Tag Archives: national practitioner data bank

Campaign wants some immunity for docs who apologize

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.

According to my mother, it sometimes isn’t enough to just say you’re sorry. In The Kansas City Star, Alan Bavley writes that, apparently, some physicians disagree. In particular, an organization called “Sorry Works!” thinks that apologies are powerful enough that they should provide doctors with immunity from some malpractice and disclosure rules. And, he writes, they’re campaigning to make it official.screen-shot-2012-05-22-at-25535-pm

…about five years ago, Sorry Works! changed from a coalition of doctors, lawyers, insurers and patient advocates. Now it’s a commercial consulting firm. Founder Doug Wojcieszak offers training to hospitals and doctors. And he has started crusading for new immunity for doctors who apologize.

According to Bavley, “Wojcieszak wants the (National Practitioner Data Bank) bank to keep malpractice payments secret in many cases when doctors make apologies and disclosures. Further, he wants doctors shielded from medical board discipline on these cases.”

Consumer’s Union and patient safety organizations have come out against the Sorry Works! campaign because, as Bavley writes, “proposal would give doctors who were going to settle a suit anyway an incentive to apologize just to keep it off their record.”

Under Sorry Works! three strikes rules, the vast majority of doctors (who face one or fewer malpractice suits during their career) would be able to stay clear of the data bank entirely, thus denying the public and medical boards access to crucial information that’s currently being made public.

William Heisel at ReportingOnHealth.org explains why Consumer’s Union and Robert Oshel, the designer of the National Practitioner Data Bank’s Public Use File are not in favor of the campaign .

HHS responds to questions about enforcement of NPDB restrictions

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.

Journalists who name troubled physicians in their stories after downloading a public version of the National Practitioner Data Bank do not have to answer government questions about their sources and will not be subject to criminal, civil or administrative penalties if they violate new restrictions on use of the database.npdb-041312

That’s according to a spokesman for the U.S. Department of Health and Human Services, who wrote to AHCJ last week. AHCJ had asked the U.S. Health Resources and Services Administration, which operates the database, how it intended to enforce the new restrictions on its use, which were imposed late last year.

The federal response is the latest in a long-running dispute between the Obama administration and journalism organizations about the Public Use File of the government’s doctor disciplinary database.

The National Practitioner Data Bank compiles malpractice payouts, hospital discipline and regulatory sanctions against medical practitioners, for private use by hospitals and other organizations that credential them.

While the data bank is secret, for years HRSA has posted a Public Use File, often consulted by reporters and researchers. This public version of the data bank lists the disciplinary actions, but identifies the doctors and other practitioners only by number. As required by law, it contains no identifying information, such as names, addresses, Social Security numbers or dates of birth. But reporters have used the Public Use File to enhance information they had gathered elsewhere on known doctors.

HRSA removed the Public Use File from its website last year for two months after a doctor and his lawyer complained that a Kansas City Star reporter improperly used it to identify him. Following protests from journalists and consumer groups, in November, HRSA restored the public file but began requiring anyone wishing to download it to agree he or she will not use it to identify individual physicians.

The Association of Health Care Journalists, Investigative Reporters and Editors, National Association of Science Writers, National Freedom of Information Coalition, Reporters Committee on Freedom of the Press, and Society of Professional Journalists protested this decision.

In a letter sent to HRSA administrator Mary Wakefield in December, the groups asked what process HRSA would follow to determine whether a reporter had violated the agreement and whether HRSA would ask to see notes and talk to sources, among other questions.

In a response, HHS Deputy Assistant Secretary for Public Affairs Chris Stenrud wrote:

“As you know, HRSA is required by law to maintain the information in the Public Use File of the National Practitioner Data Bank (NPDB) in a form that does not permit the identification of individual practitioners or health care entities. The data use agreement (DUA) was added to help ensure that the data would be in such a form and HRSA’s legal obligation under the statute would be met.

