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)
An analysis of the National Practitioner Data Bank Public Use File for 1990-2009 found that of a total of 10,672 physicians in the data bank with one or more clinical privilege actions – revocation or restriction of their clinical privileges – 45% also had one or more state licensing actions. However 5,887, or 55%, of these physicians – more than half – had no state licensing actions. This report is an analysis of violations by and the privileging actions taken against these physicians who, despite clinical privilege actions, escaped any state licensing action.
Types of violations causing Clinical Privileging Actions
The reason for the actions against these 5,887 physicians included:
- 220 physicians disciplined because they were an “Immediate Threat to Health or Safety”
- 1,119 physicians disciplined because of incompetence, negligence or malpractice
- 605 physicians disciplined because of substandard care
Other categories of serious deviations of physician behavior/performance that resulted in clinical privilege revocation or restrictions included Sexual Misconduct, Unable to Practice Safely, fraud, including insurance fraud, fraud obtaining a license, and fraud against health care programs, and narcotics violations.
Thus, a total of 2,071 physicians (35% of those physicians with clinical privilege actions but no medical board actions), had one or more of the above most serious categories of violations.
Types of Clinical Privileging Actions taken against the 5,887 physicians
3,218 physicians in our study lost their clinical privileges permanently, and an additional 389 physicians lost privileges for more than one year.
Thus, 3,607 physicians, representing 61% of those with one or more clinical privilege reports but no state disciplinary action, had either a permanent clinical privilege penalty or a penalty of one year or more.
In addition, many of the 5,887 physicians who had been disciplined by hospitals, but had no state medical board action, had a history of medical malpractice payments (as reported to the NPDB). A physician in New Mexico had 26 malpractice cases while a physician in Indiana had 20. Fourteen states had a physician with at least one clinical privilege report, no state licensure action, and at least 10 medical malpractice payments.
Hospital disciplinary reports are peer review actions that are one of the most important sources of information for medical board oversight. Subsequent state medical board action against a physician’s license provides a greater assurance than a hospital disciplinary action alone that the practitioners medical practice would be monitored or limited and that other state medical boards and future employers will have a more complete account of a practitioner’s practice history.
Our analysis of physicians with clinical privilege reports but no state licensure action raises serious questions about whether state medical boards are responding adequately to hospital disciplinary reports and whether, as required by federal law, state medical boards are receiving such reports.
Because the NPDB Public Use File de-identifies physicians through the use of code numbers, Public Citizen is asking state medical boards to work cooperatively with the Health Resources and Services Administration, which operates the NPDB, to identify the physicians in our study and take the appropriate action.