Health Letter, April 2018
By Michael Carome, M.D.
If you’re not outraged,
you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
In 1990, the U.S. Department of Health and Human Services began operating the National Practitioner Data Bank (NPDB), which was authorized by the Healthcare Quality Improvement Act of 1986. The NPDB plays a central role in ensuring patient safety by providing a comprehensive clearinghouse of information concerning the disciplinary history and malpractice payments of physicians (as well as dentists and other health care professionals) to state licensing boards, hospitals and others.
A major goal of the NPDB was to improve health care quality by preventing physicians who have been disciplined by state medical boards or hospitals for serious mistakes or misdeeds that threatened the health and welfare of patients from quietly moving to another state or hospital without the prior misconduct or incompetence being disclosed or detected.
However, a disturbing March 7 exposé published jointly by the Milwaukee Journal Sentinel and MedPage Today revealed that state medical boards, which are responsible for licensing and disciplining physicians, rarely query the NPDB as part of their background checks of physicians applying for medical licenses or seeking renewal of their licenses. As a result, numerous physicians who had their medical licenses restricted or revoked in one state for serious transgressions — such as misprescribing opioids, bungling surgeries, misdiagnosing patients or sexually abusing patients — have been able to obtain a license and resume medical practice in another state.
Surprisingly, although hospitals are required by federal law to query the NPDB before granting or renewing a physician’s clinical privileges, state medical boards are not required to do so before initially granting or renewing a physician’s medical license.
Among the findings reported by the Milwaukee Journal Sentinel and MedPage Today were the following:
- In 2016, the NPDB logged 7.5 million searches by hospitals, health insurers and state medical boards.
- In 2017, state medical boards — which collectively license approximately 950,000 doctors across the U.S. — accounted for just 137,000 searches. Two states — Wyoming and Florida — conducted more than two-thirds of these searches.
- Last year, 30 of the nation’s 63 state medical boards (some states have two medical boards, one for physicians with M.D. degrees and another for those with D.O. degrees) checked the NPDB fewer than 100 times.
- Thirteen boards did not check the data bank even once.
State medical boards can enroll in an NPDB service called “continuous query.” This valuable tool allows boards to conduct continuous real-time monitoring of licensed physicians. Under the service, the NPDB will notify the medical board within 24 hours when it receives a new report of disciplinary action by a state medical board (note that physicians often are licensed in more than one state at the same time) or hospital or a report of a malpractice payment. This service costs just $2 per physician annually.
The Milwaukee Journal Sentinel and MedPage Today reported that only 12 state medical boards use the continuous query service, and most of these only use it for a few licensed physicians.
By not using all of the available tools to conduct rigorous background checks and monitoring of physicians, state medical boards are failing to fulfill their obligations to protect patients from incompetent or dangerous doctors. The remedy for this problem is simple: All state medical boards should immediately enroll in the NPDB’s continuous query service for all their licensed physicians. The benefits to patients from doing so will far outweigh the trivial financial costs to the boards.