Friends of Refugees

A U.S. Refugee Resettlement Program Watchdog Group

Catholic Charities of Southern Nevada’s refugee medical screenings violate federal standards

Posted by Christopher Coen on August 26, 2012

Catholic Charities of Southern Nevada’s refugee medical screenings do not appear to conform to federal standards by having community health nurses conduct the screenings. ORR guidelines state that the refugee medical “screenings should be performed by a qualified licensed health care professional.” ORR requires either a physician, a physician’s assistant, or a nurse practitioner. An a article at the Nevada Policy Research Institute examines the issue:

LAS VEGAS — Refugees from around the world come to Southern Nevada, often from countries with diseases not commonly seen in the native U.S.-born population.

How sound is the medical screening refugees receive? Are they getting adequate medical care?…

Because the refugees often come “from regions of the world with high rates of certain diseases,” notes the federal agency, “refugees face special health challenges.” They thus must first undergo medical screening overseas to ensure they are medically eligible for the U.S. Refugee Program. Then, after arriving in the U.S., they are directed to undergo more in-depth medical examination.

One purpose of the U.S.-based screening, says ORR, is to protect the public health of U.S. citizens. A second purpose is to “provide refugees with a level of health and well-being required for and supportive of successful resettlement in the U.S.”

Since 1994, ORR’s partner in Nevada for refugee services has been Catholic Charities of Southern Nevada (CCSN). For fiscal year 2010-11, the nonprofit administered some $6.7 million in federal refugee funds. CCSN not only serves as ORR’s designated State Refugee Coordinator, but also operates the local refugee resettlement office. 

The Southern Nevada Health District, under contract to Catholic Charities since at least 2008, conducts the federally required medical screenings for the refugees — including their health histories and physical examinations.

The refugee medical screenings conducted by SNHD over the last five years, however, do not appear to conform to federal standards.

ORR guidelines state that the refugee medical “screenings should be performed by a qualified licensed health care professional.” And by such a professional, ORR means — as demonstrated through ORR’s use of federal billing codes — either a physician, a physician’s assistant, or a nurse practitioner.

SNHD’s contracts with Catholic Charities, however, only state that the district will have “a Community Health Nurse” do “a complete history and physical” on refugees.

All of the district’s community health nurses are registered nurses (RNs), according to the Nevada State Board of Nursing, and none are nurse practitioners (NPs), also called, in Nevada, advanced nursing practitioners (ANPs).

The health district’s use of RNs for such work would also appear to violate the Nevada Administrative Code’s regulations governing nurse practice…

The difficulty with such screening by RNs, notes James D. Hook, director of healthcare consulting at the Fox Group, LLC, is that recognizing whether some patient’s condition actually is abnormal may at times require a greater level of medical expertise than even a typically competent RN would have… Read more here

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