Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Knittle’s report, based on public records, spotlights doctors and a physician’s assistant who have been disciplined for things that include substance abuse and sexual improprieties.
The executive director of the Oklahoma Board of Medical Licensure and Supervision points out that discipline doctors can have trouble finding a job and may find they can’t be network providers on insurance programs, so they turn to jobs working for the government:
Medical professionals with disciplinary records also work at the state Department of Veterans Affairs and medical facilities at Fort Sill, a federal installation.
The story includes links to the complaints mentioned in the article.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages 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.
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.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Chedekel used records from Connecticut’s Department of Public Health and public disclosures from pharmaceutical manufacturers: “A check of physician records shows about a dozen Connecticut doctors receiving drug company benefits either shortly before or after being sanctioned by the state for various offenses.”
Her reporting reveals a doctor received payments from three drug companies while he was being investigated for allegations that he over-medicated patients. Some of the payments continued after his license was suspended. Another doctor got payments from four companies while “federal prosecutors were investigating allegations that he wrote out 11 illegal prescriptions for controlled substances.”
Other doctors reaping the benefits from drug companies were disciplined for things that included failing to provide proper post-operative care, referring a patient for an MRI despite the fact the patient had a pacemaker, over-prescribing narcotics, allowing unlicensed employees to practice medicine and nursing and more.
Currently a dozen pharmaceutical manufacturers publicly disclose their payments to physicians. As Chedekel points out, many do so as the result of legal settlements with the government. Beginning in September 2013, such payments will be posted online in accordance with the Physician Payment Sunshine Act, though it’s not yet clear exactly how the law will be implemented.
Chedekel notes that ProPublica’s Dollars for Docs investigation also has revealed payments to doctors who had been accused of professional misconduct, had been disciplined or lacked credentials.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
The Association of Health Care Journalists and five other journalism organizations asked federal health officials this week to specify how they plan to enforce new rules governing access to the public version of the National Practitioner Data Bank.
In a letter to Mary Wakefield, administrator of the Health Resources and Services Administration, the groups continued to express disappointment in the agency’s restrictions on the data bank’s Public Use File. In the past, reporters have used the file to expose faulty oversight of doctors by state medical boards.
The Health Resources and Services Administration removed the public file from its website in September after a complaint from a doctor who complained information on him was used inappropriately. The agency republished the data last month but put in place restrictions on how the data could be used.
Among the restrictions is a provision that bars users from matching data in the Public Use File with other data sources to identify physicians. If journalists or others are found to have violated the provision, they could be required to return the data and be barred from receiving it in the future.
In the letter to Wakefield, sent Wednesday, the groups asked for answers to several questions:
What process will HRSA follow to determine whether a reporter has violated the agreement? If a reporter identifies a doctor in a story and also had access to the Public Use File, how will the agency find out whether the reporter used the file to identify the doctor or got the information from another source? Will HRSA ask to see notes and talk to sources? What will the agency do if reporters decline to discuss their reporting methods beyond what appears in their stories?
What recourse will reporters have if they believe they have been unfairly barred from future access to the file?
If you ask a reporter to return data, will you take any steps to ensure the data hasn’t been copied or saved elsewhere? If so, what will those steps be?
How will HRSA address stories written based on copies of the Public Use File downloaded before Sept. 1? Such files are available without restriction on the websites of journalism organizations, and reporters do not need to sign any agreement to access them. Will reporters face penalties if they use the information in a way that HRSA objects to?
AHCJ president Charles Ornstein said he continues to believe that the new restrictions are both ill-advised and likely unconstitutional. But he added, “If HRSA intends to stick to them, it’s imperative that journalists understand how they will be enforced before deciding whether to use this information.”
Other groups signing the letter were 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.
Investigative Reporters and Editors, working with AHCJ and the Society of Professional Journalists, has posted the data for download, free to the public.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages 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.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
