Tip Sheets

Investigating health professionals

Tips for researching health professionals

Jeremy Kohler
Investigative Reporter
St. Louis Post-Dispatch
Twitter: @jeremykohler

Blythe Bernhard
Medical Writer
St. Louis Post-Dispatch
Twitter: @blythebernhard

You can read their series at http://STLToday.com/patients

Download and analyze the public use file of the National Practitioner Data Bank.

Congress established the NPDB in 1986 so doctors would not be able to hide malpractice, or actions by hospitals, licensing boards or professional societies. Names in the databank can be accessed by hospitals and some medical practices and government agencies.

But not reporters. We get the NPDB "public use file" which removes doctors' names and obscures other identifying information. In place of names are unique identifying numbers - PRACTNUMs. Instead of exact ages or years of graduation you get ranges (i.e. 30s, 1950s.)

But if you can figure out which PRACTNUM is your doctor, it's like finding the Rosetta stone. You know how much and how many times he paid malpractice and for what reasons (i.e. wrong-site surgery), got disciplined at hospitals or by states, and for what reasons (i.e. incompetence or drug use).

You don't need to be a total data geek to do this, but you do need to use a database manager like MS Access.

Every adverse action - whether it is tied to a hospital, medical board or professional association - is tied to a PRACTNUM. Next to the PRACTNUM in each action are a few fields that tell a brief story about him - how many malpractice payouts, how many times he was disciplined by a state or hospital.

The trick is to use what you know (i.e. graduated medical school in 1966, is an osteopath, was reprimanded by Missouri board) to keep eliminating suspects. We found that if a doctor had discipline from a medical board we could almost always find his whole story in the data bank, especially if he is an osteopath, which make up just a fraction of all licensees.

Even if you can't be 100 percent sure you've found your man, you may have enough to go to him with questions (i.e. "Is this the first time that you have operated on the wrong body part?")

Go to court

Sometimes it's the doctor himself who gives you the background you're looking for - by putting it into an open court file.

Federal law says doctors conducting peer review are supposed to be immune from lawsuits.

But doctors fighting for their reputations will still sometimes sue peer reviewers under a claim that the review was biased or unfair.

Lucky for you, that opens a lot of the peer review material to your inspection. Seek out those cases in your county courthouses and on Pacer.

If your doctor has a current medical board case against him, ask to see the evidence filed in the case before there is a motion to seal it. These complaints often go to administrative courts, where there is a presumption of openness. Even though Missouri board investigations are closed records we were able to get a treasure trove of them once they were filed as evidence in a discipline case.

Go see the doctor

Go to his office. Blythe and I had a mantra while we did our reporting - showing up makes good things happen. In a story about convicted felons that continue to practice medicine, we showed that a disgraced doctor who moved to another state was displaying board certifications that he'd been stripped of. We were able to ask him on the spot: Why are you lying to patients about being board certified? He had no answer for that. In another story we were able to interview patients who didn't know their doctor had admitted to the state board that he was a diagnosed frotteur - a sexual deviant who has uncontrollable urges to rub and tough the sex organs of nonconsenting victims. One patient told us that if the board "wanted to make us vulnerable to people like that, then they should have to send their families there."

Read the newsletters

Almost every state's medical board publishes an annual or semiannual newsletter that includes blurbs about disciplinary actions against physicians. Although these newsletters are usually mailed to licensees, they should be available by request. We downloaded 10 years' worth of these newsletters and entered them by hand into a database so we could measure our board's performance. We found that 60 percent of the board's actions were automatically triggered by actions in other states, requiring no investigation. Discipline related to quality of care made up just six percent of the board's actions.

Even if your state is highly rated by Public Citizen, take a closer look at what they are doing and chances are you will see it is padding its numbers with tagalong actions. Very few of the actions will be the result of independent or original investigations.

Check out Colorado (or another state)

So your state doesn't tell you much about this doctor. Doctors often have licenses in several states. Many doctors keep licenses where they went to medical school- think New York, Boston, Philly. Doctors who ski may have a license in Colorado. Try running his name through states that have better transparency for consumers. Like Colorado. The Missouri board will only give you an address for Dr. Lynn Carlton of Springfield. But run his name through Colorado and you find out: states where he has active licenses, specialties, employers, discipline in Colorado, discipline in other states (I), DEA registration status, malpractice history, insurance status.