“HRSA will investigate alleged breaches of the DUA on a case-by-case basis. HRSA may request additional information from the reporter or third parties, but the Department cannot compel reporters or third parties to speak with us. We have been advised by the HHS Office of the General Counsel that a user who violates the Public Use File’s DUA is not subject to criminal, civil or administrative penalties. If HRSA determines that data from the PUF have been misused, however, HRSA would need to re-examine the data and consider removal of any specific data points that are making the information identifiable.”

AHCJ President Charles Ornstein said he believes the government continues to misinterpret the law governing the database, noting that previous Democratic and Republican administrations had not imposed this requirement on the same information. That said, he advised reporters using the Public Use File to exercise their rights not to answer questions about their reporting methods that federal officials may ask.

“This fight is not over,” Ornstein said. “While we are adamant that the government return free and open access to this database, this letter provides answers to some of the questions we asked,” Ornstein said. “In the event the government comes calling, reporters do not have to answer questions about their sources, and they and their organizations cannot be penalized in any way for their use of the Public Use File.”

Ornstein suggested reporters speak to their editors and attorneys before downloading the database. Another option, he said, is for concerned reporters to download a slightly older version of the file -which has no restrictions on its use – from the website of the Investigative Reporters and Editors. The file has not been updated since August 2011.

“If anyone encounters any difficulty or problems from government officials regarding their use of the doctor discipline database, please alert us immediately,” Ornstein said.

For more background, please see AHCJ’s Right to Know page or this timeline.

Related

Secrecy around data bank protects ‘Practitioner No. 222117′

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.

Alan Bavley of The Kansas City Star provides us with a stark illustration of why new restrictions on the use of the National Practitioner Data Bank are not in the public interest.

In the most straightforward example yet, Bavley reports on “Practitioner No. 222117,” a doctor whose medical licenses have been revoked or suspended by 20 states, who was banned from billing Medicaid or Medicare and whose license to prescribe was yanked by the Drug Enforcement Administration. Bavley learned all of that from perusing the data bank’s Public Use File.

The NPDB includes reports on malpractice payments and disciplinary actions involving health care professionals. Hospitals and state medical boards can use the data when deciding to grant staff privileges or when reviewing license applications, though AHCJ found state medical boards do that less than you might expect. The NPDB’s Public Use File, available for download on a public website, removes identifying information. Bavely’s article explains more about how they de-identify the data.

Despite all we know about Practitioner No. 222117, we don’t know if he or she is still practicing medicine. The public, including journalists, is restricted from using the data to identify this doctor.

In the past, reporters have used information in the Public Use File, in combination with other records, to identify to flesh out their reporting on troubled doctors and show the failure of medical boards to act against doctors with multiple malpractice awards.

That ended on Sept. 1, when the U.S. Health Resources and Services Administration, which runs the database, removed the public use file because one doctor complained about stories that Bavley was writing.

AHCJ, along with other journalism groups and patient-safety advocates, decried the database’s removal. In November, HRSA restored the Public Use File – but with restrictions on how it can be used. Reporters and researchers have to agree not to connect any individual to information in the database. Reporters can be barred from future access to the database if HRSA decides they have violated the rules. For more background, please see AHCJ’s Right to Know page or this timeline.

Agency’s restrictions on data about disciplined doctors continue to get attention

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 Kansas City Star and The Sacramento Bee ran editorials over the weekend to denounce the recent decision by the U.S. Health Resources and Services Administration to place restrictions on the public use file of the National Practitioner Data Bank.

The Star says the restrictions “display an appalling disrespect for journalists and researchers and for the public’s right to gain information about the doctors to whom they entrust their health and safety.”

It calls the move a “clumsy attempt to restrict access to public information [that] promotes nothing but confusion and darkness.”

Meanwhile, The Bee says the Obama administration has “positioned itself on the side of protecting the privacy of doctors who maim patients.” It also suggests that President Obama reread the First Amendment.

On Sunday, the Society of Professional Journalists hosted AHCJ President Charles Ornstein, SPJ President John Ensslin and Kansas City Star reporter Alan Bavley for a discussion of the data bank and the importance of its information being open to the public without restrictions.

