black eye Charles Cullen gave the nursing profession when he admitted not long ago to killing 29 patients in Pennsylvania and New Jersey -- seven locally -- you'd think hospitals would be extra cautious when hiring health professionals.
But four years after Cullen's 2003 arrest, a man convicted of involuntary manslaughter slipped unnoticed into the area's nursing ranks.
Joseph A. Mannino, 44, of Palmer Township earned his degree at St. Luke's School of Nursing in 2007, a decade after his release from a North Carolina prison, where he served three years after injecting a friend with a lethal dose of medicine. His lawyer told the jury Mannino only meant to treat the man's headache.
After graduation, Mannino went to work as an RN at Lehigh Valley Hospital, where he'd already been working as a data clerk.
LVH fired him in November 2008 after discovering "he had not revealed on his application for employment that he had been convicted of a felony in North Carolina," according to a state nursing board report.
I learned of his crime, and employment at Lehigh Valley Hospital-Allentown, when the Board of Nursing revoked his license. The revocation was in December, and the notice was posted online last month.
Mannino was charged with first-degree murder in 1992. A jury convicted him in 1994 of the lesser charge of involuntary manslaughter, which means the killing was seen as unintentional.
Through his lawyer, George Heitczman of Bethlehem, Mannino declined to talk to me.
Mannino told the nursing board he couldn't get a job after he moved to Pennsylvania and revealed his conviction to potential employers, so he stopped revealing it "out of frustration," according to the order revoking his Pennsylvania license.
"When he applied to nursing school, a criminal background check failed to reveal his conviction in North Carolina, and [Mannino] testified that he then believed that it was in the past and was no longer relevant," the order says. "[Mannino] was fully aware that what he was doing was deceitful and fraudulent."
Susan Schantz, a St. Luke's vice president, said the nursing school started doing national criminal background checks on all students through the FBI fingerprint system in 2008 -- a year after Mannino graduated at the top of his class.
Before that, since 2001, it had checked students for criminal records through state police, who only look for offenses in Pennsylvania, and for child-abuse histories through the Department of Public Welfare.
The only students St. Luke's checked through the FBI before 2008 were those who had lived in Pennsylvania for less than two years. Mannino met the two-year residency requirement so he wasn't subject to the national check, St. Luke's spokeswoman Denise Rader said.
LVH spokesman Brian Downs told Morning Call reporter Veronica Torrejon that Mannino was hired in April 2005 to work as a data clerk in the AIDS Activities Office at LVH, 17th and Chew streets, Allentown.
"We were not aware that he did not tell the truth on his employment application," Downs said.
At the time, the hospital checked all prospective employees through state police. LVH didn't start doing national checks on all employees through the FBI until 2008. That year, the state started requiring anyone working professionally with children to undergo state police, federal and child-abuse background checks, said Stacy Kriedeman, spokeswoman with the state Department of Health.
Downs said doctors had been subject to a deeper background check through the National Practitioner Data Bank, a federal database that includes licensing infractions and malpractice payments from all states. At the time, nurses weren't included in that database. They were just added March 1. Even if nurses had been in the data bank when Mannino got his nursing license in 2007, his conviction wouldn't have shown up because the database doesn't include criminal records, and his nursing license hadn't been sanctioned yet.
After getting his nursing degree, Mannino was promoted to a position overseeing quality assurance and quality improvement at the AIDS Activities Office, Downs said. The position required nursing credentials.
Mannino had some patient-care duties. He provided patient education and counseling, Downs said, and made sure patients followed treatment recommendations.
As a nurse, he also had the authority to administer medication according to doctors' orders, Downs said. But patient care was "not the bulk of his position," he said, as his primary role remained data entry.
Another employee eventually told LVH officials Mannino may have done something criminal in North Carolina, Downs said. Mannino was fired and LVH reported its findings to the state nursing board. Downs said there were no complaints against Mannino and there is nothing in his patient-care records to raise any red flags.
"He was dismissed for lying on his application," Downs said. "His work here was satisfactory and we have no cause for concerns based on his work."
The fact Mannino got into nursing school, got a state license and landed a job raises plenty of red flags for me about what Pennsylvania is doing to protect patients.
Mannino's case clearly is different from that of Charles Cullen, whose murders were many and premeditated. A jury didn't find intent in the single case against Mannino.
Yet it's hard not to think about Cullen when something like this comes up, considering Cullen was a nurse who killed by lethally injecting patients with drugs.
Four years ago, Cullen was sentenced to 18 consecutive life terms for the murders -- one at Lehigh Valley Hospital-Cedar Crest, five at St. Luke's Hospital-Fountain Hill, one at Easton Hospital in Wilson and 22 in New Jersey.
The matter still isn't resolved. One lawsuit is pending, and another was resolved just last week in Lehigh County Court.
Slipping through the cracks
Cullen's actions should have scared all hospitals, locally and nationally, into taking extraordinary steps to make sure employees, especially those caring for patients, are clean.
The fact two hospitals that had been victims of Cullen would start doing national criminal background checks on prospective nurses or nursing students only two years ago is mystifying.
It's also surprising LVH didn't do a broader background check on Mannino when he went from data clerk to nurse.
