FOI

Reporters use NPDB's public use file to expose gaps in oversight of doctors

Below are several examples in which reporters have used the Public Use File of the National Practitioner Data Bank to write stories exposing gaps in the oversight of doctors in several states. Each example includes a description of the story and an explanation from the reporter of how the data bank was helpful to his/her research.

The Kansas City Star linked anonymous reports in the Public Use File to a Johnson County, Kan., neurosurgeon by matching its information to the contents of court records of malpractice cases. The story was about doctors who have long histories of alleged malpractice but have not been disciplined by the Kansas or Missouri medical boards. It was published on Sept. 4, 2011. An excerpt:

Maribeth Chase didn't know that the neurosurgeon who would be operating on her had been sued at least 16 times for allegedly making medical mistakes.

She didn't know that former patients and their families contended in court records that he had botched treatments that left one patient dead, several more with paralysis and still others in need of remedial operations.

Or that a dozen years before, federal records show, a health care organization had denied him clinical privileges over concerns about the quality of his care.

Robert Tenny's Kansas medical license was in good standing. And even though state licensing officials had access to his history of malpractice claim payments, dating to the early 1990s, they had never taken action against him.

Reporter Alan Bavley:

"The court file on this surgeon provided a compelling story in itself, but whether it held broader implications – was he an isolated case or an example of a more general situation – could only be determined by using the National Practitioner Data Bank. In the Data Bank's Public Use File I discovered 21 Kansas and Missouri doctors who had at least 10 malpractice payments but had never been disciplined. Their payments totaled more than $65 million. This information served the public and would have been impossible to provide without ready access to the NPDB."

The St. Louis Post–Dispatch used the public file last year in an investigation of the lax and secret system of doctor discipline in Missouri. The investigation led to a new law that gives the state healing arts board more power and gives patients more information about their doctors.

Reporter Jeremy Kohler:

"Blythe Bernhard and I used the NPDB to prove what sources told us: the Missouri Board of Registration for the Healing Arts had failed to discipline a doctor who (according to the NPDB and a Missouri database of malpractice payouts) removed the wrong kidney from a patient at DePaul Health Center in Bridgeton, Mo. A $1.6 million payment was made to that patient in a secret out-of-court settlement, so the public data were our only insights to the case.

"Our stories portrayed several other doctors who had repeatedly injured patients by their negligence, and yet had received slaps on the wrists from the healing arts board. The data bank was key again in giving us more detail about specific acts of malpractice.

"We were even able to identify a case in which several states, including Colorado and Hawaii, disciplined a Missouri doctor for negligent patient care that occurred in Missouri, but the Missouri healing arts board looked the other way. This was key to showing the lax enforcement of Missouri's medical practice act.

"We used the NPDB to identify the extremely low number of cases in which Missouri hospitals reported discipline based on peer review to the NPDB."

The Duluth (Minn.) News Tribune in May published a major story about how a local neurosurgeon had amassed a record of malpractice allegations despite praise and high pay from his hospital. The newspaper followed up with additional pieces in August about the money the hospital reaped from the neurosurgeon's department and the growing list of patients complaining that they were harmed by the doctor. An excerpt:

Neurosurgeon Stefan Konasiewicz practiced medicine in Duluth for most of the past decade. He became one of the highest-paid physicians at St. Luke's hospital, which praised him for his "outstanding care and skill."

He also racked up nine malpractice suits and a sanction from the Minnesota Board of Medical Practice for "unethical and unprofessional conduct."

When he moved from Duluth about three years ago, Konasiewicz left behind two dead patients, one woman paralyzed from the neck down and six others who say his treatment caused them serious physical harm.

His former employer, St. Luke's hospital, was aware of the harm Konasiewicz was alleged to have caused and yet continued to let him practice, according to records obtained and interviews conducted by the News Tribune.

Reporter Brandon Stahl made no secret in a May article of how he used the database, writing a story specifically about it. It quoted data bank officials. Stahl writes:

"We were tipped by doctors that if we dug deeper, we'd find numerous cases of alleged patient harm that dated back over a decade. But reporting that out initially proved difficult. One of the areas we looked were malpractice cases: Dr. Konasiewicz had more filed against him than any other doctor in the last ten years in our county.

"But the cases gave us little information. The majority had settled, and the parties signed confidentiality agreements forbidding them from revealing settlements to the media. Other than the names and brief descriptions of the allegations, there was little there. And we had no idea of the monetary amounts of the settlements.