As regular Covering Health readers know, the public use file has been used regularly by reporters who have covered lax oversight of troubled doctors. When Bavley was working on such a story, however, a doctor he was investigating contacted HRSA and complained the data was being used improperly. That doctor’s complaints led to HRSA threatening Bavley with a fine, which it later backed down from, and pulling the data off of the website.

After protests from journalism organizations, consumer groups, academic researchers and U.S. Sen. Charles Grassley, the agency republished the data file last Wednesday but placed restrictions on how it was to be used. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, the journalism groups called the new restrictions “ill-advised, unenforceable and probably unconstitutional. Restricting how reporters use public data is an attempt at prior restraint.”

Grassley also has expressed his disappointment in the restrictions: “HRSA is overreaching and interpreting the law in a way that restricts the use of the information much more than the law specifies.”

For more background, this timeline tracks the story:

Grassley blasts HRSA over data removal after seeing letter exchange with doc

Len Bruzzese

About Len Bruzzese

Len Bruzzese is the executive director of AHCJ and its Center for Excellence in Health Care Journalism. He also is an associate professor at the Missouri School of Journalism and serves on the executive committee of the Council of National Journalism Organizations.

The action taken by the U.S. Health Resources and Services Administration to remove the public version of the National Practitioner Data Bank came only after the urging of a Kansas neurosurgeon with a long history of malpractice payouts, according to records released Thursday by U.S. Sen. Charles Grassley.

The doctor, Robert Tenny, sent six letters to HRSA both before and after the Kansas City Star wrote a story that said he had been sued at least 16 times for malpractice and had paid out roughly $3.7 million since the early 1990s.

Grassley blasted HRSA for making a hasty decision to remove the data bank’s Public Use File from its website without doing independent research and he called for its immediate restoration.

“Instead of conducting its own research into the professional conduct of Dr. Tenny, HRSA appears to have over reacted to the complaint of a single physician based on no evidence other than that he received a call from the press,” Grassley wrote Thursday in a letter to Health and Human Services Secretary Kathleen Sebelius.

The documents released by Grassley also show that HRSA warned 28 hospitals and health plans throughout Kansas about discussing the data bank records of Tenny following the doctor’s allegation that a hospital must have leaked information about him to Star reporter Alan Bavley.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has posted aggregate information from the data bank in a Public Use File that did not identify individual providers.

HRSA officials removed the public file from the data bank website on September 1 because a spokesman said they believe it was used to identify physicians inappropriately. The Association of Health Care Journalists has protested the action, along with Investigative Reporters and Editors, Society of Professional Journalists, National Association of Science Writers, Reporters Committee for Freedom of the Press, and National Freedom of Information Coalition.

Grassley released the documents Thursday in response to a letter he received from HRSA administrator Mary Wakefield.
 
Among them was an email showing that the data bank’s director quickly notified Tenny’s lawyer about a letter she sent to Bavley threatening the reporter with civil penalties if he ran a story based on information from the data bank. Cynthia Grubbs, director of HRSA’s division of practitioner data banks, forwarded the letter to Tenny’s lawyer, Charles R. Hay, less than three hours after sending the warning to Bavley. (HRSA subsequently backed off its threat against Bavley.)

 “HRSA’s response makes it apparent that HRSA simply accepted the complaint of the physician involved at face value and jumped to conclusions about how Mr. Bavley obtained the information,” Grassley wrote. “Once HRSA learned of its mistake, it then compounded the error by shutting down access to information that Congress intended to be public” through the Public Use File.

“All Mr. Bavley did was use publicly available data, and HRSA’s response to that was to shut down access to that data for everyone,” Grassley wrote.

AHCJ President Charles Ornstein, responding to the documents Grassley released Thursday, reiterated his call for HRSA to republish the Public Use File immediately.

“We are past due for HRSA to acknowledge its mistake, apologize and restore access to this file on its website,” he said. “Journalists have used this information responsibly for years to write about questionable physicians, and their stories have led to new laws and regulations that have improved patient protections.”

Ornstein also said the documents released by Grassley “raise troubling questions about HRSA’s due diligence before taking this major action.”

