Turning a Blind Eye: Hospitals Fail to Discipline Doctors, Exploit Loopholes to Avoid Requirement to Report Doctors

Though a federal law requires hospitals to report
physicians who have had their admitting privileges revoked or
restricted for more than 30 days, a Public Citizen report released today
found that in addition to inadequate discipline of physicians,
hospitals routinely exploit loopholes to avoid government requirements,
with nearly half of all hospitals not submitting a single doctor's name
to the National Practitioner Data Bank (NPDB) in the more than 17 years
it has existed.

The failure of hospitals to adequately discipline doctors or to
report cases of physician discipline to the NPDB deprives state medical
boards of critical information needed for regulatory oversight and
creates the potential for patient harm, Public Citizen said in the
report and in a letter sent today to Kathleen Sebelius, secretary of the Department of Health and Human Services.

When the database was first created, federal officials estimated
that hospitals would report approximately 5,000 cases a year. But since
it began 1990, the database has averaged only 650 reports a year,
Public Citizen found.

"It is impossible to justify the fact that thousands of hospitals,
which collectively have granted admitting privileges to hundreds of
thousands of doctors, have not reported a single discipline case in 17
years," said Dr. Sidney Wolfe, Public Citizen's acting president and
director of its Health Research Group. "Our report shows there is an
urgent need for the Obama administration to step in and hold hospital
administrators accountable as well as ensure that hospital medical
staffs hold their own physicians accountable for patient safety."

Pubic Citizen compiled the report by reviewing studies by the Office
of the Inspector General, medical journal articles, work by the
non-profit Citizen Advocacy Center and recommendations from an October
1996 national meeting on hospital underreporting attended by hospital
administrators, government officials, medical associations and consumer
advocates, including Public Citizen. Public Citizen also analyzed the
NDPB to examine the relationship between hospital reports and actions
taken by state medical boards on the same physicians.

The report points to two troubling factors behind the dangerously
low number of hospital discipline reports: 1) Lax peer review,
including a culture among doctors of not wanting to "snitch" on a
colleague; 2) hospital administrators evading reporting requirements by
doing things such as imposing discipline of less than 31 days, thereby
evading the reporting requirement or giving doctors a leave of absence
in lieu of suspensions.

Public Citizen makes several recommendations, including amending the
Health Care Quality Improvement Act of 1986 to add fines for each
instance of a hospital's failure to report and tying compliance with
the act to the hospital accreditation process and Medicare conditions
of participation.

"Hospital peer review has been called one of the pillars of quality
assurance in the U.S. health care system," said Al Levine, the Public
Citizen researcher who compiled the report. "Based on all the data and
reports we analyzed, it appears to be a questionably effective form of
self-regulation that needs more accountability and better oversight. We
hope our report is the tipping point for action by Congress and the
Department of Health and Human Services."

Public Citizen's letter to Sebelius urges her to implement
recommendations made long ago by the HHS Inspector General's office but
never acted upon.

READ the letter.

READ Public Citizen's report.