Agency Finds Flaws in Malpractice Databank
The National Practitioner Data Bank, the repository off-limits to consumers that includes malpractice payments made by doctors and disciplinary actions filed against them, is flawed by inaccurate and incomplete information, concludes a report released recently by the General Accounting Office.
The congressional watchdog agency also contends that the Health Resources and Services Administration, the federal agency charged with overseeing the databank, has failed to address long-standing problems such as significant underreporting by the nation’s hospitals.
The databank, launched in 1990 to make it harder for bad doctors to flee problems in one state and set up practice in another, is closed to consumers. But hospitals and health plans are supposed to query it before granting credentials and continue to consult the databank every two years thereafter.
About 80% of the 250,000 reports filed with the databank are reports of malpractice payments. Recently a bill to open the databank to consumers sponsored by retiring Rep. Thomas Bliley, R-Va., died in subcommittee.
The measure was ferociously opposed by the American Medical Assn., which has repeatedly argued that consumers are not knowledgeable enough to interpret the malpractice and disciplinary information. The AMA also has sought to kill the databank, arguing that the medical establishment polices itself sufficiently without it.
Since the databank’s inception, hospital reports of disciplinary actions against physicians have been much lower than the 10,000 initially projected, the GAO notes. To date, fewer than 9,000 sanctions have been filed, and 60% of the nation’s hospitals have never reported taking any action against a doctor.
Health Resources officials told the GAO that underreporting is a long-standing problem, the extent of which is unknown. In an interview, Thomas Morford, the agency’s deputy director, said the agency is conducting an audit he hopes will quantify the problem.
In its 46-page report, the GAO also found serious flaws in the timeliness and completeness of malpractice information and actions by state medical boards. Investigators who examined all data-bank reports received in September 1999 found that a quarter of 1,300 reports of malpractice payments were submitted late, not within 30 days after a payment, as specified by law. There are no penalties for late reporting, according to the report, and Health Resources officials told investigators they worry that fines could have a chilling effect on submissions.
Another loophole addressed by the GAO--one that Health Resources has not yet closed--is known as the “corporate shield.” Names of doctors who make payments to settle malpractice cases must be reported to the databank, as long the payment is made in their name. Increasingly malpractice settlements reached in lieu of a trial often include a condition that the name of the doctor be dropped and payment made by a corporation, such as a health plan or a hospital, that is not subject to reporting. Health Resources has proposed regulations to close the loophole but hasn’t issued a final rule.
The GAO also found that 11% of 252 sanctions reported by state medical boards contained inaccurate or misleading information on the number of times a doctor had been disciplined. And nearly one-third of these reports did not say what disciplinary action was taken or why it was ordered.
Morford defended the databank, saying it was providing information as Congress intended. “We think the databank actually works pretty well,” he said. “This is a screening device. It was never intended to be the be-all and the end-all of quality.”
AMA officials pounced on the report as evidence that the computerized registry is a failure. Thomas R. Reardon, the group’s immediate past president, called the databank “seriously flawed” and added that it is “clearly struggling to fulfill its mandate.”
Medical consumer groups countered that the remedy is to fix the problems GAO identified and to open it to the public it is supposed to protect.
“But you could ask the rhetorical question: Will this ever be accurate unless it’s public?” said Arthur Levin, executive director of the New York-based Center for Medical Consumers.
