March 15, 2011
Robert Oshel, Ph.D.
Sidney Wolfe, M.D.
View entire report (pdf)
View letter to Secretary Sebelius about this report (pdf)
View sample letter to state medical boards which failed to discipline 50 percent or more of the physicians with clinical privilege reports
- Executive Summary
- The Problem
- Understanding the Problem
- Appendix and Exhibits (PDF)
Our analysis of physicians with one or more clinical privilege reports but no licensure report raises serious questions about whether state medical boards are responding adequately to hospital peer review determinations of substandard care or conduct, and, secondarily, whether state boards are getting copies of hospital reports to the NPDB. Given the value of hospital disciplinary reports, such reports must be received and properly utilized by medical boards to assure patient safety. In this regard, the public is entitled to know answers to the following:
Why have 5,887 physicians who have had clinical privilege disciplinary actions (in one case 12 such actions) not had any state medical board licensure action?
Why have 220 physicians who have been found by peer review to be an “Immediate Threat to Health or Safety” not had a medical board action?
Why have 1,851 physicians who have had a clinical privilege action for incompetence, sexual misconduct, fraud, etc. not had a medical board action?
Why have so many physicians with a history of one or more clinical privilege actions and multiple medical malpractice payments (in one case, 26 malpractice payments) not had a state medical board disciplinary action?
Why have 3,218 physicians who received a “permanent penalty” on their clinical privileges not had a medical board action?
Medical boards should regard clinical privilege reports as an important source of information for investigating and possibly disciplining physicians for substandard care. It is therefore troubling that 5,887 physicians with one or more clinical privilege reports (and in many cases, multiple malpractice payouts) have never had licensing board actions. In terms of patient safety, the reason(s) for this medical board inaction needs to be determined. Because of documented differences in the rate of disciplinary actions among state medical boards, it is clear that one factor is uneven medical board performance. If state boards are failing to properly and regularly consider hospital disciplinary reports that they are aware of in reviewing physician performance and conduct, state legislatures and the state executive and legislative branches should take steps to strengthen board oversight
Another problem may be that some state medical boards may not be getting copies of hospital disciplinary reports. As noted earlier, hospitals and other health care organizations that report a clinical privilege action to the NPDB are required to send a copy of the report to the “relevant state board.” While this is typically the board of the state in which the facility is located, other boards that may also license the physician are not notified directly by the reporter. If this is so, National Practitioner Data Bank staff and the boards must work on fixing the reporting process. Furthermore, boards can routinely query the NPDB or use its ProActive Disclosure Service to ensure that boards receive hospital disciplinary reports that have been filed with the NPDB.
Public Citizen calls upon all state medical boards to work cooperatively with HRSA to regularly identify physicians in their respective states who have had clinical privilege reports submitted to the NPDB but have not had a state licensure action.
Public Citizen also calls for the Office of Inspector General (OIG), Department of Health and Human Services, to re-initiate investigations of state medical boards. During the 1980’s and 1990’s the OIG acknowledged the importance of effective medical board oversight; during this time period they conducted 16 evaluations of state health professional licensing boards including 9 specifically addressing inadequate medical boards performance. Because of highly questionable legal constraints imposed by OIG lawyers, the last OIG review of state medical boards was 18 years ago.
 If there is a problem with the reporting process, it may require a legislative fix to cover practitioners with licenses in more than one state. The actual language of the Health Care Quality Improvement Act of 1986, which established the NPDB, states, in Section 424 (c) (2) that clinical privilege reports “…shall also be reported to the appropriate State Licensing board in the State in which the health care entity is located…”
 Which automatically provides a newly received report without the state board having to query.