Audit cites Department of Public Health procedural weaknesses

The state Department of Public Health issued licenses to day-care facilities without the needed criminal background checks on employees, failed to take action against a dentist despite four complaints, and paid more than $25,000 to volunteer stem cell grant reviewers that it might not have had the authority to spend, according to a state audit released Thursday.

The audit, which covered the period from July 1, 2007 through June 30, 2009, also raised concerns about the department’s oversight of contracts and overtime payments, and inadequate membership of licensing boards and commissions.

State law requires that prospective day-care employees submit to state and national criminal records checks. The department must also check whether they’re included in the state’s child abuse registry.

But the Auditors of Public Accounts reviewed three day-care centers that were newly licensed during the 2009 fiscal year and found that two of them got licenses even though three employees’ background checks had not been completed. Three years later, the results of the three checks still hadn’t been received — something that the auditors said was only discovered through their review, not by the department.

The auditors also found that DPH did not have policies or procedures in place for the criminal background check process.

“Without evaluating the results of background checks, children could be at risk,” the audit noted.

DPH disagreed with the auditors’ assessment, saying in a written response included in the audit that it has policies and procedures for background checks.

“The process of screening for convictions and Department of Children and Families’ records and the assessment of the findings is labor intensive,” the department said. “The Department of Public Health conducts the required criminal and abuse/neglect background checks to the extent possible within available appropriations.”

But the auditors said some of the policies the department cited are not supported by law. That includes issuing a license to a day-care center after enough staff has been evaluated. State law requires each prospective employee to submit to background checks, the auditors wrote. In addition, the auditors took issue with the department’s statement that new staff can work with children before the results of background checks are received, a position the auditors said is not supported by statute.

The auditors also identified problems in handling complaints against dentists. In three of 10 complaints reviewed, the auditors found that the department had not investigated all the issues raised. In one, only charges related to a hygienist were pursued, not a “more critical issue” involving whether the dentist met the standard of care in handling a patient’s infection.

In addition, the auditors found a 2-year-old complaint for which the department had not gotten a consultant’s opinion. Although three other complaints against the same dentist had been filed, the lack of an opinion left the department unable to move ahead with an action against the dentist, the auditors said.

“By not investigating and prosecuting complaints thoroughly and in a timely manner, the public is at a greater risk of injury by licensees who may not be meeting the standard of care,” the auditors wrote.

They said they were told that the department did not have enough money to hire consultants and that there was a shortage of volunteers who would consult for free, leading to delays. In addition, they said, DPH’s investigations unit and legal office didn’t collaborate as well as they could have.

In its response, DPH said funds to pay consultants had not been appropriated this fiscal year, but that it would explore other sources of funding.

The auditors also raised concerns about the handling of contracts for human-service programs. During the period covered by the audit, DPH approved 807 contracts for $192.6 million.

But only 7 percent of those contracts were approved before their official start date. And 362 of the contracts — nearly 45 percent — were approved between 91 and 548 days after the contractual start date.

“It is likely that many contractors provided services without the proper approvals and before a commitment of funds for the obligation was recorded,” the auditors wrote.

The auditors recommended that the department improve its controls over human-services contracts, and DPH said it agreed with the findings and said it is working on ways to improve controls and documentation of contracts.

Auditors John Geragosian and Robert Ward also raised concerns that $25,863 paid to volunteers reviewing stem cell research grant applications might not have been allowed. Minutes of a 2008 committee meeting showed that the reviewers couldn’t be paid based on existing statutes related to stem cell research, but that they could be paid through another law that requires approval from the commissioner of administrative services and secretary of the office of policy and management. The auditors said DPH couldn’t document that those two officials had approved the payments.

In its response, DPH said it is in compliance with state laws related to paying peer reviewers.

The auditors also noted problems with many of the regulatory and advisory boards and commissions DPH oversees. Seven of the boards had vacancies, and 55 members from nine different boards missed so many meetings they were considered to have resigned.

DPH said it has “an extremely limited ability” to control the board appointments made by the governor or legislators, but that it would notify appointing authorities about members who have been absent repeatedly and vacancies.

The auditors pointed out that the Connecticut Homeopathic Medical Examining Board did not meet during the 2009 fiscal year, but DPH said there were only eight licensed homeopathic physicians in the state that year, and that the board did not have enough members for a quorum. It now has enough members and met in 2010 and 2011.

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