According to the documents, Tenny repeatedly wrote Grubbs, questioning the motives of a hospital that he contends hired a publicist to try to destroy his career and impugning Bavley.

In another letter, he alleged a “coordinated attack.” And in another, he told Grubbs to “stay strong and keep up the good work!”

In response, Grubbs wrote Tenny on Sept. 26, saying, “We have contacted the hospitals and health centers…who have queried on you in the past 6 years to remind them of the confidentiality requirements and the sanctions for violations of confidentiality. We instructed the hospitals to examine their records and report back to us with any potential confidentiality breaches. We will act swiftly to investigate any potential violations of confidentiality.”

In her letter to Grassley, dated Tuesday, Wakefield said HRSA is working toward “a solution that meets its responsibilities regarding confidentiality under the Data Bank statute while reflecting its commitment to facilitating important research.”

“Our goal is to make as much information available as soon as we can, but we do not have a specific timeline at this point,” she wrote.

In addition to calling for restoration of the public file, Grassley asked for an immediate briefing by the HRSA official responsible for the decision to remove it in the first place.

Journalists, researchers renew call for access to data during public call

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.

Officials at the U.S. Health Resources and Services Administration held a conference call on Thursday to seek input from the public about the future of the National Practitioner Data Bank’s Public Use File. Reporters and researchers had a similar response: Bring it back.

HRSA removed the public version of the doctor discipline database last month because officials said they were concerned a reporter had used it inappropriately to identify physicians.

But journalists, led by AHCJ president Charles Ornstein, and researchers told HRSA officials they believe the agency overreacted or was misinterpreting the law. Ornstein and others pointed out that  the public version of the data bank had been used by reporters to expose faulty oversight of physicians by state medical boards, leading to greater transparency and additional patient protections.

“I implore you not to go backwards and implore you not to increase secrecy but rather to restore the Public Use File as it was,” said John Ensslin, president of the Society of Professional Journalists.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. Pursuant to the law, the public version of the database did not identify physicians by name or address, but did provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against doctors across the country.

HRSA says it took the Public Use File offline after a lawyer representing a physician complained that Kansas City Star reporter Alan Bavley had obtained information improperly from the data bank. HRSA threatened Bavley with monetary sanctions if his paper ran the story. His article ran Sept. 4, prominently featuring the doctor and using the Public Use File to fill in details about him. HRSA did not pursue fines against Bavley.

Six national journalism organizations, as well as consumer groups and academic researchers, have formally objected to HRSA’s decision to take the database off its website. Sen. Charles Grassley, R-Iowa, condemned the decision in a letter to HRSA Administrator Mary Wakefield and HHS Secretary Kathleen Sebelius.

“The idea of taking down the Public Use File is really a big deal. There is no substitute for having it,” said Sidney Wolfe, M.D., director of Public Citizen’s Health Research Group. “The case can’t be stronger for having the data bank in the form that it used to be in.”

Cynthia Grubbs, director of the division of Practitioner Data Banks, gave no commitment about whether the Public Use File would return or in what format.

“We understand you have concerns with that decision,” she said at the beginning of the call. “We are trying to balance the need to protect confidentiality under the data bank statute with our continued desire to shine a bright light” on the quality and safety of patient care across the country.

Grubbs asked a series of questions about how HRSA could provide usable information on its website, including charts and graphs.

But Jeremy Kohler, a reporter for the St. Louis Post-Dispatch, said, “It is not even close to a substitute for restoring the raw data that was on the data bank before.”

Grassley criticizes federal agency over removal of doctor discipline data

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.

Grassley’s letter to HRSA Administrator Wakefield

See an interactive timeline of the National Practitioner Data Bank controversy.

Oct. 2: Former Practitioner Data Banks official says HRSA ‘erroneously interpreting the law’
Oshel’s letter & statement (PDF)
Letter to Sebelius & Wakefield (PDF)

Sept. 28: Journalists turn to Sebelius for access to National Practitioner Data Bank file
Letter to Sebelius (PDF)

Sept. 22: Agency declines to restore public data
Letter from HRSA (PDF)

See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors

Sept. 21: More journalism groups join effort, send letters to Congress to restore access
Letter to members of Congress
(PDF)

Articles, editorials about public access to the NPDB public use file (PDF)

Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website
HRSA letter to Bavley (PDF)

Get the NPDB public use file

Investigative Reporters and Editors, working with AHCJ and the Society of Professional Journalists, has posted the data for download, free to the public.

