The Westminster Nursing and Convalescent Center didn't know the man it hired as a nursing assistant in November 1993 had a criminal record and a history of mental illness that had put him in state psychiatric hospitals a dozen times the previous seven years.
Michael Paul Griffith -- who was convicted last week in Carroll Circuit Court of killing a 94-year-old patient a month after he was hired -- never disclosed his questionable history on his employment application.
And officials at the nursing home didn't check it.
That is about to change. Like a handful of the state's 320 nursing homes, the Westminster facility has begun to run criminal background checks on all new employees.
It's a move that's catching on nationwide as the country's 20,000 or so nursing homes grapple with increased violence and theft victimizing their 2.5 million patients.
"To a certain extent, every employer is in this dilemma, but ours is a different kind of situation because our business is taking care of people," said Nancy Stocks, director of Westminster Nursing and Convalescent Center.
"We implemented checks in light of this incident, and we recognize that there is a national push in this direction."
According to a 1994 Gannett News Service investigation, just less than 2 million people nationwide are certified to work as nursing assistants. But, while all states have regulations regarding certification and training, the ability of health officials to keep track of complaints, criminal convictions and the competence of nursing aides is severely hampered.
The Gannett investigation revealed that among the 630,000 nursing aides who are working at any given time, more than 20,000 have criminal convictions.
In Maryland, 18,000 people are certified nursing aides, according to the Office of Licensing and Certification. Forty-two are listed on a separate registry that tracks criminal convictions involving violence or theft.
The system "may not function as well as some would like it to," said Francis Miller, coordinator of the office's geriatric aide programs.
Theoretically, the system is supposed to allow nursing homes to call the state office, determine if a person is certified and if that certification is valid. But it doesn't always work that way.
Maryland requires all nursing aides to complete at least 75 hours of training. There are two ways to fulfill that requirement: through schooling, or, if a nursing home has a state-approved curriculum, on-the-job certification within four months.
Griffith, 32, took the latter route. He applied for the $12,000-a-year job and was in the process of certification when he suffocated Carrie Marie Ecker, a 94-year-old patient who frequently complained that she was in pain and wanted to die.
Mrs. Ecker had been a resident at the Westminster Nursing and Convalescent Center for 15 years, and her family acknowledged that she sometimes was in excruciating pain.
Originally, her death was attributed to natural causes. But after Griffith confessed to state police that he killed her, Mrs. Ecker's body was exhumed and a state medical examiner ruled her death a homicide.
Griffith, who entered an Alford plea in the case, was convicted of second-degree murder.
"I cared about those patients out there," Griffith said before he was sentenced Monday to 10 years in prison. "I wouldn't do anything to hurt them."
While there is no direct correlation between Griffith's background and his performance as a nursing aide, the nursing home at least would have had that information before it made a hiring decision if it had done a background check, said Elizabeth E. Kirk, the state's Long-term Care Ombudsman.
As in 43 other states, Maryland does not require criminal background checks on nursing aides.
"The system, as we have it now, is a joke," Ms. Kirk said. "Even when somebody is registered as a convicted criminal, in the time between the charge and the conviction, they could be on to a home somewhere else. We have supported criminal background checks as a start in fixing the way nursing aides are certified and registered."
Maryland has 27,000 nursing home patients and most of their daily care -- bathing, feeding, clothing -- is in the hands of nursing aides.
While Ms. Kirk says most nursing aides are hard-working and law-abiding, the conditions of their workplace can play a role in the escalating number of violent attacks on and thefts from patients.
"This is not a glamorous job in any sense of the word. They [aides] are sometimes treated like animals, they're not respected and their pay is unbearably low," Ms. Kirk said. "But they have to remember they are dealing with vulnerable people."
Her office investigates the nearly 800 complaints filed against Maryland's nursing homes every year, she said.
"Somebody has got to stand up and speak for these people," Ms. Kirk said of the patients. "They often can't do it themselves."