Tag Archives: disciplinary actions

HHS responds to questions about enforcement of NPDB restrictions

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.


Numbers reveal how often, or how rarely, states check doctors’ disciplinary records

How often does your state medical board search doctors in the National Practitioner Data Bank?

Surprisingly not often, according to data provided to the Association of Health Care Journalists by the U.S. Health Resources and Services Administration, which runs the data bank.

Get a spreadsheet showing how often each state medical board searches for doctors in the National Practitioner Data Bank. One worksheet shows information about physicians, the other shows information about residents and interns.

AHCJ and other media groups have been pushing the government to restore unfettered access to the Public Use File of the data bank, citing important stories that journalists have written about lax oversight of doctors by state medical boards.

State medical boards have access to complete information within the data bank about a doctor’s disciplinary history, hospital sanctions and malpractice payouts. The Public Use File, which had been available to reporters and researchers for years, provided the same information without identifying information about the doctors involved.

HRSA removed  the Public Use File from its website on Sept. 1 following complaints from a doctor that a reporter from The Kansas City Star inappropriately used it to identify him. The agency restored the file last week, but with new restrictions that seek to bar reporters from using it with other data sets to identify physicians. AHCJ and other media groups call the new restrictions unworkable and an unconstitutional prior restraint.

AHCJ requested data from HRSA so reporters could see how often their states check the backgrounds of MDs and DOs, as well as interns and residents. The numbers are available in two different charts. Beyond that, HRSA said, three state boards have a relationship with HRSA in which they automatically get updates when new information is entered on a physician. They are: Nevada (DO), Oregon (MD) and Pennsylvania (MD).

“I encourage journalists to look up their state medical boards in our chart and see how often they consult the data bank,” AHCJ President Charles Ornstein said. “If they are not looking physicians up, they should be asked how they are sure they are protecting the public from dangerous or incompetent doctors.”

HRSA spokesman Martin Kramer said in an email that,

HRSA is also working proactively to protect the public by reducing potential barriers for State licensing boards to receive NPDB information.

One step that HRSA took in the past year was to conduct a small pilot study with the Federation of State Medical Boards to determine if hospitals and medical malpractice payers send a copy of  the NPDB report, as required, to the licensing board.

To assure that Medical Boards receive the hospital and medical malpractice payment reports, in January 2012 the reporters (hospitals and medical malpractice payers) will be able to send an electronic copy to the State medical board through the NPDB.

We believe this change will be cost saving and time effective for the reporters and State medical boards.”

For more background, this timeline tracks the story:

Agreement lets disciplined nurses work in 24 states

ProPublica’s Tracy Weber and Charles Ornstein are back on the disciplined caregivers beat, this time cooperating with USA Today to expose a licensing gap that makes it easier for disciplined nurses to find work in other states. The licensing agreement in question was signed a decade ago as 24 states agreed to recognize each other’s licenses in an attempt to alleviate care shortages by allowing nurses to work where they are needed most.

In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients’ needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.

Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.

Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.

Ornstein and Weber found numerous instances in which a caregiver disciplined in one state was able to work for an extended period in another without being red-flagged, and are helping spark a debate over the costs, benefits and implementations of such agreements.

ProPublica guides reporters to check local boards

For those of you who have followed the ongoing investigation ProPublica’s Charles Ornstein and Tracy Weber have done into nurses and whether states are reporting disciplinary actions, you might have a chance to localize the story.

ProPublica has posted a guide, “Reporting Recipe: How You Can Investigate Your State’s Oversight of Its Nurses and Other Licensed Professionals,” to help reporters and the public check up on what’s happening in their states.

ProPublica editor-in-chief Paul Steiger and managing editor Stephen Engelberg, explain why they are providing the reporters’ techniques and insights:

We hope that others will use the techniques created by Ornstein and Weber to hold local officials accountable. Reporters who look into the local boards that oversee nurses or other health professionals will make new discoveries, some of which will undoubtedly go beyond what we have found. That, in turn, will help others push the story ahead. We hope statehouse reporters, beat reporters, general assignment reporters, bloggers, citizen journalists and others will use this road map.

Use the state-by-state guide prepared by Ornstein (also president of AHCJ’s board of directors) and Weber that shows what information is available to the public in each state and specific things to look for in the records.

They have used the data to identify some states that appear to be  inconsistent in reporting disciplinary actions against medical professionals. If you are covering any of these states, you should probably be looking into the story yourself:

  • Florida
  • Georgia
  • Illinios
  • Indiana
  • Kentucky
  • Michigan
  • Mississippi
  • New Jersey
  • Ohio
  • Tennessee
  • Wisconsin
  • West Virginia