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)
Public Citizen is concerned that many physicians with peer-reviewed clinical privilege sanction reports in the National Practitioner Data Bank (NPDB) have not had a subsequent state medical board licensure action. While not all clinical privilege reports to the NPDB would necessarily result in state board action, the large number of physicians (5,887) determined by our analysis to have had one or more clinical privilege reports but no state licensure action suggests that boards are not properly acting on such reports after becoming aware of them, and, secondarily, that hospitals may not be sending such reports to all of the appropriate state licensure board(s) where the doctor is known to be licensed.
State medical board action against a physician’s license, if warranted, provides a greater assurance than a hospital privilege action alone that (a) the practitioner’s medical practice would be monitored, limited or curtailed by a medical board order and (b) other state medical boards and future employers will have a more complete account of a practitioner’s practice history.
 Clinical privilege report refers to a peer review based disciplinary action that is taken by a hospital or managed care organization or other health care entity. If a physician’s privileges to practice in the health care organization are limited or revoked for a period of more than 30 days, the action must be reported to the National Practitioner Data Bank, which is a national clearinghouse of doctor disciplinary and medical malpractice information operated by the Department of Health and Human Services and available to only health care organizations and State medical boards.
 Hospitals and other reporters are required to send a copy of each clinical privilege report directly to the relevant state licensing board. The “relevant board” is determined by the facility reporting the clinical privilege action and is probably, but not necessarily, the licensing board in the facility’s state. For example, physicians working for the federal government in federal facilities are only required to have a license; they are not required to be licensed in the state where the federal facility is located, so long as they treat federal patients.
 State medical board disciplinary actions are submitted to a national data base maintained by the Federation of State Medical Boards; this data base is used routinely by State boards. In addition, State boards can access disciplinary reports, including clinical privilege reports, in the National Practitioner Data Bank, but they are not required to do so.