Hospitals Exploit Loopholes to Avoid Reporting Discipline of Doctors

According to a report by a the prominent consumer advocacy group Public Citizen, approximately half of all hospitals in the United States have avoided reporting disciplinary actions taken against their physicians as required by law, depriving state medical boards of information needed to protect patients from a potential risk of medical malpractice.

The report on physician oversight, released in late May, discovered that in the 17 years the National Practitioner Data Bank (NPDB) has been established; only half of all hospitals have reported any disciplinary action against doctors who may have been negligent, committed medical malpractice or otherwise received a disciplinary action on behalf of the hospital that employed them.

The NPDB was created by the Health Care Quality Improvement Act of 1986 to protect patients from physicians with a history of questionable practices, such as surgical mistakes and repeated failure to follow the accepted standard of medical care. The Act requires hospitals to report any disciplinary action taken against attending physicians.

According to Public Citizen, at the time the NPDB was created, the Department of Health and Human Services (DHHS) anticipated 5,000 reports per year. The health industry estimated twice that number; 10,000 reports per year. But so far, reports have averaged only 650 reports per year, with half of the nation’s hospital not submitting a single report in 17 years.

Public Citizen notes that there is an apparent “culture among doctors of not wanting to ‘snitch’ on a colleague’” and many hospitals take disciplinary actions against doctors that are specifically designed to avoid reporting requirements of the NPDB. These actions can include disciplinary periods of less than 31 days, or forcing physicians to take a leave of absence instead of an actual disciplinary action. In addition, some hospitals purposefully avoid disciplining physicians that are known to have committed medical malpractice.

“In one of the most egregious recent examples of the breakdown of hospital peer review, two physicians at Redding Medical Center in Redding, California performed clearly unnecessary bypass and valve surgeries between 1992 and 2002 on hundreds of patients,” the report stated. “Peer review of the cardiac program and discipline of these physicians was not done because of the ‘prestige’ of one of the physicians involved and the revenue for the hospital generated by the surgeries.”

The consumer advocacy group sent a letter to former Governor Kathleen Sebelius, head of DHHS, on May 27 asking that the Obama administration take action and enforce the Act’s requirements. They also called for amendments that would add fines for each instance of a hospital’s failure to report and tying compliance to the hospital accreditation process and Medicare conditions of participation.

Public Citizen said their report found that states with strong penalties for not reporting disciplinary action received more reports from hospitals than those states that did not have such penalties. Inadequate hospital discipline and allowing loopholes in reporting discipline even when it occurs increases the risk of patient harm from preventable medical mistakes at hospitals throughout the United States.