A recent report by Public Citizen uncovered glaring holes in a key government-run database meant to identify doctors and other health care providers who may not be fit for employment. The report found that the National Practitioner Data Bank (NPDB) contains at least 50,000 incomplete files, a huge gap which makes it difficult for hospitals and other health care organizations to effectively screen doctors.
The NPDB serves a clearinghouse for medical malpractice information, with hospitals, hospital regulatory boards and other organizations feeding information into the database every time problems arise. Nearly 17,000 groups rely on the NPDB, including state licensing boards and hospitals, to conduct background checks before making crucial hiring decisions. Incomplete or inaccurate information provided by the OIG thus makes it difficult for these groups to get a full and accurate picture of the candidates they are considering hiring.
According to Public Citizen, the problem exists because of flaws in the reports taken by the Office of Inspector General (OIG) of the Department of Health and Human Services. An investigation found that incomplete and inaccurate information relating to the identity of physicians resulted in only 47 percent of all the exclusion reports provided by the OIG being available to those groups conducting searches. By comparison, 71 percent of the reports provided by medical boards were available and 85 percent of all hospital disciplinary records were accessible.
Experts say some relatively simple changes could improve the accuracy of the reports and make the information more accessible to those who need it. For one thing, the OIG only recently began using something known as the National Provider Identification Number (NPI). Though other groups have included the NPI on reports to the NPDB for years, the OIG only this year committed to including the NPI on its reports. NPIs are incredibly useful because they allow those groups conducting background checks to more easily pull together all the relevant information on one physician.
Beyond these accuracy issues, there are also serious problems with the accessibility of the NPDB, especially for the attorneys of injured patients. A plaintiff’s attorney can only access the NPDB records under very limited circumstances and only if there is evidence that a hospital failed to conduct a query that it should have as part of its credentialing process. The NPDB’s own website specifies that any information obtained by an attorney may be used only in the litigation against the hospital and not against the practitioner. Though attorneys of injured plaintiffs could benefit greatly from knowing if the doctor they are suing has previous reports on file, they are barred from viewing that information. Instead, the information is protected under the umbrella of confidential peer review.
Though the NPDB can be a great way for hospital to keep track of physicians who have made costly mistakes, there are unfortunately a variety of loopholes that make the system opaque. For instance, the guidelines of the Department of Health and Human Services clearly state that any payments made by a physician out of his or her own pocket do not require any report be filed with the NPDB.
Another glaring loophole in the database that has generated substantial controversy is known as the corporate shield. This refers to the rule that says when an entity (like a hospital or clinic) makes a payment in a suit that does not identify a specific practitioner and when a practitioner has been dismissed from a lawsuit prior to settlement, no report must be filed with the NPDB. The problem is that this allows doctors to game the system, having insurers cut a deal with plaintiff’s attorneys to dismiss the doctor from the suit and allow settlement payments to be made by the doctor’s hospital or another corporation, shielding the doctor from damaging med mal reports.
The Department of Health and Human Services has long recognized this loophole and has repeatedly considered limiting its use. Though efforts have been made to stop the practice, physicians groups have successfully countered such attacks and the loophole remains in place today. It’s sad to think the NPDB, which could be used to help protect unsuspecting patients from negligent or incompetent doctors, is instead full of unreliable or inaccessible information.