June 20, 2003

Government Must Tell Medicare Patients Results of Investigations Into Complaints That Doctors Erred, Appeals Court Says


HHS Policy of Withholding Information Violates Law, Court Concurs with Public Citizen

WASHINGTON, D.C. — A federal appeals court has ruled that the government cannot keep secret the results of its investigations into Medicare patients’ complaints about the quality of their medical care. Under the policy at issue in the case, the government would keep secret the results of investigations, even when it found that the doctor in question made a medical error, if the doctor refused to consent to disclosure.

The U.S. Court of Appeals for the District of Columbia held that this policy violated the Peer Review Improvement Act, affirming a July 2001 ruling by a district court.

Public Citizen filed suit in 2000 against the U.S. Department of Health and Human Services (HHS). The complaint stemmed from the agency’s refusal to disclose investigation results to Kentucky resident David Shipp, who filed a complaint related to his wife’s care in 1998 and 1999 at Baptist East Hospital in Louisville. HHS’s Peer Review Organization (PRO) launched an investigation into three doctors, but refused to tell Shipp the results of the investigations into two of the doctors because the physicians did not consent to the disclosure.

Lawyers for HHS argued that maintaining this confidentiality was consistent with the law and necessary for the PRO to perform its duties. However, that litigation position was at odds with a report from HHS’ Office of Inspector General, which concluded that the policy of keeping investigation results secret "hinder[s] the PROs’ ability to be responsive to beneficiaries who complain" and urged that the results of all investigations be disclosed. Public Citizen contended that the policy violated the Peer Review Improvement Act of 1982, as amended in 1986, which states that PROs "shall inform the individual (or representative) of the organization’s final disposition of the complaint."

In today’s ruling, the three judge panel agreed with Public Citizen that the form letter HHS had sent to complainants, notifying them only that their complaint had been received but not disclosing the results of the investigations into the quality of medical care provided under Medicare, did not meet the requirements of the law. Click here to view the ruling.

"The decision is a victory for Medicare patients who are the victims of substandard medical care," said Amanda Frost, an attorney with the Public Citizen Litigation Group. "People who have personally been harmed, or whose family members have been harmed, deserve to know what came of their complaint."