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State Medical Boards Fail to Discipline Doctors With Hospital Actions Against Them

March 15, 2011

Alan Levine
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



We analyzed the NPDB Public Use File and extracted information about 5,887 physicians (identified in this file only by a coded number) who had at least one clinical privilege report in the NPDB but no medical board licensure action report in the NPDB.

For the purposes of our analysis, these physicians were assigned to a state based on the state in which the last clinical privilege action occurred. Thus, a physician may have had two clinical privilege actions reported in state A, but the third and most recent report was for state B. The physician in this example would have been assigned to state B for the purposes of our analysis. This means that, by definition, for the state-stratified data in this report, every state that is counted as having failed to take a license action after a previous hospital action is the same state in which the most recent hospital action occurred. In addition, if a physician with one or more clinical privilege actions had a licensing board action in any state, the practitioner was not included in our study.

We examined the following: (1) the number of clinical privilege reports per physician, nationally and by state; (2) the number of clinical privilege reports for reasons that would much more likely warrant a medical board action, such as “Immediate Threat to Health or Safety,” incompetence and sexual misconduct; and (3) the number of medical malpractice payment reports for the 5,887 physicians with one or more clinical privilege actions but no board licensure action in our study. Unless otherwise noted, the data in the report and in the exhibits cover the period from September 1, 1990, the date the NPDB started collecting data, through December 31, 2009.

Clinical privilege actions, which totaled 8,734 reports (involving 5,887 physicians) in our analysis of physicians without a medical board licensure action, could include extensions or decreases in length of sanction, reinstatements and other changes in sanctions, thereby accounting for more than one report for many physicians.[1]

[1] Automatic reinstatements after a suspension would not be included, but neither would the action that was voided. Although these reports of changes to penalties increase the number of reports in a physician’s record, they are relatively infrequent, and therefore we do not believe they affect the core conclusions of our analysis since such reports are included in a physician’s record only if the original action was reported.  Furthermore, their actual impact on our analysis, if any, is debatable, since they may indicate either a more severe penalty based on a physician’s failure to meet conditions imposed with an original action or a reduction in the originally imposed penalty. 

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