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Government Must Tell Medicare Patients Results of Investigations Into Doctor Complaints, Court Says

July 16, 2001

Government Must Tell Medicare Patients Results of Investigations Into Doctor Complaints, Court Says

HHS Policy of Withholding Information Violates Law

WASHINGTON, D.C. – A federal policy of withholding investigation results from Medicare patients who have filed complaints about doctors is illegal and must change, a judge has ruled.

Public Citizen filed the case last year 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.

The government argued that maintaining this confidentiality was consistent with the law and necessary for the PRO to perform its duties. 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 a July 10 ruling issued by the U.S. District Court for the District of Columbia, U.S. District Judge Ellen Segal Huvelle found that the policy violated the statute and the intent of Congress. The judge found that an examination of the history, structure and underlying purpose of the statute supported the finding that a PRO must inform complainants of the substantive dispositions of their complaints. She ordered HHS to amend the policy within 20 days.

“The decision is a victory for Medicare patients who are the victims of substandard medical care,” said Amanda Frost, an attorney with Public Citizen Litigation Group. “This decision means that the government can no longer hide doctors’ errors from Medicare patients.”

“I think it’s a wonderful decision,” said Shipp, now retired and living in Louisville. “When you want the truth and you seek it, it should be given to you. That’s why you pay taxes.”