U.S. Sen. Charles Grassley (R-Iowa) sent a letter today to the Health Resources and Services Administration, criticizing its decision to remove a public version of the National Practitioner Data Bank, which has helped reporters and researchers to expose serious gaps in the oversight of physicians.

“Shutting down public access to the data bank undermines the critical mission of identifying inefficiencies within our health care system – particularly at the expense of Medicare and Medicaid beneficiaries,” Grassley wrote to HRSA Administrator Mary Wakefield. “More transparency serves the public interest.”

Grassley, ranking Republican on the Senate Judiciary Committee, continued: “Generally speaking, except in cases of national security, the public’s business ought to be public. Providers receive billions of dollars in state and federal tax dollars to serve Medicare and Medicaid beneficiaries. Accountability requires tracking how the money is spent.”

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has posted aggregate information from the data bank in a Public Use File that did not identify individual providers.

HRSA officials removed the public file from the data bank website last month because a spokesman said they believe it was used to identify physicians inappropriately. The Association of Health Care Journalists has protested the action, along with Investigative Reporters and Editors, Society of Professional Journalists, National Association of Science Writers, Reporters Committee for Freedom of the Press, and National Freedom of Information Coalition.

Grassley’s letter comes days after the official who created the Public Use File in the mid-1990s and managed it until 2008 said that HRSA was “erroneously interpreting the law” governing the data bank by removing the public version.

In a letter to AHCJ, Robert Oshel said HRSA officials have confused the requirements of the law.

“HRSA’s current management seems to confuse the law’s requirement that a public data file not permit use of its records to identify individual practitioners with a very different requirement, and one not in the law: that the file not allow the records of previously identified practitioners to be identified in the file,” Oshel wrote.

Oshel further wrote that HRSA’s view will “seriously hinder use of the file for important public policy research.”

Sen. Charles Grassley

Sen. Charles Grassley

In his letter to Wakefield, Grassley was sharply critical of a threat HRSA made to Kansas City Star Reporter Alan Bavley. After a complaint from a lawyer representing a doctor, HRSA threatened Bavley with civil money penalties if he ran a story based on information from the data bank. HRSA did not pursue the fine, officials later said, because Bavley did not have access to confidential information. But the agency did remove the file from its website.

“It seems disturbing and bizarre that HRSA would attempt to chill a reporter’s First Amendment activity with threats of fines for merely ‘republishing’ public information from one source and connecting it with public information from another. A journalist’s shoe-leather reporting is no justification for such threats or for HRSA to shut down public access to information that Congress intended to be public,” Grassley wrote.

Grassley asked Wakefield a series of questions and asked for responses by Oct. 21.

AHCJ President Charles Ornstein called on the Obama administration once again to restore access to the Public Use File. “Using this file, reporters across the country have prepared stories that have exposed holes in the oversight of doctors – and those stories have led to greater transparency and improved patient protections,” he said. “This information needs to be restored now.”

Journalists turn to Sebelius for access to National Practitioner Data Bank file

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 and five other journalism groups appealed to Health and Human Services Secretary Kathleen Sebelius to intervene in the dispute over the Public Use File of the National Practitioner Data Bank and restore access to this important data tool.

HHS Sec. Kathleen Sebelius spoke to journalists at Health Journalism 2010 in Chicago.

HHS Sec. Kathleen Sebelius spoke to journalists at Health Journalism 2010 in Chicago.

AHCJ was joined in its letter to Sebelius by Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press and the National Freedom of Information Coalition. The groups have more than 15,000 members.

