(The Center Square) — The Louisiana Department of Health has significant shortcomings in overseeing its adverse actions lists for certified nurse aides and direct service workers, according to a new report from the Louisiana Legislative Auditor’s Office.
These lists are meant to identify health care workers who have findings of abuse or neglect against them, which should prevent them from working in settings where they could harm vulnerable individuals.
At one nursing facility, 11.1% of all certified nurse aides were found to have been employed despite being on the adverse action list. Of 380 direct service workers who worked for intermediate care facilities for individuals with developmental disabilities, 4.2% continued to be employed after being added to the list.
Between 2019 and 2023, the state health department recorded findings for 80 certified nurse aides and 431 direct service workers on the adverse actions lists.
The report notes that the data from the Louisiana Workforce Commission includes only wage information and does not specify job roles or responsibilities. As a result, it is unclear whether certified nurse aides and direct service workers listed on the adverse actions lists and later employed in prohibited health care settings were involved in direct care or worked in other roles, such as administrative, janitorial or food service positions.
A primary concern is the lengthy process for evidence reviews. On average, it took the state health department 390 days for certified nurse aides and 375 days for direct service workers to add findings to the adverse actions lists after facilities reported allegations.
During this time, these workers were allowed to continue their employment. “LDH does not have adequate staff to conduct reviews timely,” the auditor said.
The auditor identified cases where individuals continued to work in prohibited health care settings despite being added to the adverse actions lists.
For example, 10 of 90 certified nurse aides and 16 of 380 direct service workers on the lists were found to have worked in nursing or intermediate care facilities. This loophole, combined with the lack of mandatory crosschecking of the lists by some employers, poses risks to patient safety.
The auditor also highlighted the lack of formal criteria for determining what incidents should lead to findings against certified nurse aides and direct service workers. Such guidelines would help ensure certified nurse aides and direct service workers are treated consistently in being added to the list, according to the auditor’s office. Without it, decisions can vary, leading to inconsistencies that undermine the system’s credibility.
Over half of the findings against certified nurse aides and direct service workers – 64 out of 125 – were ultimately rescinded after an appeal. The lack of clear policies leaves state health department staff with limited guidance, making it difficult to ensure fair and consistent enforcement.
The auditor made seven recommendations to improve the state health department’s oversight. Key among them is establishing formal criteria for what constitutes abuse or neglect and setting timelines for evidence reviews. The report also urged the state health department to require nursing facilities to check both the certified nurse aid registry and the adverse actions list before hiring and periodically for current employees.
While the state health department agreed to update policies for managing delays and improve its processes, it disagreed with the recommendation to formalize criteria for determining findings, arguing that it already uses definitions from federal regulations. However, the report emphasized the need for clearer, more detailed policies to enhance consistency and fairness.
The findings underscore a critical need for the state health department to act swiftly. With more than 500 findings added to the lists over five years — including instances of physical and sexual abuse — the current system’s weaknesses leave patients at risk.