In March 2006, a Long Beach hospital put state licensing authorities on notice: Two patients had accused a nurse of molesting them on a single night. One said that he massaged her breasts, the other that he groped her under her hospital gown, according to hospital and court records.
By year's end, licensed vocational nurse Carlito Paar Manabat Jr. had pleaded no contest to two counts of sexual battery. He went on to serve six months in jail and register as a sex offender.
Last February, he renewed his license, checking "yes" on the application when asked if he'd been convicted of a crime.
It wasn't until July, more than two years after first being alerted to the problem, that the California Bureau of Vocational Nursing and Psychiatric Technicians took the first formal steps to revoke or restrict Manabat's license.
Today, with the case pending, Manabat is still free to practice -- though he says he doesn't, on the advice of his probation officer.
A review of the vocational nursing bureau by The Times and ProPublica, a nonprofit investigative newsroom, found many cases similar to Manabat's in which regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.
"Obviously the public isn't protected," said John M. Brion, an assistant clinical professor at the Duke University School of Nursing and former executive director of the Ohio Board of Nursing. "If you have a person who's already been convicted and served their time and they haven't even been charged by the board . . . I would really question what's wrong with their system."
In an interview, Manabat denied molesting his patients, saying they must have been hallucinating. He didn't fight the charges, he said, fearing a lengthy prison sentence.
The findings expand upon a Times report last month that examined the bureau's sister agency, the Board of Registered Nursing, and cited dozens of examples in which RNs retained their licenses for years despite serious or repeated criminal convictions.
Problems with the two agencies, both overseen by the state Department of Consumer Affairs, may signal a broader breakdown in the regulation of health professions. The department presides over more than 30 professional boards and bureaus, with varying and sometimes inconsistent approaches to screening for criminal offenses.
"The fear is that there's any vulnerability in the consumer protection we're offering," said Carrie Lopez, the department's director.
In general, Lopez said, she does not believe it is acceptable to take two years for regulators to file a formal complaint against a convicted sex offender. "We want to see action taken as soon as possible," she said.
The best way to do that, Lopez said, is to require all applicants for professional licenses to provide their fingerprints, allowing law enforcement to notify regulators of any arrests. The vocational nursing bureau has usable fingerprints from fewer than half of its 79,000 licensees because fingerprinting has been an on-again-off-again requirement since 1952.
The Times previously reported that more than 40% of the state's 344,000 registered nurses had no fingerprints on record because they were not required before 1990. After the story ran, the Board of Registered Nursing voted to require fingerprinting for all its licensees.
Registered and vocational nurses account for the bulk of bedside care in hospitals, nursing homes and other health facilities. Registered nurses have more training and assume primary responsibility for fulfilling doctors' orders and monitoring patients' conditions. Vocational nurses perform more basic tasks such as administering medications and taking vital signs.
In examining the vocational nursing bureau, reporters reviewed 162 disciplinary decisions made in 2007 against licensed vocational nurses. The documents were obtained through a Public Records Act request because the bureau historically has not made them available on its website.
Twenty-seven nurses racked up three or more criminal convictions before regulators filed complaints against them. Three had accumulated nine or more. In some cases the bureau took so long to act that judges said revoking the nurse's license was no longer necessary to protect the public.
That was the case for Donna Redcross of Mountain View. From 1990 to 2001, she was convicted three times for petty theft, three times for driving without a license and once each for possession of methamphetamine, disturbing the peace and drunk driving, bureau records show.
But the bureau made no move to restrict her license until February 2007. An administrative law judge, citing that delay, put her on three years of administrative probation. Through her lawyer, Redcross declined to comment.