War on terrorism brings collateral damage to hospitals.

It's already hard enough for most hospitals to fill their ranks of nurses, but now terrorism concerns are making it even tougher.

A new rule promulgated by the Department of Homeland Security is requiring foreign nurses who want to work in the United States to undergo more rigorous background checks than ever before--adding up to a half-year to the process of hiring foreign nationals by hospitals.

That wouldn't be such a big deal in other industries, but some hospitals rely on foreign nurses for more than half their nursing staff. A nationwide labor shortage is particularly acute in California, where hospitals are struggling to meet new state nurse-to-patient ratios.

"Under these new rules you are looking at a four- to six-month process after you have made the decision to bring someone in from another country," said Linda Burnes Bolton, vice president of nursing for Cedars-Sinai Medical Center, where foreign-trained nurses make up a third of the nursing staff.

The new rule, which is being implemented ill phases through July, is requiring a Philadelphia-based body called the Commission on Graduates of Foreign Nursing Schools to take steps to eliminate potential fraud from foreign nationals seeking a visa to work as a nurse in the United States.

The steps include no longer accepting transcripts directly from applicants but having commission officials write to foreign nursing schools for original transcript copies. Similarly, copies of foreign licenses must be sent directly from foreign licensing bodies, not from applicants.

"We have no control over the (foreign) issuing authority in terms of the timeliness in which they send documents." said Barbara Nichols, chief executive of the commission.

The requirement arises from a desire to curb the use of fraudulent documents, a rampant international problem.

Burnes Bolton said previous regulations were already fairly stringent, including requiring most foreign nurses to pass U.S. licensing exams. She said at least some of the motivation for the new rule appears to arise from unrelated broader terrorism concerns, a view Nichols agreed was valid.

Revised Charity Policy

After being the subject of full-page ads in the Washington Times attacking its charity policies, Catholic Healthcare West has announced a new policy aimed at easing medical costs for uninsured patients.

The San Francisco-based hospital system, which operates four facilities in Los Angeles County, will consider providing free care to families at or below 200 percent of the federal poverty limit, and charging discounted Medicare prices to families up to 300 percent of the limit.

It also will offer interest-free, extended payment plans to low-income patients, and is promising not to garnish wages or place liens on low-income patients who make a good faith effort to settle their bills.

CHW's new policy follows a decision last year by Tenet Healthcare Corp. to establish its own "Compact With Uninsured Patients" following similar attacks by activist K.B. Forbes.

Forbes was on vacation last week and could not be reached for comment on whether Catholic Healthcare's actions would satisfy his concerns. The hospital industry has been under attack by Forbes and other activists for charging uninsured cash-paying patients far more than the discounts given insurers.

No Muss, No Fuss

Health Net Inc. has introduced what it is calls the nation's first paperless, Internet-only health plan.

Net Plan, which is being offered to individuals and families without access to employer-or government-sponsored health plans, includes an all-online application process that Health Net officials say will help keep costs down.

The plan, which is available through Health Net's Web site, offers preferred provider organization coverage starting at $33 a month. Consumers can apply for it directly or through insurance brokers such as EhealthInsurance.com.

Applicants who like paper can download information and print all they want, but they have to pick up the dime for the ink.

Staff reporter Laurence Darmiento can be reached at [phone] ext. 237 or at [e-mail].