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08 March 2018

State Medical Boards Aren’t Checking National Malpractice Database, Report Finds

Many medical licensing boards don’t even look at the National Practitioner Data Bank, a government-run database of medical malpractice judgments and enforcement actions, according to a new investigation from Medscape and the Milwaukee Journal Sentinel.

Why Don’t Licensing Boards Use The Practitioner Data Bank?

The investigation’s results reveal a shocking lack of interest in what may well be America’s best resource for identifying and penalizing bad doctors, beyond civil litigation and the private choices of informed patients.

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Created by Congress in 1986, the National Practitioner Data Bank is an internet database of incriminating reports against physicians and other medical care professionals. The database’s information is kept confidential, away from public eyes, and doctors who have been accused of misconduct can submit their own accounts to correct the record.

How Do We Track Bad Doctors?

The National Practitioner Data Bank was established to solve a very specific problem. How do we keep track of doctors who may be dangerous when they move from state-to-state?

Every state has its own medical licensing boards. The panels review a doctor’s credentials and past performance, then either grant or deny the physician the authority to practice medicine within the jurisdiction. And state licensing boards also field complaints against doctors who hurt their patients, allowing them to update their licensing decisions and revoke a physician’s license if appropriate.

Obviously, there’s no practical way for these separate state boards to maintain perfect communication with one another, at least in a free society where medical professionals are allowed to pick up and move. So Congress set up the National Practitioner Data Bank, a resource that would accept reports of sub-par medical practice and allow state licensing boards to access them.

Many States Never Check The Database

Now, thanks to the work of Medpage and reporters at the Milwaukee Journal Sentinel, we know that the database isn’t being used as intended.

In 2017, licensing boards from 13 states didn’t check the database once, according to review of data from the Health Resources and Service Administration, the federal office that manages the National Practitioner Data Bank. And another 30 states checked the database fewer than 100 times during the year, despite having renewed hundreds of medical licenses every year.

Florida & Delaware: Two Very Different Pictures

Then, there are a select number of states that use the database a lot. Florida, for example, submitted 86,495 requests to the database, including 83,942 “continuous” requests, in which the State’s licensing board asked for continual updates on the records of specific physicians.

Compare that to Delaware, where the State’s Board of Medical Licensure made only 4 requests during the entire year. That’s strange. Delaware is currently home to 2,951 active physicians, according to the Kaiser Family Foundation. And medical licenses in Delaware are renewed every two years, so we should expect that the State’s licensing board reviewed around 1,475 applications in 2017. Yet only 4 requests for information were sent to the National Practitioner Data Bank.

Other Options For Identifying Sanctioned Physicians

So how is Delaware making its licensure decisions? The National Practitioner Data Bank isn’t the only way to check up on a doctor’s performance. Indeed, it’s likely that most complaints against a doctor, along with the majority of medical malpractice judgments, are reported first to a state licensing board, rather than the national database. But that doesn’t mean the NPDB is useless; for that to be true, we’d have to assume that no doctors moved to Delaware in 2017.

It’s certainly not useless in Wyoming. In Wyoming, where state regulators queried the national database 4,554 times in 2017, the federal system is working, according to Kevin Blohnenblust, executive director of the State’s licensing board. Since it began using the service, Wyoming officials are tagging around 10% more applications for additional review than they used to.

The Physician Data Center

So why aren’t medical boards utilizing the federal database? One possibility is that boards have found other ways of screening out bad doctors. Or, more accurately, they went out and set up their own way to do it.

The Federation of State Medical Boards, a non-profit that represents America’s 70 state medical and osteopathic licensing boards, maintains its own Physician Data Center to track the movement of doctors around the country. But this separate database doesn’t have information on medical malpractice lawsuits and, moreover, it’s completely voluntary.

“Medical boards, hospitals and malpractice insurance companies,” Medscape writes, “are required to report infractions to the federal data bank.” So there’s no way the Physician Data Center could replace the NPDB. Nor could the NPDB replace the Physician Data Center, which tracks all physicians, rather than just doctors who have been penalized for bad practice.

The reality is likely that both databases supplement one another. “They’re complementary,” says Lisa Robin, an officials at the Federal of State Medical Boards. “We would recommend they’re both utilized.”

Cost Concerns

There is a significant hurdle standing in the face of state medical boards who would like to use the national database: cost. Every search in the NPDB comes with a fee of $2. That’s chump change if you’re only making one query, but if, like Florida, you’re making around 86,000 requests every year, you have to spend hundreds of thousands of dollars. Beyond the annual membership fee of $2,400, the Physician Data Center is free for members to search.

500 Doctors Allowed To Move & Practice, Despite History Of Misconduct

This isn’t an idle problem, according to the authors at the Milwaukee Journal Sentinel and Medscape. In their investigation, reporters identified 500 doctors between 2011 and 2016 who were penalized in one state, but able to move to a new one, set up shop and start practicing medicine with an untarnished medical license.

The list includes a physician who was listed as an “imminent danger to the public” in Illinois (but is free to practice in Missouri), a specialist in Colorado who was sued seven times for misdiagnosing multiple sclerosis (now happily practicing medicine in Florida) and a cosmetic surgeon in New York who needed to “have a chaperone in the room whenever he was with a female patient (but has never been sanctioned in Wisconsin, where he also holds a medical license).

Of course, there’s another way to argue this data. In a country with around 877,000 active physicians, 500 is a drop in the bucket. You could even consider that an astounding success rate from a certain vantage point.

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