Public Citizen data on hospital laggards deserves second look
Pia Christensen of the Association of Health Care Journalists responded to an earlier blog post that I had essentially ignored some good reporting on the Public Citizen report about how hospitals are failing in a very big way to report bad doctors to the National Practitioner Data Bank. She cited three stories, saying:
"The data is easy to break down on a state-by-state level, and folks such as the Miami Herald's John Dorschner, the Detroit Free Press's Patricia Anstettand the Contra Costa Times' Sandy Kleffmanhave already reported local versions of the story."
The numbers are easy to break down by state, and it's a shame that more publications haven't taken the time to do so. Here are a few who did.
The Miami Herald localized the story:
Almost half of the hospitals in Florida never reported having a problem with any doctor over a 17-year period, according to a report released Thursday.
Public Citizen, a Washington watchdog group, said 105 of 227 Florida hospitals - 46.3 percent -had never filed a complaint from 1990 through 2007 with the National Practitioner Data Bank, the federal group that keeps track of problem doctors nationwide.
Co-authors Alan Levine and Sidney M. Wolfe dismissed the notion that so many hospitals could have had perfect doctor performances for almost two decades. They said the real reason was the clubby atmosphere in which the healthcare industry protects its own. Nationwide, Public Citizen reported 48.9 percent of hospitals had never reported a problem doctor in the 17 years.
A couple of gold stars for Dorschner, one of the hardest-working health care writers in the country. A lesser reporter might have looked at the fact that the state, at 46.3 percent, is actually doing better than the national average of 48.9 percent and decided not to write a story at all. If your average is no better than half bad, it's hard to brag.
Dorschner also brought in some much needed context, pointing out, without comment, that "an earlier Public Citizen report said Florida's Board of Medicine ranked 35th in the country for the rate that it disciplined doctors." It appears the board is mostly holding up its end of the bargain, but hospitals are falling well short. As an example of the board's actions, Dorschner offers Miami-Dade heart surgeon Alex Zakharia, writing "18 months after he had entered a criminal plea deal about exaggerating his surgical experience in a case in which he admitted to being bothered by memory loss that was getting worse." This example is a little vague, but I applaud the effort.
The Contra Costa Times took a national angle:
Many hospitals are failing to adequately discipline and report substandard doctors, making it easier for such physicians to relocate to another institution or state where their track records are not known, a citizens group charged Wednesday.
Nearly half of hospitals nationwide did not submit a single doctor's name in 17 years to a national databank that keeps track of physicians whose privileges have been revoked or restricted for more than 30 days, concluded a report released Wednesday by Public Citizen.
California hospitals have higher reporting rates than the national average. Out of 414 hospitals in the state, 132, or nearly 32 percent, did not report a physician to the national databank from 1990 to 2008, according to the Public Citizen study.
Kleffman, a former California Endowment Health Journalism Fellow, does a great job of getting right to the point in the lead. Why do we care about the National Practitioner Data Bank? Because when hospitals don't report bad doctors to the NPDB, it makes it easier for physicians to skip from state to state or hospital to hospital without a trace. Kleffman also raised an important point highlighted in the Public Citizen report: fines. Public Citizen wants hospitals to be fined "up to $25,000 for each instance of a hospital or other health care entity's (e.g. HMO) failure to report an adverse action to the National Practitioner Data Bank." Why? Because, as the report notes, "after adjusting for differences in hospital characteristics, hospitals in states with strong penalties were 40 percent more likely to have reported an adverse action over the five years of the study than hospitals in states with no penalties."
Kleffman cites California as an example, saying "unlike many other states, California imposes financial penalties for hospitals that fail to report certain disciplinary actions to the Medical Board of California. Hospitals can be fined $50,000 per violation, or $100,000 if the failure to file is determined to be willful, said medical board spokeswoman Candis Cohen."
(Can I just pause for a moment to say that I wish every government spokesperson were as thorough, efficient and pleasant as Candis Cohen. Even when she doesn't give you everything you want, you feel like you have been dealt with fairly.)
Kleffman also brings up the startling example of the unnecessary heart surgeries at Redding Medical Center, one of the all-time greatest medical horror stories. "The study states that one of the physicians was able to block hospital peer review because of the earnings generated by the unnecessary surgeries."
The Detroit Free Press took a statewide angle:
In the first 17 years of a national database, more than a third of Michigan hospitals never reported a single disciplinary action against a physician, according to a report released Wednesday by a Washington health watchdog organization.
Now, the Free Press charges $4 to read any more than that. Hmmm. I'll assume that the story was about as interesting as that lead, which does call Public Citizen a "Washington health watchdog organization," when, in fact, it has a much broader mission.
Overall, out of hundreds of thousands of newspapers, news stations and news sites nationwide, the coverage of this issue has been weak. Here are a few more links to media outlets that wrote up the report: