Tag Archives: malpractice

‘On The Media’ covers NPDB controversy

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

This week’s “On The Media” show features AHCJ President Charles Ornstein discussing the public use file of the National Practitioner Data Bank.

Conference call: Future of NPDB Public Use File

Journalists can participate in a call with HRSA officials on Oct. 13, 1-2 p.m. ET. Please register in advance.

Listen to On The Media

As regular readers of Covering Health know, this is an important file that has been used by patient safety advocates, reporters and other researchers to report on medical disciplinary actions, lax oversight and loopholes at state medical boards. The Health Resources and Services Administration, part of the federal Department of Health and Human Services, took the file offline on Sept. 1 following a complaint from one doctor’s lawyer.

AHCJ and other journalism groups have protested the removal of the file and have called for it to be returned to the public site. U.S. Senator Charles Grassley has joined the protest with a letter to the HRSA administrator that demands answers to his questions about why this file is no longer publicly available.

Duff Wilson of The New York Times wrote a blog post about the file being taken offline and Grassley’s letter. For complete coverage of the issue, please see AHCJ’s Right to know news.

Journalism organizations offer data government blocked from public

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

Another development in the protest by three key journalism groups to the Obama administration’s decision to block public access to a public database of physician discipline and malpractice: Now, Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.

The data are posted for the entire U.S. in the original text format with documentation. IRE has also made available state-by-state Excel spreadsheet files.

On Thursday, the groups sent a letter protesting the decision to pull offline a the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

The public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

“We applaud IRE for making this data available for free to the media, researchers and the public,” said Charles Ornstein, AHCJ’s president. “While the government has decided that this ‘public use file’ should no longer be public, our organizations believe that it continues to be a critical resource. I encourage reporters, even those who have never used it before, to look for stories within it now.”

Journalists have used the data for years to draw attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and The Kansas City Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

The U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

Several news outlets – The New York Times, Los Angeles Times, Reuters and the St. Louis Post-Dispatch – are following the story.

AHCJ, other journalism organizations protest removal of data from public website

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

The Association of Health Care Journalists, joined by the Society of Professional Journalists and Investigative Reporters and Editors, sent a letter to the Obama administration today protesting its decision to pull offline a public database of physician discipline and malpractice payments.

Read the letter sent by the journalism organizations to Mary K. Wakefield, administrator of the Health Resources and Services Administration.

Stories using the NPDB

The Kansas City Star

• Doctors with histories of alleged malpractice often go undisciplined
• Obama’s HHS shuts down public access to doctor malpractice data

Duluth (Minn.) News Tribune

• AHCJ article: Duluth News Tribune exposes malpractice allegations
• As Duluth hospital reaped millions, surgeon racked up complaints
• Multiple allegations against former St. Luke’s doctor
• Ailing patients speak out about former Duluth doctor
• Wisconsin restricts former Duluth doctor’s license
• In Texas, former Duluth surgeon may be sanction-free
• Federal database of malpractice cases doesn’t make public doctors’ names, or where they practice

Propublica

States Fail to Report Disciplined Caregivers to Federal Database

St. Louis Post-Dispatch

• Reporters encounter hospital’s lack of transparency
• Tip sheet from Bernhard & Kohler on researching health professionals.
• Award entry: Who Protects the Patients?
• Serious medical errors, little public information
• Caution urged with facedown restraints
• Doctor lost hospital privileges but kept clean record
• Girl, 16, dies during restraint at an already-troubled hospital

Milwaukee Journal-Sentinel

• Dangerous Doctors
• AHCJ article: Records show ‘dangerous doctors’ rarely face discipline
• Tip sheet from Gina Barton on state oversight of health professionals

Connecticut Health Investigative Team

• Disciplined Docs Practice Freely In State

West Hawaii Today

Medical malpractice in Hawaii
Diagnosis-related claims among top reasons for suit

Public Citizen

• Hospitals avoid reporting disciplined docs: The nonprofit group released a report showing that hospitals nationwide are taking advantage of  loopholes to avoid reporting disciplined physicians to a national database.  The Miami Herald‘s John Dorscher, the Detroit Free Press‘s Patricia Anstett and the Contra Costa Times‘ Sandy Kleffman reported local versions of the story that are no longer available online.

Earlier stories about access to NPDB:

• Data Mine reports on access to practitioner data: The Center for Public Integrity focuses on the National Practitioner Databank and the lack of public access to information in the database.
• Access to list of disciplined health workers in limbo: NPR’s Joseph Shapiro looked into the status of the Healthcare Integrity and Protection Data Bank.
• Public Citizen posted an open letter to HHS Secretary Kathleen Sebelius explaining why the database is important, and details the consequences of keeping it under wraps.

