We Are All Alan Bavley: How to Get HRSA's Attention on Doctor Database

There seems to be a movement building around Alan Bavley.

Bavley is the Kansas City Star reporter who wrote about a neurosurgeon with a history of malpractice who continued to operate in Kansas with a clean medical board record. In writing his story, Bavley made use of a public dataset from the National Practitioner Data Bank, a compilation of data from state medical boards and other agencies around the country and managed by the Health Resources and Services Administration (HRSA).

The doctor who was the chief example in his story, Dr. Robert Tenny, complained to HRSA, and HRSA took the unusual step of both threatening Bavley with an $11,000 fine and removing the "Public Use File" from its website.

Within days of Bavley writing about the threat and the file's removal, the heads of three prominent journalism organizations wrote HRSA demanding that the file be restored and calling foul on the threat against Bavley. Public Citizen and Consumers Union Safe Patient Project and other groups wrote letters, too. Investigative Reporters & Editors, one of the groups that sent the letter to HRSA, made a version of the Public Use File, current through August 2011, available on its website for free.

"The removal of the Public Use File - whose very name means for public use - eliminates a valuable tool for journalists whose goal is to educate and protect the public. This database has allowed reporters to uncover flaws that have toughened legislation, and without a doubt, saved the lives of patients across the country," IRE President Manny Garcia said on IRE's site. "We are also stunned that a public servant has the hubris to threaten a health care reporter for doing his job. HRSA should be delighted that journalists are using public information to help saves lives."

The story has been covered by The New York Times, Medscape, MSNBC, Reuters, PLoS, The Los Angeles Times and many others.

But, so far, nobody at HRSA has apologized to Bavley, or to the public. And HRSA has made it clear that it intends to alter the Public Use File to make it even more protective of doctors – and thereby less protective of patients – than it was before.

"It is important to understand that the law that created the National Practitioner Data Bank requires that information about individual practitioners [doctors, nurses, etc.] must remain confidential," HRSA spokesman Martin Kramer told the LA Times' Noam Levey. "When HRSA became aware that a reporter in Kansas City was able to use the information in the Public Use File and other information to obtain details about a specific physician we had no choice but to take down the Public Use File."

Now, Kramer said, the agency is looking for ways to alter the data to make it harder for the public to identify physicians. As Charles Ornstein, president of AHCJ and a Pulitzer Prize winning journalist who has written extensively about medical practitioners who have harmed patients, pointed out to Reuters, the fact that HRSA is talking about altering the Public Use File is a big departure from past practice.

"Nothing else has changed; just their interpretation (of the law) seems to have changed," Ornstein said.

Those of us who made it through Spike Lee's overlong homage to Malcolm X still remember the ending, where school children around the world stand up and say "I am Malcolm X," followed by Nelson Mandela giving a rousing speech. Most critics considered the ending over-the-top. I think Lee intended it that way because he wanted to jar people into thinking about what a forceful – if divisive – figure Malcolm X was and what an important role he played in history.

In a similar way, I think we should have an over-the-top response to the threat against Bavley and the decision to make valuable public information secret. This may be the only way to really get HRSA's attention, and it may be the only way to get the rest of the public to care about something called a "Public Use File." It doesn't tend to get the blood boiling quite the same as health reform or the jobless rate.

So, I am asking intrepid people who care about patient safety and who care about public information to stand up like those school kids. Take a picture of yourself with a sign saying "I am Alan B." Or use a video camera to filming people standing up and saying, "I Am Alan B." Let's create a YouTube channel and start bombarding HRSA with emails linking to the videos.

To take it one level over over-the-top, we could find a cheap way to make baseball hats, too, black with a silver "B," just like the Malcolm X hats that were briefly popular in the early 1990s. I was able to design one in five minutes at Lids.com. It costs less than $30.

Or, for you Kansas City Royals fans, put on your Royals cap and declare your unity with Alan Bavley!

I see a pro-Bavley future filled with t-shirts, posters, mockumentaries, a variation on that Downfall/Hitler Reacts video meme (Hitler finds out that Alan Bavley has used the Public Use File to write about doctors harming patients.)

Let's make some noise for patient safety, people! And let's get the Public Use File back in the hands of the public!

Have a better idea? Send it to askantidote@gmail.com or post it in the comments below.

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