The four applicants for Massachusetts nursing licenses didn’t seem to have much in common. They gave addresses in Randolph, Everett, Milton, and Lihue, Hawaii. Their applications arrived between last October and June.
All four claimed to already have nursing licenses from Hawaii, and each filed a form purportedly signed by Kathleen Yokouchi, identified as an officer of the Hawaii nursing board.
There was one problem: Yokouchi retired five years ago.
“OMG . . . these verifications are totally fraudulent,” wrote Lee Ann Teshima, executive officer of the Hawaii Board of Nursing, in a Sept. 2 e-mail to an investigator with the Massachusetts Board of Registration in Nursing.
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But it wasn’t just those four. A Globe review of documents at the heart of the Massachusetts investigation into fraudulently obtained nursing licenses reveals a pattern of applicants using what appear to be doctored licenses from other states in an effort to prove professional certification.
Three applicants pretended they had Alabama licenses, filing a form signed by either “Genell Lee” or “N. Genell Lee.” Alabama officials told the Massachusetts nursing board that valid forms would be signed by someone else. Another three claimed to have Oklahoma licenses, each using the same incorrect name for an official on their forms.
The phony forms open a window onto how 13 people allegedly secured nursing licenses from Massachusetts health regulators. The licenses for all 13 were revoked or suspended in recent weeks.
For someone desperate to work as a nurse in Massachusetts, getting a license from another state is like an all-access pass. Massachusetts officials accept that document as proof the nurse is properly educated and passed the national nursing examination, a requirement to practice. State regulators say only one of the 13 had passed the national qualifying examination.
Interviews with hospital and nursing home representatives suggest most rely on Massachusetts health regulators to vet the qualifications of nurses and do not independently authenticate nurses’ licenses.
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“Everyone wonders how this can happen,” said David Schildmeier, spokesman for the Massachusetts Nurses Association. “We’re just hoping this provides a process for tightening up. People work really hard for these licenses and to maintain them.”
Most of the 13 found to have fraudulently obtained licenses in Massachusetts submitted licenses from the few states that don’t participate in Nursys, a national database of nurse disciplinary actions. Still, even those states have their own online licensing databases that can quickly confirm to a future employer whether someone has a legitimate license.
Some applications had other shortcomings. One applicant didn’t provide a Massachusetts address on her form. Another provided an address in Milton that does not exist.
At least nine of the 13 had practiced as nurses in Massachusetts in recent months, according to state officials. All of those nine worked in nursing homes and one also worked in a hospital.
It is unclear how much experience the workers had in any kind of health care job.
Several had licenses as certified nursing assistants and one — Claudel Jean Baptiste — worked in fall 2013 as a personal care assistant, a position that doesn’t require a license, at Newton-Wellesley Hospital.
Jean Andre Clemat of Roslindale appears to be the only one who passed the nursing examination, but only to be a licensed practical nurse, a position that requires less training than a registered nurse, according to state officials.
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Jesula Eustache of Milton and Edna Tunis of Roslindale obtained degrees as licensed practical nurses from a New Hampshire school that was closed in 2010 because fewer than two-thirds of its graduates could pass the exam. Eustache and Tunis also failed the nursing exam. The state has found no evidence that any of the others even registered for the exam, said state health department spokesman Scott Zoback in an e-mail.
Still, state officials say they have found no evidence the fake nurses harmed patients.
Those who allegedly held the fake licenses could not be reached.
The implicated nurses worked in places such as Kindred Nursing and Rehabilitation in Braintree.
Sami Almadi, the executive director of Kindred Braintree, said in an e-mailed statement that his facility has long counted on the state’s nursing board to verify that the licenses it grants are reliable.
Kindred Braintree employed two of the 13 who have been implicated by the state, Guerla Belony of Randolph and Herold Phillippe of Brockton. Phillippe’s license from Oklahoma and his alleged degree from an Oklahoma college were fraudulent, according to Massachusetts regulators. Belony and Phillippe worked as registered nurses. Almadi declined to answer questions about the two.
Administrators from several nursing homes said they, like Almadi, relied on the veracity of licenses granted by the state’s nursing board.
Joanna Cormac Burt, chief operating officer of EPOCH Senior Living, said her nursing homes check criminal records and documents that might indicate histories of sex offenses and fraud and abuse. Three of the implicated nurses worked in Epoch Senior Living’s Chestnut Hill nursing home.
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One of those disciplined by the state, Eustache, worked in an operating room at Brigham and Women’s Hospital from May through July. She was always under supervision, according to hospital spokeswoman Erin McDonough.
McDonough said Eustache had been a beloved employee for decades before she tried her hand at nursing. She worked as a patient care assistant starting in 1987 and a surgical technician starting in 1996. Eustache, working as a surgical technician, was part of a Brigham team that traveled to Haiti to give care after the 2010 earthquake.
“Earlier this year, she applied for an RN position and presented evidence of licensure, which we validated via the state’s website,” McDonough wrote in an e-mail. “Jesula [Eustache] had been a respected colleague and dedicated, compassionate care provider at the Brigham for nearly 30 years.”
Asked whether the Brigham knew Eustache had failed her qualifying exam, McDonough said employers don’t have access to exam results and rely on licensure as evidence of passing. “Going forward, we will independently verify all accessible information,” she said.
The state has outsourced the vetting of nurse licensure applications for decades. Since 2000, that contract has been awarded to Professional Credential Services of Nashville, which also reviews license applications for pharmacists, psychologists, optometrists, and many other professionals in Massachusetts. The company collects licensing fees from applicants and keeps a portion of those fees.
The state is reviewing whether it wants to continue working with Professional Credential Services.
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Very few nurse license applications are rejected. Of the 7,500 to 9,500 applicants reviewed each year in Massachusetts, only a handful are turned away — three each in 2015 and 2014. Among those rejected this year were two from people who supplied false information similar to that of the 13 whose licenses were suspended or revoked.
Felice J. Freyer can be reached at felice.freyer@globe.com. Kay Lazar can be reached atkay.lazar@globe.com.