Half of the 6,500 hospitals in the U.S. have never reported any physicians they disciplined for medical competency or conduct problems to a national database in nearly two decades. Many other hospitals exploit loopholes to avoid the requirement, according to a Public Citizen report released today.
"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 Sidney Wolfe, MD., acting president and director of Public Citizen's Health Research Group, which issued the 38-page report.
The widespread practice allows problem physicians with serious performance issues to move their practices to communities in other states and receive staff privileges in hospitals whose medical staffs are unaware of their prior problems. They potentially can cause further harm to more patients or medical teams.
Wolfe says the report, which was coauthored by Public Citizen researcher Al Levine, "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."
Specifically, Wolfe wants Secretary of Health and Human Services
Kathleen Sebelius to advocate a change in federal law that would allow the Centers for Medicare and Medicaid Services to stop reimbursing hospitals for treating Medicare and Medicaid patients if they failed to report disciplined doctors.
He also wants the administration to advocate passage of legislation that would impose monetary penalties "for each instance of a hospital's failure to report."
Loopholes assist hospitals with getting around the law, he said. For example, rules require reporting to the National Practitioner Data Bank the name of any physician whose staff privileges were revoked or restricted for more than 30 days. To skirt that rule, hospitals revoke or suspend privileges for 30 days or less. Another way around the law is to give a physician a leave of absence in lieu of a suspension or revocation.
The problem is exacerbated by what Wolfe calls "a culture among doctors of not wanting to 'snitch' on a colleague."
Hospital officials support the requirements to report problematic physicians saying that it's an important way to avoid granting staff privileges to someone with ongoing problems, say Dorel Harms, senior vice president of clinical services and Wendy Keegan, legal counsel of the California Hospital Association. But they explain that often, many problems are avoided with interventions that resolve issues within the 30-day period.
In California, it often happens faster because disciplinary actions are required to be reported to the Medical Board for practice limitations set forth over 13 days.
"Often the doctors all know each other, seeing each other, and handling things if there are issues, on a person-to-person basis, before it gets to the point where it needs that kind of approach," says Harms, referring to the lengthy administrative hearing process that must take place before a physician loses all freedoms to see patients within the hospital setting.
That process can sometimes be complicated by lawsuits physicians file against the hospital for limiting staff privileges, as in a recent case involving a physician in Los Angeles, they say.
Fear of being sued by a practitioner, as well as the concern that if the physician were not allowed staff privileges, the hospital would lose valued business, are other concerns that thwart the intent of the law, Wolfe said.
"Congress should provide the Office of Inspector General with authority to investigate state medical boards' handling of adverse hospital clinical privilege reports," Wolfe said.
Many of the recommendations in his report were proposed years ago by the Office of Inspector General, but "none of the recommendations have ever been put into effect," he said. "The problems have been recognized for a long time, but nothing has ever been done about it."
Many hospitals fail to observe the full extent of the requirements. Even restrictions on scope of practice must be reported if they are in place for more than 30 days, "such as requiring that a doctor can't do a particular operation without having another surgeon watching," he said.
The highest rates of no reporting occur in hospitals in South Dakota, where 75% of hospitals had not filed a physician disciplinary report since the rule went into effect in 1990. Other states with the highest number of non-reporting hospitals include North Dakota, 70.2%; Louisiana, 68.9%; Wyoming, 69 %; Kansas, 68.7%; Montana, 66.7%; Oklahoma, 65.3%; Minnesota, 63.9%; Nebraska, 63.9%; Texas, 63.4%; Iowa, 62.4%; and Mississippi, 60.8%.
The states with the most hospitals reporting include Rhode Island, where only 18% of hospitals have failed to ever report a physician's name to the bank; Connecticut, where 25% had never reported; and New York, where 28.5% had never reported.
Other states with the highest number of hospitals not listed previously include California, where 31.9% of hospitals had never filed a report; Florida, where 46.3% had never filed; Illinois, 36.4%; Ohio, 42.6%; and Pennsylvania, 42.1%.