Archive for December, 2009


You Can Bank on Your Doctor’s Competence

December 17, 2009 | Posted by Ken Eisner | No Comments

In this day and age, patients are encouraged to be knowledgeable and therefore ask questions of their healthcare providers about their conditions.  While this line of questioning by patients is considered normal, it is probably not appropriate to ask your physician about his or her competence and more specifically, how many times he or she has been sued for medical malpractice and what were the results.  There is frankly limited opportunity for patients to know about the competence of their physicians other than what they have heard from other patients.

There are, however, protections to ensure that your physician and other healthcare practitioners are competent.

For example, each physician when he or she applies to a medical staff of a hospital in order to practice there is required to provide significant information about his experience.  The hospital reviews these credentials and the hospital administrators, along with the medical staff, make a determination as to the competence of the physician to practice at that facility.  One problem was that confirming this information for its accuracy was previously extremely difficult.  That is, until the creation of the National Practitioners Data Bank (“NPDB”).

The NPDB is an electronic data bank that consists of all payments that are made on behalf of physicians in connection with medical malpractice cases, as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other healthcare practitioners.  The NPDB was established by Congress as part of the Health Care Quality Improvement Act of 1986, which became law when signed by then President Ronald Reagan in 1986.  The Health Care Quality Improvement Act was enacted because Congress believed that the increasing number of medical malpractice cases and the need to improve the quality of healthcare had become national problems that required more effort than any individual state could provide.  At the time, the medical community was relying upon professional peer review to restrict the ability of incompetent practitioners from moving from state to state without disclosing prior performance.  The heightened concern with improving the quality of healthcare led to the establishment of the NPDB on October 17, 1989.

The information available in the NPDB includes:

  1. medical malpractice payments made on behalf of a physician, dentist, or other healthcare practitioner;
  2. adverse action reports based on a healthcare practitioner’s competence or conduct that adversely affects the practitioner’s medical staff privileges for more than 30 days;
  3. disciplinary actions related to competence or professional misconduct against a healthcare practitioner, including revocation, reprimand, probation, suspension and surrender of license;
  4. professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society; and
  5. Medicare and Medicaid exclusion reports containing sanctions due to fraud and abuse.

The information in the NPDB is not available to the general public. This information is available to:

  1. healthcare entities under certain circumstances relating to medical staff privileges, employment and other affiliation relationships;
  2. practitioners requesting information about themselves; and
  3. boards of medical examiners or other state licensing boards.There remains limited information available to the general public as to the quality of healthcare practitioners.

There are a few web sites that provide limited information for a price.  See for example, healthgrades.com, which provides the specialties of a healthcare practitioner and certain instances of professional misconduct.  This information is, however, minimal.  You may also attempt to contact the State Medical Board to see if any licensure action has been imposed on your healthcare practitioner.  However, malpractice and criminal information is typically withheld from state medical boards.

The bottom line is that with the advent of the NPDB and the various other professional peer review protections that exist, you can feel pretty comfortable that your physician is competent and no further background check is necessary.  Simply relax and take a deep breath.

In this day and age, patients are encouraged to be knowledgeable and therefore ask questions of their healthcare providers about their conditions.  While this line of questioning by patients is considered normal, it is probably not appropriate to ask your physician about his or her competence and more specifically, how many times he or she has been sued for medical malpractice and what were the results.  There is frankly limited opportunity for patients to know about the competence of their physicians other than what they have heard from other patients.
There are, however, protections to ensure that your physician and other healthcare practitioners are competent.
For example, each physician when he or she applies to a medical staff of a hospital in order to practice there is required to provide significant information about his experience.  The hospital reviews these credentials and the hospital administrators, along with the medical staff, make a determination as to the competence of the physician to practice at that facility.  One problem was that confirming this information for its accuracy was previously extremely difficult.  That is, until the creation of the National Practitioners Data Bank (“NPDB”).
The NPDB is an electronic data bank that consists of all payments that are made on behalf of physicians in connection with medical malpractice cases, as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other healthcare practitioners.  The NPDB was established by Congress as part of the Health Care Quality Improvement Act of 1986, which became law when signed by then President Ronald Reagan in 1986.  The Health Care Quality Improvement Act was enacted because Congress believed that the increasing number of medical malpractice cases and the need to improve the quality of healthcare had become national problems that required more effort than any individual state could provide.  At the time, the medical community was relying upon professional peer review to restrict the ability of incompetent practitioners from moving from state to state without disclosing prior performance.  The heightened concern with improving the quality of healthcare led to the establishment of the NPDB on October 17,
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