The National Practitioner Data Bank
Many medical professionals who encounter the unfriendly end of a professional review, disciplinary action, or licensure proceeding may not realize the extent to which information about those actions is collected and available to third-parties. The reality is that hospitals, Boards of Medical Examiners, professional societies, or even insurance companies may be required to report adverse information to a national database made available to the medical community. Understanding what your file contains and how to dispute erroneous reports is critical to limiting the effects of this national reporting system.
National Practitioner Data Bank
The Health Care Quality Improvement Act of 1986, 42 U.S.C. §§ 11101 et seq., sought to increase the availability of information related to adverse actions taken against physicians, dentists, and other health care practitioners. The Act accomplished this by creating the National Practitioner Data Bank, a nation-wide database containing the reports of adverse information about a medical practitioner. In all cases where a report is filed with the Data Bank, the report will contain a description of the action taken and the reasons for the adverse action. The information reported to the Data Bank generally falls into one of three categories.
1) Medical Malpractice – If an insurance company pays on a claim or judgment against any health care practitioner, it must file a report with the Data Bank and the relevant State Board.
2) State Licensure Actions – If a Board of Medical Examiners revokes or suspends a physician’s or dentist’s license, the Board must file a report with the Data Bank. It must also report any action against a doctor or dentist that censures, reprimands, or places him or her on probation.
3) Restriction of Clinical Privileges – If a health care entity or professional society restricts a doctor or dentist’s privileges for more than 30 days (or the doctor or dentist accepts the surrender or restriction of privileges in the face of a review), such information must be reported to the State Board, which will report it to the Data Bank. If a health care entity restricts the clinical privileges of a nurse or other non-physician practitioner, the reporting of the adverse action is voluntary and within the discretion of the health care entity.
The Act requires hospitals to request a report on any health care practitioner it considers hiring. Hospitals must also request a report every two years on every professional with medical privileges. It is apparent, therefore, that adverse findings against a health care practitioner can have significant repercussions on employment prospects and reputation.
In subsequent articles, we will examine how a practitioner can learn the contents of his or her report and dispute any controversial information. |
