Inept Doctors Not Being Identified As Required
May 29, 2001 5:13 pm EST

By Will Dunham

WASHINGTON (Reuters) - Health maintenance organizations and hospitals are undercutting a law aimed at protecting Americans from inept doctors by failing to report them to the U.S. government as required, federal officials said on Tuesday.

Between 44,000 and 98,000 Americans die annually due to medical errors, medical experts estimated in 1999.

But a new report by the U.S. Department of Health and Human Services (HHS) Office of Inspector General found that 84 percent of HMOs from 1990 to 1999 failed to report even one physician to a government data base on incompetent doctors.

In addition, 60 percent of hospitals reported no doctors to the data base, the report said.

The National Practitioner Data Bank was created by Congress in 1986 amid concern among lawmakers that doctors who had been stripped of their licenses to practice medicine in one state simply were moving to another state and setting up shop.

Information reported to the data base about specific bad doctors is not made available to the public. The data base is intended to serve as a national repository of information to help state licensing boards and health care providers make well-informed decisions regarding doctors.

"It's a very troubling report," Oregon Democratic Sen. Ron Wyden, author of the law, said in an interview.

"I hope they (HMOs) will take it as a wake-up call that it's fine to talk about how you are for quality health care, but if you don't report a practitioner who has engaged in flagrant misconduct, that is not in the public interest nor is it promoting quality health care."

The report said HMOs and hospitals were required under the law to report to the data base any disciplinary action that affected a doctor's clinical privileges for at least 30 days.

The discipline could stem from actions including negligent care such as unwarranted surgery or operating on the wrong side of a patient's body, having sex with patients, improperly prescribing drugs and personal drug use. The report called such discipline an "adverse action."

"With close to 100 million individuals enrolled in these organizations and hundreds of thousands of physicians and dentists associated with them, fewer than 1,000 adverse action reports over nearly a decade serves for all practical purposes as non-reporting," the report said.

The report covered a decade when HMOs and other managed care providers became the foremost source of medical care in the United States.

PATIENTS "ARE GOING TO BE INJURED"

"Ultimately, patients who go to these doctors are going to be injured or harmed because they are going to people who are known to have committed some act of negligence," said Dr. Sidney Wolfe, director of consumer group Public Citizen's Health Research Group.

"It's just another horrendous example of how various parts of our health care system are cheating the reporting requirements of the National Practitioner Data Bank."

The report said some managed care organizations had failed to make quality assurance a priority, adding that "in a health care marketplace that has been changing rapidly, many managed care organizations devote little attention to clinical oversight."

Susan Pisano, vice president for communications for the American Association of Health Plans, which represents more than 1,000 HMOs and other managed care firms, said her group asked HHS officials on May 15 to clarify whether the industry actually was obligated to report doctors to the data base.

She said her group believed the industry was obligated to report doctors only to the appropriate state medical board.

"The plans take the reporting obligations very seriously," she said. "It's a question of the requirements being unclear."