The U.S. Health Resources and Services Administration removed the Public Use File (PUF) from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

Letter to Sebelius (PDF)

See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors

Letter to members of Congress (PDF)

HRSA letter to Bavley (PDF)

Articles, editorials about public access to the NPDB public use file (PDF)

Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website

Get the NPDB public use file

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 groups took issue with a letter written last week by HRSA administrator Mary Wakefield, in which she defended the decision to remove the Public Use File from the agency’s website.

“We believe the stance taken by administrator Wakefield and HRSA staff is overly restrictive based on the law governing the data bank. We do not dispute that federal law precludes the administration from sharing confidential information from data bank reports, including the person being reported and the institution filing the report. We disagree with HRSA that the Public Use File, removed from the web earlier this month, did this.”

The letter also criticized HRSA’s research protocol under which reporters can now request data from the data bank as intrusive and unfair. The agency’s new web page about the Public Use File and how to make requests for data says: “At this time, a researcher must provide a proposal (including table shells) for their need of data. DPDB will review the request and approve or deny the request for data. DPDB will provide only the variables needed to complete the research.”

“We find it troubling that a federal agency now wants to judge the quality of reporters’ stories and make individual decisions about which one is worthy –perhaps putting officials in the position of denying requests that may make HRSA or the data bank look poor,” the letter said. “We don’t see any provisions in the act governing the data bank that gives HRSA the authority to deny research data as long as it doesn’t identify individuals.”

The groups said they stood ready to meet with Sebelius and work with her on a solution that will provide continued access to the Public Use File.

“Reporters have exposed dangerous lapses in oversight by state medical boards, prompting legislation to increase transparency and improve patient protections,” the letter said. “We hope you will agree that this is a matter of public concern and that you will urge HRSA to change course and immediately restore the Public Use File of the data bank.”

The letter to Sebelius followed a request for assistance to members of Congress last week.

Agency declines to restore public data

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 U.S. Health Resources and Services Administration resisted demands by three major journalism organizations for the immediate restoration of a Public Use File of the National Practitioner Data Bank, a tool that reporters have used to expose lapses in oversight of troubled physicians.

HRSA removed the Public Use File from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

In letters to the Association of Health Care Journalists, Investigative Reporters and Editors and the Society of Professional Journalists, HRSA Administrator Mary Wakefield said her agency regretted having to remove the Public Use File from its website and hopes to bring it back in some form “as quickly as is possible.” She did not provide a date.npdb-hrsa-response-1

“The statute that governs the NPDB clearly states that we are obligated to keep data about individual practitioners housed in the NPDB confidential,” Wakefield wrote. “We now know that the PUF in its current form can be manipulated to identify individual practitioners, and therefore were compelled to act.”

Wakefield said HRSA shared the groups’ interest in transparency and patient safety but was compelled to act in the way that it did.

Wakefield was responding to a Sept. 15 letter from the three groups, which called for the Public Use File to be returned online without delay.

AHCJ President Charles Ornstein took exception to Wakefield’s comments, noting that reporters have used the Public Use File responsibly for many years and that the agency only acted after a single complaint from one doctor’s lawyer. He said HRSA has been well aware of how reporters have used the database and even assisted them in their statistical analysis.

“It is not true that the Public Use File can be ‘manipulated’ to identify individuals,” Ornstein said. “Nothing in that data can be used to identify individuals if reporters or researchers don’t already know who the bad actors are. We remain troubled that it appears HRSA is more interested in protecting doctors accused of harming patients than protecting the patients themselves.”

Wakefield’s response came the same day the journalism groups – joined by the National Association of Science Writers, the Reporters Committee for Freedom of the Press, and the National Freedom of Information Coalition – wrote letters to members of Congress asking for their help in getting the old version of the Public Use File restored. The groups would like to see that file regularly updated.

Wakefield said HRSA is reconfiguring the Public Use File to prevent identification of a health care provider or patient, and that researchers and members of the media can request data in the interim on the agency’s website. She also said there would be a call at 1 p.m. Eastern on Oct. 13 to hear from the public about what they would like from the Public Use File.

But Ornstein said it remained unclear how useful the information would be if the agency removes unique identifiers for individuals, which had allowed reporters to see what type of follow-up action was taken against doctors who repeatedly made malpractice payouts or had been disciplined repeatedly by hospitals.

