Few incompetent doctors are reported to US national data bank

A report last month by the inspector general of the United States Department of Health and Human Services criticised the National Practitioner Data Bank for failing to protect patients from doctors who provided poor care.

The data bank, which was set up the Congress in 1986, requires hospitals and health maintenance organisations to inform the government of any disciplinary actions taken against doctors for incompetence or misconduct. Under the law, hospitals and health maintenance organisations cannot be sued for errors they investigate and properly report. The data bank was designed to protect patients from doctors who move from state to state without disclosing that they have been censured or disciplined in some way for providing poor care. In the past decade, however, 1176 of 1401 (84%) health maintenance organisations and 60% of hospitals did not report a single “adverse action” to the government.

The report, based on an 18 month study, said that from 1990 to 1999, while managed care became the dominant form of health care in the United States, covering more than 100 million Americans, health maintenance organisations reported only 715 “adverse actions.” These included performing surgery on the wrong side of the body; performing unnecessary surgery; giving fatal overdoses of drugs; having sex with patients; prescribing narcotics for personal use; and fraudulently billing Medicaid for services never provided.

From 1990 to 1999, physician groups reported only 60 adverse actions to the data bank. Federal investigators said that health maintenance organisations frequently consulted the data bank to check on doctors' qualifications but rarely contributed any information of their own.

Oregon Democratic senator Ron Wyden, author of the 1986 law creating the data bank, said that the low level of reporting was unacceptable. “The inspector general's study sounds an alarm bell. Health plans ought to do more than just pay lip service to the goal of quality in health care,” he said.

Margaret O'Kane, president of the National Committee for Quality Assurance, which evaluates and accredits the health plans, said, “The health plans are very nervous about reporting to the data bank because they are afraid of being sued by doctors.”

The vice president of the American Association of Health Plans, Carmella Bocchino, said that many health maintenance organisations were not aware that they were “required to tell the government when doctors were disciplined for incompetence or misconduct.”

Medical errors, though not necessarily incompetent doctors, kill 44000 to 98000 Americans each year (BMJ 1999, 319:1519).