AHCJ, SPJ and IRE called for the government to immediately restore access to the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

Pursuant to the law, the public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

As an example, the database would allow a reporter or researcher to discover that certain, unnamed physicians have been sanctioned repeatedly by their hospitals but never were disciplined by their state’s medical board. It would also be possible to find doctors with lengthy trails of malpractice who continued to enjoy clear licenses.

The groups also expressed their deep disappointment that the U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

The government said that it had to act now because reporters were able to link information in the data bank to specific doctors, and the law prohibits the public use file from identifying doctors. A HRSA spokesman said the data bank will be offline for at least six months and may never return unless the physician privacy concerns are adequately addressed.

AHCJ President Charles Ornstein said he was puzzled by HRSA’s sudden action because reporters have used the public version of the data bank for years to assist in their reporting and learn additional details about physicians they already had been researching.

“We are troubled that the Obama administration appears to have placed the interests of physicians ahead of the safety of patients,” Ornstein said. “Attempting to intimidate a reporter from using information on a government website is a serious abuse of power.”

Stories written by reporters using the public version of the National Practitioner Data Bank have drawn attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and the Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

Some of these stories have resulted in new legislation and other steps that protect patients, by increasing transparency and sometimes toughening requirements on doctors.

The groups wrote that if HRSA determines the public version of the database violates the law in any way, it should seek swift legislative changes to remedy the problem and once again make the database available.

“In one stroke, the very administration that promised greater transparency not only excludes information of obvious public value to patients across this country but threatens legal action against a reporter for using public records,” said SPJ President Hagit Limor. “This is clearly outrageous.”

IRE President Manny Garcia said, “The removal of the Public Use File - whose very name means for public use – eliminates a valuable tool for journalists whose goal is to educate and protect the public. This database has allowed reporters to uncover flaws that have toughened legislation, and without a doubt, saved the lives of patients across the country.

“We are also stunned that a public servant has the hubris to threaten a health care reporter for doing his job. HRSA should be delighted that journalists are using public information to help saves lives, but in this instance the response is: get lost or get fined.”

Spreadsheet lists malpractice claims against VA

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

In its “FOIA Friday” feature, the Project On Government Oversight reveals a spreadsheet (XLS format) of claims against the Department of Veterans Affairs, including thousands related to medical malpractice.

The spreadsheet lists administrative claims, the first step in the VA’s process for filing claims.

Nick Schwellenbach explains more about the data:

The data provided has details on over 12,000 claims against the VA from 1989 to November 2008, although the data appears largely incomplete for the first several years. Not all of the claims are medical malpractice-related, but several thousand are. There are fields for the VA facility involved, the date the claim was received, the date of the last tort status (where the claim is in the administrative process), the date of that status, alleged negligence descriptions (none exist for non-medical malpractice tort cases), and amount paid out, if any. The spreadsheet is over two years old, so the latest tort status field may be out-of-date for many of these claims.

The spreadsheet includes 16 cases in which more than $1 million was paid out. The descriptions of the allegations are pretty vague but those 16 cases include:

  • Failure To Obtain Consent or /Lack Of Informed Consent; Improper Technique; Improper Performance; Improper Management; Delay In Diagnosis; Failure To Treat; Failure To Order Appropriate Medication; Failure To Monitor; Failure To Diagnose (i.e., Concluding That Patient Has No Disease or Condit[ion)]
  • Failure To Respond To Patient
  • Surgical or Other Foreign Body Retained
  • Unnecessary Procedure; Intubation Problem; Improperly Performed Test; Improper Management

It’s worth noting that another recent “FOIA Friday” also was related to health. It was a letter sent by the National Institutes of Health to Emory University “after the media exposed Dr. Zachary Stowe’s cozy financial relationship with GlaxoSmithKline (GSK) while also receiving NIH grants to study antidepressants like GSK’s Paxil in pregnant women.”

Las Vegas Sun caps series by showing solutions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the Las Vegas Sun reporter Marshall Allen wraps up his wide-ranging Do No Harm series on hospital quality by showing how Nevada hospitals could be approaching medical errors differently.

lasvegassunHis focus is the Seven Pillars program at the University of Illinois at Chicago, which should be familiar to Covering Health readers. The key to the program is a commitment to admitting errors and discussing them with patients, an approach that improves the patient experience and reduces the risk of malpractice suits.

To cap off the series, the Las Vegas Sun included the thoughts of Allen’s boss, Publisher and Editor Brian Greenspun.

Related

The Chicago chapter of AHCJ recently hosted a discussion about medical errors and transparency, which included David Mayer, M.D., who, with Tim McDonald, M.D., has co-founded an organization dedicated to the prevention of patient harm. Most recently, McDonald and Mayer were awarded a $3 million federal grant to implement and evaluate patient safety efforts on a larger scale. AHCJ members can read about the discussion and listen to Mayer’s comments.

