Failure to investigate or report cases of doctor wrongdoing endangers patients.
Washington, DC, May 27, 2009 — Though a federal law requires hospitals to report physicians who have had their admitting privileges revoked or restricted for more than 30 days, a Public Citizen report released today found that in addition to inadequate discipline of physicians, hospitals routinely exploit loopholes to avoid government requirements, with nearly half of all hospitals not submitting a single doctor’s name to the National Practitioner Data Bank (NPDB) in the more than 17 years it has existed.
The failure of hospitals to adequately discipline doctors or to report cases of physician discipline to the NPDB deprives state medical boards of critical information needed for regulatory oversight and creates the potential for patient harm, Public Citizen said in the report and in a letter sent today to Kathleen Sebelius, secretary of the Department of Health and Human Services.
When the database was first created, federal officials estimated that hospitals would report approximately 5,000 cases a year. But since it began 1990, the database has averaged only 650 reports a year, Public Citizen found.
“It is impossible to justify the fact that thousands of hospitals, which collectively have granted admitting privileges to hundreds of thousands of doctors, have not reported a single discipline case in 17 years,” said Dr. Sidney Wolfe, Public Citizen’s acting president and director of its Health Research Group. “Our report shows there is an urgent need for the Obama administration to step in and hold hospital administrators accountable as well as ensure that hospital medical staffs hold their own physicians accountable for patient safety.”
Pubic Citizen compiled the report by reviewing studies by the Office of the Inspector General, medical journal articles, work by the non-profit Citizen Advocacy Center and recommendations from an October 1996 national meeting on hospital underreporting attended by hospital administrators, government officials, medical associations and consumer advocates, including Public Citizen. Public Citizen also analyzed the NDPB to examine the relationship between hospital reports and actions taken by state medical boards on the same physicians.
The report points to two troubling factors behind the dangerously low number of hospital discipline reports: 1) Lax peer review, including a culture among doctors of not wanting to “snitch” on a colleague; 2) hospital administrators evading reporting requirements by doing things such as imposing discipline of less than 31 days, thereby evading the reporting requirement or giving doctors a leave of absence in lieu of suspensions.
Public Citizen makes several recommendations, including amending the Health Care Quality Improvement Act of 1986 to add fines for each instance of a hospital’s failure to report and tying compliance with the act to the hospital accreditation process and Medicare conditions of participation.
“Hospital peer review has been called one of the pillars of quality assurance in the U.S. health care system,” said Al Levine, the Public Citizen researcher who compiled the report. “Based on all the data and reports we analyzed, it appears to be a questionably effective form of self-regulation that needs more accountability and better oversight. We hope our report is the tipping point for action by Congress and the Department of Health and Human Services.”
Public Citizen’s letter to Sebelius urges her to implement recommendations made long ago by the HHS Inspector General’s office but never acted upon.