PHYSICIAN DATABASES: Missing the Mark?
The declining number of disciplinary actions taken against physicians over the past decade raises questions about the "adequacy of information in the national computerized data bank that hospitals and health plans rely on for information about doctors' records," according to a study in the Journal of the American Medical Association. In an analysis of The National Practitioner Data Bank, a repository of physician information designed to prevent "bad doctors from moving from hospital to hospital or state to state undetected and with impunity," researchers found that only 800 reports of suspended doctors' privileges were entered into the data bank in 1998, out of an estimated 14,000 reports officials expected to receive (Boodman, Washington Post, 8/3).
The low numbers, researchers hypothesize, indicate that physicians are "reticent to take reportable ... actions against their peers" (JAMA, 7/28). Since the data bank began in 1991, "physicians have become totally intransigent about settling a case in a reasonable way," said Roger Rosenblatt, coauthor of the study, adding, "Its existence has transformed physician behavior. The contortions people go through to stay out of the data bank are truly stunning." Hospital complicity in keeping physicians out of the data bank, possibly in attempts to demonstrate "loyalty and dedication" to their staff, contributes to the problem. For example, the data bank requires the reporting of all suspensions of thirty days or more. A growing number of hospitals are now "imposing 29-day suspensions and other penalties that don't have to be reported." Physicians seeking to avoid entry into the data bank often get their names removed from malpractice suits, leaving a hospital, health plan or group practice as the defendant, since settlements against these entities are not reported to the database. The study found that rural hospitals were less likely to report disciplinary actions than urban hospitals. Hospitals in three states -- California, New Jersey and West Virginia -- that impose fines of more than $5,000 for failing to notify state medical boards of disciplinary actions -- "had significantly higher rates of reporting to the data bank" (Washington Post, 8/3).