"But the National Practitioner Data Bank shed light on those settlements, revealing that in two of Konasiewicz's malpractice cases he was accused of causing his patients' deaths, while in another the settlement showed he was accused of causing a patient a permanent, significant injury. Konasiewicz and the hospital where he practiced, St. Luke's, settled those cases for more than $3 million, the data bank's records showed.

"That information helped other doctors feel comfortable coming forward and going on record for an article featuring their belief that the hospital continued to allow Konasiewicz to practice, despite warnings from them that he was a potential danger to his patients. It's safe to say that without the NPDB, we wouldn't have been able to bring these serious issues to light to our community."

The (Raleigh, N.C.) News & Observer used the database in 2005 to investigate a partially blind neurosurgeon with a long trail of malpractice payouts. The article specifically cites using the data bank to match up payments with the doctor. (Lawsuits, eye problems fail to stop surgeon, The News & Observer, Raleigh, N.C., July 17, 2005)

The story prompted the state medical board to adopt a number of changes:

• Doctors applying for a North Carolina medical license have to provide a report from the National Practitioners Data Bank, a federal database that tracks all malpractice payments and disciplinary actions nationwide.

• When reapplying each year for their medical license, doctors must list all malpractice payments made in the past year.

• The medical board put more information on its website: the names of hospitals where the doctor has privileges; the doctor's board certification, if any; and other states and countries where the doctor holds licenses.

• Each January, the medical board reminds insurance companies providing malpractice coverage to report all payments on behalf of North Carolina doctors.

• Each February, the medical board consults the National Practitioners Data Bank to collect all malpractice payments and disciplinary actions taken against doctors who hold North Carolina licenses.

Later, over the intense opposition of the North Carolina Medical Society, the medical board agreed to post all malpractice payments over $80,000 on its website.

Reporter Joseph Neff:

"I did use the NPDB, but not to initially identify the doctor. Once I knew about him, I checked the NPDB to see how many settlements/payments had been made on his behalf. Some of the payments were not listed in the NPDB. I also used it to identify payments on behalf of his former partner in Arizona.

"The irony: it's not easy for us reporters to identify doctors in NPDB, but we do. The N.C. Medical Board had access to the entire unabridged NPDB, but never checked it when licensing a physician from out of state. They do now."

The Virginian-Pilot in 2002 exposed holes in the oversight of doctors, focusing on a surgeon who had drawn dozens of complaints before he ultimately lost his license. (Operating Behind Closed Doors, The Virginian-Pilot, Norfolk, Va., June 23, 2002) An excerpt:

The saga of the surgeon's final decade in medicine raises serious questions about whether Virginia adequately protects patients from dangerous doctors. His story exposes a medical system shrouded in secrecy and reluctant to root out the worst offenders.

Doctors, nurses and hospital administrators describe an anxious atmosphere. They fear lawsuits from patients if they admit mistakes. And they fear litigation from doctors if they report a colleague or discipline an employee. It is a system, critics say, designed to safeguard livelihoods, not lives.

State medical board disciplinary cases can quietly continue for years, leaving patients no way to learn that the physician to whom they've entrusted their lives is under investigation. Officials loath to damage doctors' reputations conduct inquiries behind closed doors, rarely releasing their findings or even acknowledging that the probes took place.

Reporter Liz Szabo:

The National Practitioner Data Bank was important in our investigation, because it allowed us to piece together information that local doctors, hospitals and even the state government did their best to hide.

Using this data, we were able to show that Robert G. Brewer paid a $250,000 legal settlement to one of his patients in 1992. We also learned that Sentara Bayside Hospital in Virginia Beach had revoked Brewer's medical privileges in 1998. Establishing this timeline was important, because a neighboring hospital hired him anyway. And the Virginia Board of Medicine didn't get around to yanking Brewer's license until 2001.

In the intervening years, Brewer racked up a sickening record of problems: one of his patients miscarried after he failed to check the results of a pregnancy test before surgery; several died; one had the wrong organ removed. Dozens of others contacted me to tell me how their lives were ruined by Brewer's botched surgeries and his heavy-handed methods of covering up his mistakes, which included blaming his victims for their own suffering.

The NPDB also pointed out systemic failures. At the time that my story was published, 43% of hospitals had never reported a single disciplinary action. It was clear that doctors were operating under a cult of secrecy, and that patients were suffering.

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 such as Brewer. Patients in Virginia are safer today due to our reporting, and due to the data provided by the NPDB."