Data bank overseer cautions against making it public

A second hearing on opening the National Practitioner Data Bank to the public as a patient-safety tool yields more arguments against the idea.

By Susan J. Landers, amednews staff. April 3, 2000.

Washington -- Physicians' competency cannot be determined by simply checking the number of adverse reports filed against them in a national data bank, the federal administrator who manages the data bank has told a House Commerce Committee panel.

The oversight and investigations subcommittee was holding its second of two hearings on whether to open the confidential data bank to public scrutiny, a move favored by Commerce Committee Chair Thomas Bliley, Jr. (R, Va.) as a consumer protection measure.

The National Practitioner Data Bank emerged in 1990 as a supplement to a professional peer review process designed to shield consumers from incompetent physicians and dentists, said Tom Croft, a director in the Dept. of Health and Human Services Health Resources and Services Administration, at the March 16 hearing.

The data bank helps to ensure that a physician or dentist "cannot move from place to place in the hope of escaping a checkered past," Croft said.

But "nothing in the data bank's information is intended to produce an independent determination about the competency of an individual practitioner," he told the panel.

For example, a physician's failure to send employees home after a chemical plant explosion prompted 177 reports to the data bank. But no one could tell if the physician made the proper decision based on that information alone, Croft said.

The vast majority of the information in the data bank concerns medical malpractice settlements that, many argue, would tell the public little or nothing about a physician's competence.

Croft testified that more than 70% of the physicians and dentists in the data bank have only one report filed against them; nearly all of those are medical malpractice settlements.

The AMA, strongly opposed to opening the data bank, argues that the existence of a malpractice action does not shed any light on the abilities of a physician.

In testimony before the panel's first hearing, AMA President Thomas R. Reardon, MD, noted that a New England Journal of Medicine study indicates that only about one in five medical malpractice settlements result from negligent care.

The AMA also joined with more than 30 medical specialty societies in recommending, via a March 14 letter to the committee, that enhancements to state-based credentialing systems could be the best route toward improved patient safety.

"State medical boards are in the best position to conduct peer review activities, access accurate data on physicians, and revoke or suspend medical licenses to protect patients," said the groups.

A hospital mandate

In addition to malpractice settlements, the data bank contains information on licensing, credentialing and professional society actions taken against more than 146,000 practitioners, of whom 100,000 are physicians.

Hospitals are required to query the data bank when a physician applies for privileges.

Croft urged the panel to carefully consider any action it contemplates that could jeopardize the data bank's confidentiality and thereby discourage hospitals from reporting.

Subcommittee Chair Fred Upton (R, Mich.) said that he was not yet ready to draft legislation but suggested he would consider making certain changes to the data bank.

For example, he said he'd like to work more closely with state medical boards to ensure they have the tools they need to prevent dishonest physicians and dentists from practicing.

Also among the issues raised at the hearing was the low reporting rate by hospitals, which are now required to report disciplinary actions to the data bank. Bliley said he was concerned that more than 60% of hospitals had never made a single report to the data bank and only two had ever been warned about their reporting failure.

Croft said his agency would hire an accounting firm to devise a system of auditing hospital records to address this problem. HHS also is considering a recommendation made by its Office of Inspector General to seek a legislative change that would impose monetary penalties on hospitals that fail to report actions, he said.