Editor’s note:

Allen completed part of this series while on an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund

Innovative approaches to malpractice, errors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

American Medical News reporter Kevin O’Reilly writes about a presentation by David Mayer, M.D., University of Illinois at Chicago Institute for Patient Safety Excellence co-director, at an AHCJ Chicago chapter event. The event shed light on some ways to tackle malpractice and errors in a way that will benefit both physicians and their patients.

David Mayer, M.D.

David Mayer, M.D.

Mayer talked about turning doctors away from the “deny and defend” approach to malpractice and toward an open disclosure of medical errors. He seeks to reduce malpractice suits through a “seven pillars” approach. Here’s a quick summary of how things work:

  1. Patient safety incident reporting: Push for fast reporting of possible incidents
  2. Investigation: Figure out if something really went wrong.
  3. Communication and disclosure: Keep patient and family informed during the entire process. Even if it involves very bad news.
  4. Apology and remediation: Don’t just apologize, tell them how you’re going to fix the damage and/or offer compensation.
  5. System improvement: Change the system to prevent it from happening again, invite the patient and family to participate.
  6. Data tracking and performance evaluation: Keep a massive database of all safety incidents and use it with impunity, even for public outreach.
  7. Education and training: Carefully monitored continuing education that is informed and directed by error monitoring and in-house incidents.

Meyer’s pillars are going to be implemented in nine Chicago-area hospitals, thanks to a $3 million grant from the HHS Agency for Healthcare Research and Quality. The grant is one of seven “demonstration grants” the AHRQ awarded as part of its program to evaluate “Patient Safety and Medical Liability” projects. The agency also awarded 13 smaller planning grants.

Calif. malpractice cap: Model or cautionary tale?

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The San Francisco Chronicle‘s Victoria Colliver reports on how a discussion of a health reform-related push for medical malpractice reform can learn from California’s 34-year old law capping malpractice awards at $250,000.

First, the case against the cap: It’s too small (1975′s $250,000 is equal to about a million of today’s dollars) to make malpractice suits worth a lawyer’s while.

Critics object to the fact the $250,000 cap hasn’t been adjusted for inflation in 34 years . They also argue that because the law allows unlimited awards for economic losses, such as lost wages and ongoing medical costs, it discriminates against children and seniors, who have limited earnings if any, as well as against the families of those who died and did not have high medical costs.

“It’s economic suicide for a medical malpractice lawyer in the state of California to undertake too many or any cases that are capped at just 250,000,” said Erik Peterson, a San Francisco medical malpractice attorney who agreed to take on the Volkmuth’s case, even at a loss.

inflation1 Cap proponents say the law helps keep costs down and to attract physicians to the state.

Supporters say the law has resulted in improved access to care for patients because it has persuaded doctors to stay in California without fear of skyrocketing insurance premiums.

Lisa Maas, executive director of Californians Allied for Patient Protection, pointed to her group’s research, which shows the average annual premium for a specialist in obstetrics and gynecology in Los Angeles was about $90,000 last year, compared to nearly $195,000 a year for the same specialist in Nassau and Suffolk counties of New York, a state without medical malpractice reforms.

Malpractice reform joins health system debate

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Erica Werner of The Associated Press reports that Ezekiel Emanuel, a key adviser on health issues to President Obama and brother of White House chief of staff Rahm Emanuel, offered some hints recently about the role of malpractice lawsuit reform in the debate over changes to the country’s health care system.

Ezekiel Emanuel

Ezekiel Emanuel

At a meeting of the American Medical Association, Ezekiel Emanuel said:

“I’m not going to give you any details because I can’t. I just can tell you I’ve been thinking long and hard about that,” Emanuel, an oncologist and the brother of White House chief of staff Rahm Emanuel, told the doctors when asked about malpractice lawsuit reform. “It hasn’t gone unnoticed. So stay tuned.”

Mary Ann Geier, organizer of Health Camp Philadelphia, posted on Twitter that she wonders what the hidden agenda is and whether it might not be incompatible with true reform. She says it’s something the average person can’t figure out. Reporters, what can you tell us?

Senate Finance Committee Chairman Max Baucus, D-Mont., has proposed developing “alternate litigation models,” similar to proposals offered by Obama and Hillary Clinton.

Sen. Ron Wyden, D-Ore., says malpractice reforms are key to overhauling the health care system.

“I think it’s an essential piece for there to be enduring reform, reform that will stick and will get a significant bipartisan vote in the United States Senate,” Wyden said.

Perhaps Wyden will expand on those comments when he speaks at Health Journalism 2009 on April 17.