Under LVH's current system, would Mannino's criminal record have been uncovered?
"I can never say it would never happen again, but we do do additional checks now that were not done in 2005 that we would hope would bring that to light," Downs said.
Hospitals would be wise to do the broadest background check they can, because health-care professionals often attend school or intern in one state and take a job in another, said Robert G. Miller, a member of the Employee Health, Safety & Security Panel at the Society for Human Resource Management in Alexandria, Va.
"If they only search their own individual state, they're going to miss some things," said Miller, a former hospital human-resources specialist.
As for the Pennsylvania Board of Nursing, state law doesn't require it to check criminal backgrounds of first-time applicants taking the exam or applying for license by endorsement, meaning they're already licensed elsewhere.
"We take applicants at their word when they answer the criminal history question," said Leslie Amoros, a spokeswoman for the Pennsylvania Department of State, which oversees licensing boards. "If there is a "no' answer, then no further inquiry is made. If they answer "yes,' then we ask for the criminal documents and a records check."
In other words, they rely on the honor system, which might work for you and me but creates a giant hole for the average felon to slip through.
Mannino has not worked as a nurse since LVH fired him, the nursing board said in its December order, which is on my blog at http://blogs.mcall.com/watchdog/.
He was a week from completing medical school at the University of North Carolina when his roommate died. He admitted injecting him with antihistamines to ease his migraine headache, but did not admit injecting lidocaine, which triggered the death, according to accounts in The News & Observer newspaper in Raleigh, N.C.
Trial testimony indicated Mannino and his roommate had been feuding. A friend testified that before the death, Mannino told her he could kill his roommate with an injection and no one would know what happened, The News & Observer reported.
Mannino did not testify and the defense presented no evidence, the newspaper reported. His lawyer contended throughout the trial that Mannino had been trying to help, not hurt.
The Pennsylvania nursing board order says the North Carolina court, when imposing its sentence, considered Mannino's reputation in his community and his excellence in college and medical school, as well as his participation in programs providing medical care for the poor. Mannino was sentenced to seven years, and served three. He completed his parole in 1997 and eventually returned to his home state of Pennsylvania.
The nursing board report says he has not been charged with any subsequent crimes. At the hearing on his license status, a physician from the AIDS Activities Office testified Mannino "was kind and compassionate, provided quality care for his patients, and would not create a substantial risk of harm to individuals he cared for as a professional nurse."
The hearing examiner determined quality of care wasn't the issue, but rather his failure to be honest on his licensing application. "Had [he] done so, such disclosure would in all likelihood have had less impact on his licensure status," the report says.
Database has holes
A newly expanded federal database has been created to prevent professionals from moving between states to escape their past. The National Practitioner Data Bank was established by Congress in 1986, but initially focused on doctors and dentists. It included information provided by state licensing boards, professional associations and other sources, including hospitals and medical malpractice payers. This month, the system, which hospitals have access to, was expanded to include information about other health professionals, including nurses.
The unveiling came with controversy, though. Nonprofit investigative journalism organization ProPublica reported the system is incomplete. ProPublica, working with the Los Angeles Times, found some serious disciplinary actions were missing from the database, including cases involving health-care professionals who had harmed patients. It found licensing boards in some states hadn't reported sanctions they'd issued.
ProPublica's investigation, and more information on the National Practitioner Data Bank, are on my blog.
The departments in charge of the database have acknowledged there are "information gaps." Last month, officials wrote to all governors urging them to instruct their licensing boards to provide the information.
"The information is as good as the information we get from the states," said Martin Kramer, spokesman for the Health Resources and Services Administration.
Boards that don't cooperate will be publicly identified in a July 1 U.S. Department of Health and Human Services report. Kramer said that's the extent of the punishment that's allowed.
Can hospitals hire known felons?
The Department of State told me all Pennsylvania licensing boards have complied. ProPublica's investigation didn't mention any shortcomings with Pennsylvania records. The data isn't available to the public, so I can't access it to check.
Kramer said any gaps in the database do not relieve health-care providers of doing their homework when hiring professionals. He said the database isn't meant to be the only source to check.
"This is really meant to be a flagging system as opposed to be a one-stop shop," Kramer said.
It's not, because it doesn't include criminal records. But the information will get out if state licensing boards sanction professionals for criminal actions. That licensing information is available to hospitals through the National Practitioner Data Bank.
If a background check turns up a crime, an employer shouldn't automatically rule out hiring that person, said Miller, with the Society for Human Resource Management. He said that could lead to trouble with the Equal Employment Opportunity Commission, which could consider it discriminatory because of the disproportionate number of minorities convicted of crimes.
Miller said employers should consider how long ago the offense was, evidence of rehabilitation and whether the nature of the crime could conflict with the duties of the job.
Pennsylvania laws go a step further, requiring criminal background checks for certain health-care workers who come in contact with children and seniors. The laws prohibit applicants from being hired if they are convicted of certain crimes, including involuntary manslaughter.
As a result, if Mannino had told the truth about his criminal history, it would have excluded him from being hired at LVH, Downs said. It is unclear if Mannino's criminal record would have barred him from attending St. Luke's School of Nursing. Officials with St. Luke's did not directly answer the question.