On Wednesday, AHCJ and its partner journalism groups released a report on how reporters and news organizations have used the Public Use File in the past to expose dangerous lapses in oversight by state medical boards. Several of those articles led to new laws and rules to increase transparency and implement patient protections.

“As result of our investigation – and the solid documentation provided by the NPDB, malpractice suits and patient records – Virginia passed a law giving its state medical board more authority to crack down on doctors … ,” wrote Liz Szabo, a USA Today reporter who used the data bank in 2002 while at the Virginian-Pilot. “Patients in Virginia are safer today due to our reporting, and due to the data provided by the NPDB.”

Wakefield noted in her letter that the amount of information in the databank has increased dramatically in the past 18 months. Journalism leaders say what she failed to state was that a huge number of reports came in only after journalists (including Ornstein) showed that state agencies were not reporting discipline to the data bank and that HRSA was not following up on glaring inconsistencies and irregularities.

Wakefield did not address a request by the journalism groups to seek legislation permitting the continued disclosure of the Public Use File in the same form as before it was pulled Sept. 1.

She also did not apologize, as requested, to Kansas City Star reporter Alan Bavley, who was threatened with sanctions if he wrote a story based on information from the data bank. She said Bavley will not be pursued but was reminded that the Public Use File was for “statistical analysis only.”

Ornstein said the issue is larger than Bavley. “The threat to Alan is not a moot point just because HRSA didn’t fine him. Such threats by the federal government could have a chilling effect based on a news’ organization’s ability – and willingness – to stand up to government fines and local lawsuits.”

“There needs to be an apology and a promise that reporters won’t be threatened by the federal government when they plan to report public information,” Ornstein added.

IRE has made available free on its website a copy of the Public Use File, downloaded last month, along with documentation and instructions.

More journalism groups join effort to restore access to National Practitioner Data Bank

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.

For immediate release
Sept. 21, 2011

See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors

Letter to members of Congress (PDF)

HRSA letter to Bavley (PDF)

Articles, editorials about public access to the NPDB public use file (PDF)

Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website

Get the NPDB public use file

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.

Three additional journalism organizations have joined the campaign calling for the Obama administration to restore access to a public version of the National Practitioner Data Bank. And letters are going out to key members of Congress asking for their assistance.

The National Association of Science Writers, Reporters Committee for Freedom of the Press, and National Freedom of Information Coalition have signed the letter, along with the Association of Health Care Journalists, Investigative Reporters & Editors, and the Society of Professional Journalists.  The groups have more than 15,000 members.

The U.S. Health Resources and Services Administration removed the Public Use File (PUF) from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

“The Public Use File, while it didn’t identify doctors by name or address, provided invaluable information about the functioning of state medical boards and hospital disciplinary systems,” said the letter from the groups to members of Congress. “Reporters for years have used the data to identify holes in their states’ regulatory systems that have led to patient harm. As a result of these stories, states have enacted new legislation and medical boards have taken steps to investigate problem doctors.”

The groups also provided the representatives and senators with details of major stories written with the assistance of the Public Use File and descriptions of the changes that resulted.

Finally, the letter once again expressed concern that HRSA sent a threatening letter on Aug. 26 to Alan Bavley, a health reporter at the Kansas City Star. The letter, signed by Division of Professional Data Banks director Cynthia Grubbs, said that Bavley could be subject to a civil monetary penalty of up to $11,000 if he identified a physician based upon confidential information in the data bank. The threat came even though other reporters have done the same thing for years without penalty.

In news reports, HRSA acknowledged that the letter–and the agency’s subsequent decision to remove the Public Use File–was prompted by a single complaint: from the lawyer of a doctor who was the subject of Bavley’s story.

Although HRSA said in some news reports that it will not pursue sanctions against Bavley, he has not received an apology.

“Without stories written by our members, it’s fair to say that some unsafe doctors would continue to be practicing with clean licenses and patient protection legislation in several states likely would not have been enacted,” the letter said.