Public health reporting flaws spell trouble

Doctors complain about requirements that appear to lack follow-through.

By Victoria Stagg Elliott, AMNews staff. April 22/29, 2002.

When Karen Smith, MD, medical director of the San Francisco Health Plan, tries to alert the local health department to the occurrence of any one of the numerous medical conditions she is required by law to report, it is not an easy process.

First, she has to fill out a card, but the card doesn't specify the address where it should be sent, so she has to look that up. The form also asks questions that aren't always appropriate to the condition she is reporting. Finally, this official piece of paperwork is so small that it is easy to lose.

Nonetheless, she takes the time to do it and send it in, and then -- as far as she knows -- nothing happens.

"It's the most backward system. It's broken," she said. "They don't make it easy. You send [the card] in and you never hear back. It just goes into a black box. I don't know if I did it right or even if it matters."

As far as most physicians are concerned, the public health disease reporting system needs urgent repairs. They complain about long lists of diseases that they can't keep track of, awkward reporting systems, unanswered questions about confidentiality, little feedback and few rewards for sharing information. Doctors often don't know if the information was even received.

In addition, most local health departments have limited money to do contact tracing, so people who may have been exposed to an infectious illness don't always get tracked down for treatment. Therefore, physicians don't see any positive results from their efforts. And, although there are penalties for not reporting, punitive action is almost never taken. In addition, reporting sometimes falls through the cracks because it's not clear whose responsibility it is. [...]