Public Access to the National Practitioner Data Bank?

By Ronald L. Scott
rscott@central.uh.edu
Health Law & Policy Institute

On September 7, House Commerce Committee Chairman Thomas Bliley, R-Va., introduced H.R. 5122 to allow access by the public to all information reported to the National Practitioner Data Bank (NPDB). The NPDB was established as a central information clearinghouse to collect and release information related to the professional conduct and competence of physicians, nurses, dentists, and other health care practitioners. The NPDB supports professional peer review by allowing hospitals, state licensing boards, professional societies, and other health care entities to identify and exclude health care practitioners who engage in unprofessional conduct. The NPDB contains information about health care practitioners’ malpractice payments, adverse licensure actions, restrictions on professional membership, and negative privileging actions by hospitals.

Currently, access to information in the NPDB is not available to the public, but only to state licensing boards, hospitals, and other health care entities involved in either discipline, licensing, or credentialing peer review. It has recently been reported that Bliley wants to pass his bill before he retires in December and has offered a compromise. Under the compromise, public access could be limited to information on hospital and state medical board disciplinary actions. The provision for access to raw malpractice information available—the most contentious part of the bill—would be dropped.

The American Medical Association has long opposed public access to the NPDB, and reportedly opposes the bill even with the recent concession as to malpractice information. In defense of its position, an AMA spokeswoman said that the AMA "still supports state-based efforts to provide public information about physicians" which the AMA believes are "further along." See http://dailynews.yahoo.com/h/nm/20001018/hl/databank_1.html.

But how far along are state efforts? "DocFinder" at http://www.docboard.org is maintained by the Association of State Medical Board Executive Directors. By entering a physician’s name in one of the eighteen participating state’s sites, a search by a physician’s name will confirm license status, number, and type (e.g. M.D.), address, date of birth, original license date, license expiration date, education, specialty, and any disciplinary actions on file. See Checking Out Your Doctor’s Credentials on the Internet at HealthPolicy/990628Checking.html. Texas law mandates that fairly extensive physician profile information be available. See Extensive Texas Physician Profiles Will Soon Be Available to Public at Internet/990720Extensive.html.

However, most current profile databases have at least two serious limitations that would be corrected by Bliley’s bill. First, they are generally searchable only by a physician’s name. Therefore, the database is mostly useless in helping one locate and choose a physician. Ideally, a patient could search by zip code for all physicians in a particular specialty, and compare their credentials before choosing a physician. Although the databases clearly have relevant information available, the restrictive search engine used to access the databases significantly limits their usefulness.

Also, some state boards of medical examiners seem to go out of their way to hide disciplinary information from the public. For example, media reports indicated that Oregon physician Dr. Steven G. Moos was fined $5,000 and placed on probation for 10 years by the medical board for prescribing Viagra and other drugs via the Internet to patients he had never personally examined. A search of his physician profile at http://www.bme.state.or.us/search.html (a link from the DocFinder site) reveals that a "[p]ublic order [is]on file" and directs the visitor to "[s]ee link for details." One might assume the link would be to the order detailing Dr. Moos’ wrongdoing and imposing sanctions, but instead the link is only to a document that provides licensure definitions. "Public Order on File" is explained as "The Board of Medical Examiners has taken action that has resulted in a Public Order, which relates to the licensee’s right to practice." To obtain a copy of the order, one must file a written request with the board and include a $10 payment for each licensee. The Massachusetts site is better than most in two respects. It allows a search by city name and provides information about malpractice settlements within the last ten years. See http://www.docboard.org/ma/df/masearch.htm.

All sites should at a minimum allow searches by any category, e.g., medical school attended, location, specialty, etc., and provide greater detail on disciplinary actions. The Bliley bill, even with the compromise, would help ensure that consumers across the nation have the information they need to make choices about their doctors—the doctors they will entrust with their lives. The AMA is wrong if it believes that states are providing adequate information about physician’s credentials and disciplinary actions.

10/25/00