During his back surgery in Hawaii in 2003, Arturo Iturralde was implanted with part of a screwdriver as reported by USA Today and other news sources at the time. Upon learning that there was no titanium rod for use in the surgery, and with the nearest rods hours away on another island, Iturralde's surgeon opted to implant part of a stainless steel screwdriver instead. After undergoing three corrective surgeries, Iturralde was left a bedridden paraplegic by the surgical error. Later, it was discovered that the surgeon's license had been suspended in Oklahoma and revoked in Texas.
The National Practitioner Data Bank (NPDB) was designed to prevent these situations. Federal law requires state medical boards and hospitals to report doctors making medical malpractice payments or settlement, or facing certain disciplinary actions. But according to a study by Public Citizen, the system is not working. It was estimated that the NPDB would receive 5,000 to 10,000 reports on doctors every year; the average number of annual reports is about 650.
National Practitioner Data Bank Gathers Reports on Dangerous Docs
The American Medical Association describes the NPDB as an electronic repository of reports on all payments made on behalf of physicians in connection with medical liability settlements or judgments as well as adverse peer review actions against licenses, clinical privileges and professional society memberships of physicians and other health care practitioners. NPDB receives information including:
- All professional liability payments made on behalf of physicians or other health care practitioners to settle medical malpractice claims
- Adverse action reports based on a physician or other health care practitioner's professional competence or conduct that adversely affects privileges for more than 30 days; this includes decisions not to renew privileges because of incompetence or professional misconduct and voluntary surrender of licenses or restrictions of privileges during investigation or to avoid investigation
- Discipline related to incompetence or professional misconduct against a physician, including license revocation or suspension, sanctions such as reprimand or censure, probation and license surrender
- Adverse membership action by professional societies because of incompetence or professional misconduct
- Exclusion reports from Medicare and Medicaid because of fraud or abuse
The NPDB must make this information available to hospitals, state licensure boards, some professional societies, self-querying practitioners, and certain other health care entities in some situations.
Public Citizen Report and Letter
In a letter to the Secretary of the Department of Health and Human Services, Alan Levine and Sidney M. Wolfe of Public Citizen say that in over 17 years of existence, the NPDB has not received a single report from nearly half of the hospitals required to report doctors whose admitting privileges have been terminated or restricted for more than 30 days. Wolfe says these numbers are simply not believable.
The Public Citizen report explains two potential reasons contributing to such low reports: inadequate hospital discipline and reporting loopholes even when discipline occurs. The study indicates that the actual amount of doctor discipline is low, stemming from lax hospital peer review. Additionally, loopholes exist in the reporting requirements, such as imposing disciplinary action for less than 31 days to avoid the reporting requirement or allowing doctors to take leaves of absence instead of facing suspensions.
Dave Swankin, president of Citizen's Advocacy Center, offers further insight, saying that it is a cultural phenomenon that people do not like to turn in other people and that this includes doctors. Additionally, he says hospitals may not want to sanction doctors who are bringing in money.
The American Hospital Association (AHA) responded to these comments stating that hospitals are taking an active role in a variety of efforts to improve care and that patient care cannot be measured by the number of reports received by the NPDB. Study authors disagree and are calling for federal penalties for hospitals that fail to report doctors, including disqualification for Medicare participation and civil penalties.
Patients who have suffered injury as a result of the negligence of a doctor, physician, surgeon or other health care professional should consult with an experienced personal injury lawyer to determine whether they have a claim. Victims of medical malpractice may be able to recover compensation for medical expenses and lost wages.
