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National Practitioner Data Bank
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Information Policy Note
Crown Jewels Campaign - National Practitioner Data Bank
August 14, 1994
- Congress considers proposals to grant greater public access
to database which contains information about malpractice
actions and disciplinary actions against physicians and
dentists.
- The National Practitioner Data Bank is operated by Unisys
Corporation under a $15.9 million contract from the U.S.
Department of Health and Human Services.
- Under current federal law, only state licensing boards,
medical societies, and certain health care providers
(principally hospitals and HMO's) are allowed access to the
database.
- Citizens interested in broader access to disciplinary
actions against physicians and dentists are urged to contact
members of Congress.
I. INTRODUCTION.
The National Practitioner Data Bank (NPDB) is a system that
provides a vast amount of information that is helpful in
evaluating the performance of doctors and dentists. The database
was created under the "Health Care Quality Improvement Act of
1986" (HCQIA, PL 99-660), in response to increasing criticism
about the failure of medical licensing authorities to protect
patients from incompetent or negligent doctors. The database
includes information about payments made to satisfy malpractice
claims and "adverse" disciplinary actions by state licensing
boards, hospitals, professional medical societies, and the
federal government. (For example, revocation of licenses or
hospital privileges). The database includes information about
physicians and dentists, and other professionals may be added in
the future, although to be brief, we will refer to physicians
only.
Because of heavy lobbying by the American Medical
Association (AMA), the current legislation prohibits the
government (or authorized users) from making the data available
to anyone except for state licensing boards, medical societies,
and certain health care providers (principally hospitals and
HMO's). Neither patients nor their physicians (who need
information in order to make patient referrals) have any access
to practitioner specific information from the NPDB.
Consumer and patient rights groups are asking that the
reporting requirements for the NPDB be tightened up, and that
patients and physicians be given broader access to the
information. There are two bills pending in Congress which would
address these issues.
II. HR 4274, HEALTH CARE QUALITY IMPROVEMENT ACT OF 1994.
Congressman Ron Wyden (D-OR) and Scott Klug (R-WI), have
proposed legislation, HR 4274, the Health Care Quality
Improvement Act of 1994, that would amend the current law to
require all malpractice payments be reported, along with the
names of the practitioners "for whose benefit the payment is
made," closing a loophole under which some insurers have made
payments on behalf of corporate entities, without identifying the
individual physicians who were the subject of malpractice claims.
State licensing boards would also be required to search the NPDB
before taking action on licensure or relicensure of
practitioners. Hospitals are currently required to search the
database when hiring or conducting period reviews of staff
privileges.
The most controversial proposed changes for the NPDB concern
broader disclosure of the information to the public. The Wyden-
Klug proposal would make available to the public all adverse
actions (revocation or suspension of licenses and privileges),
and malpractice payments concerning practitioners for whom the
Data Bank has reports of two or more separate incidents that
resulted in malpractice payments.
Consumer and patient groups want the changes sought by Wyden
and Klug plus more. In a June 7, 1994 letter to the New York
Times, Dr. Sidney Wolfe and Joan Stieber of Public Citizen's
Health Research Group said:
Excluding single malpractice payments from disclosure keeps
almost three-quarters of all practitioners in the data bank
secret from the public. The restriction also sets an
unacceptable standard that more than one patient must be
injured or killed before the public can be warned about a
potentially dangerous practitioner. We believe that all
information in the data bank should be made available to the
public -- the very people it was created to protect.
III. HR 4856, THE PATIENT SAFETY ACT.
On July 28, 1994, Representative Jerrold Nadler (D-NY)
introduced the Patient Safety Act, HR 4856. This act crates a
national medical malpractice prevention program, strengthens the
role of state medical boards, requires the government to study
the causes, costs and mechanisms for prevention for medical
negligence, and it would open up the NPDB reports to the public.
This bill would provide public access to information on all
practitioners, rather than those practitioners with multiple
malpractice payments.
IV. AMA position.
The A.M.A. not only opposes all public disclosure of the
NPDB data, but it wants to eliminate the NPDB altogether. In
1993 the A.M.A. House of Delegates passed a resolution stating,
"RESOLVED, The American Medical Association...call for the
dissolution of the National Practitioner Data Bank." A spokesman
for the AMA says told TAP that it continues to favor the
dissolution of the database.
The NPDB became operational on September 1, 1990. According
to the most recent data, the database contained reports of
adverse disciplinary actions 9,752 practitioners, and one or more
malpractice payment reports on 56,566 practitioners.
Consumer groups say that broader disclosure of the
information to the public will help protect patients,
particularly in light of the lax policing of the medical
profession. Using data it obtained directly from state licensing
authorities, Public Citizen estimated that in 65 percent of cases
where physicians were found to be incompetent, negligent, or
giving substandard care, there was no suspension or revocation of
licenses, and the doctors are still practicing. Even in cases
where doctors were disciplined for criminal convictions, 38
percent were still practicing medicine.
Dr. Sidney Wolfe notes that the NPDB is the only place where
one can find in a single place reports of different disciplinary
actions or malpractice payments, including actions from different
states.
There has been no action taken on either the Wyden/Klug or
the Nadler bills. Persons who support broader access to this
important government database should write their own members of
Congress, asking that the NPDB be opened to the public.
All members of Congress can be reached through the capital
switchboard, (202) 224-3121, or by mail at:
Member Name
U.S. House of Representatives
Washington, DC 20515
or
Member Name
U.S. Senate
Washington, DC 20510
for additional information:
Dr. Sidney Wolfe or Joan Stieber , Public Citizen's Health
Research Group
2000 P Street, NW
Washington, DC 20036
202/833-3000
Center for Patient Rights
666 Broadway, Suite 410, NY, NY 10012
212-979-6670
Congressman Ron Wyden, U.S. House of Representatives
202/224-4811
Congressman Jerrold Nadler, U.S. House of Representatives
202/225-5635
American Medical Association, Office of Public Affairs
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