Posted on Tue, Sep. 13, 2011
Obama’s HHS shuts down public access to doctor malpractice data
By ALAN BAVLEY, The Kansas City Star
LINK

Patient advocacy groups are protesting the government’s shutdown of public access to data on malpractice and disciplinary actions involving thousands of doctors nationwide.

The National Practitioner Data Bank maintains confidential records that state medical boards, hospitals and insurance plans use in granting licenses or staff privileges to doctors.

Although records naming physicians aren’t available to the public, the data bank for many years provided access to its reports with the names of doctors and hospitals and other identifying information removed.

That changed Sept. 1 when the data bank removed these public-use files from its website. The action came shortly after it learned The Kansas City Star planned to use its reports.

The story, about doctors with long histories of alleged malpractice but who have not been disciplined by the Kansas or Missouri medical boards, was published on Sept. 4.

The Star linked anonymous data bank reports to a Johnson County neurosurgeon by matching its information to the contents of court records of malpractice cases. Journalists often use this technique to glean additional information about doctors from the data.

“We’ve seen (The Star’s) reporting and others that show your ability to triangulate on data bank data. We have a responsibility to make sure under federal law that it remains confidential,” said Martin Kramer, spokesman for the Health and Human Services Department’s Health Resources and Services Administration, the agency that oversees the data bank.

Kramer said his agency may make the public-use files available again after a “thorough analysis of the data field.” But that process probably will take at least six months and the files may not return in the same format as they had been.

Previously, the files could be downloaded from the data bank website as massive spreadsheets. Names of doctors were replaced by arbitrarily assigned practitioner numbers.

The ages of doctors and patients, as well as the dollar sums of malpractice payments, were presented as ranges, such as a doctor age 40 to 49, rather than as specific numbers.

The bank is not mandated to make public files immediately accessible on its website, but is required to respond to information requests.

“Whatever they do will probably make it more difficult to use the files in meaningful ways,” said Alan Levine, a health care researcher with Public Citizen’s Health Research Group, which advocates for patient safety

On Tuesday, Public Citizen sent a letter to the Health Resources and Services Administration objecting to the removal of the public-use files.

“The continued availability of this data is crucial to patient safety and research aimed at informed public policy decisions concerning malpractice, tort reform, peer review, and medical licensing. There simply is no substitute for the NPDB Public Use Data File if this vital research is to be continued,” the letter said.

The Association of Health Care Journalists also opposes removal of the files.(see below-Editor)

“We’re really disturbed by this,” said Charles Ornstein, president of the medical writer group. “We’ve seen our members do terrific work (with the files) that protects the public.”

Ornstein pointed to stories by the Hartford Courant in Connecticut and the Raleigh News & Observer in North Carolina citing the data bank’s public use files as a source on doctors whom they named.

“If it were not for this information used by reporters, their stories would not have been as strong,” he said.

“Why are they picking on this (Star) article?” asked Lisa McGiffert, director of Consumers Union’s Safe Patient Project. Consumers Union, which wants greater public disclosure by the data bank, will be asking the agency to put its files back online, she said.

“This administration (of President Barack Obama) has been touting their position for open government,” she said. “I see this action as totally counter to that.”

Kramer said the data bank was alerted to The Star’s reporting by Robert Tenny, a physician the newspaper was reporting upon. In order to provide Tenny with an opportunity to respond, The Star notified Tenny’s lawyer on Aug. 16 of specific information it intended to publish, including several matters contained in the data bank.

In a letter Aug. 26, the bank’s director Cynthia Grubbs advised The Star that violations of data bank confidentiality provisions are subject to a civil monetary penalties. (Read the letter here.) The Star, however, used only publicly available information from the Data Bank.

“A federal agency should not be intimidating reporters for using information that they put on their own website,” Ornstein said.

But Kramer said his agency must investigate any potential breaches of confidentiality.

“Once we became aware that this information may be made public, we had a responsibility to make sure that it remains confidential,” he said.

AHCJ, other journalism organizations protest removal of data from public website
For immediate release
Sept. 15, 2011
LINK
Read the letter sent by the journalism organizations to Mary K. Wakefield, administrator of the Health Resources and Services Administration.

UPDATE:
Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.
The data are posted for the entire U.S. in the original text format with documentation. IRE has also made available state-by-state Excel spreadsheet files.

“We applaud IRE for making this data available for free to the media, researchers and the public,” said Charles Ornstein, AHCJ’s president. “While the government has decided that this ‘public use file’ should no longer be public, our organizations believe that it continues to be a critical resource. I encourage reporters, even those who have never used it before, to look for stories within it now.”

Stories using the NPDB
The Kansas City Star
• Doctors with histories of alleged malpractice often go undisciplined
• Obama’s HHS shuts down public access to doctor malpractice data
Duluth (Minn.) News Tribune
• AHCJ article: Duluth News Tribune exposes malpractice allegations
• As Duluth hospital reaped millions, surgeon racked up complaints
• Multiple allegations against former St. Luke's doctor
• Ailing patients speak out about former Duluth doctor
• Wisconsin restricts former Duluth doctor's license
• In Texas, former Duluth surgeon may be sanction-free
• Federal database of malpractice cases doesn't make public doctors' names, or where they practice
Propublica
States Fail to Report Disciplined Caregivers to Federal Database
St. Louis Post-Dispatch
• AHCJ article: Reporters encounter hospital's lack of transparency
• Tip sheet from Bernhard & Kohler on researching health professionals.
• Award entry: Who Protects the Patients?
• Serious medical errors, little public information
• Caution urged with facedown restraints
• Doctor lost hospital privileges but kept clean record
• Girl, 16, dies during restraint at an already-troubled hospital
Milwaukee Journal-Sentinel
• Dangerous Doctors
• AHCJ article: Records show 'dangerous doctors' rarely face discipline
• Tip sheet from Gina Barton on state oversight of health professionals
Connecticut Health Investigative Team
• Disciplined Docs Practice Freely In State
West Hawaii Today
• Medical malpractice in Hawaii
• Diagnosis-related claims among top reasons for suit

Public Citizen
• Hospitals avoid reporting disciplined docs: The nonprofit group released a report showing that hospitals nationwide are taking advantage of loopholes to avoid reporting disciplined physicians to a national database. The Miami Herald's John Dorscher, the Detroit Free Press's Patricia Anstett and the Contra Costa Times' Sandy Kleffman reported local versions of the story that are no longer available online.
Earlier stories about access to NPDB:
• Data Mine reports on access to practitioner data: The Center for Public Integrity focuses on the National Practitioner Databank and the lack of public access to information in the database.
• Access to list of disciplined health workers in limbo: NPR's Joseph Shapiro looked into the status of the Healthcare Integrity and Protection Data Bank.
• Public Citizen posted an open letter to HHS Secretary Kathleen Sebelius explaining why the database is important, and details the consequences of keeping it under wraps.

The Association of Health Care Journalists, joined by the Society of Professional Journalists and Investigative Reporters and Editors, sent a letter to the Obama administration today protesting its decision to pull offline a public database of physician discipline and malpractice payments.

AHCJ, SPJ and IRE called for the government to immediately restore access to the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

Pursuant to the law, the public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

As an example, the database would allow a reporter or researcher to discover that certain, unnamed physicians have been sanctioned repeatedly by their hospitals but never were disciplined by their state's medical board. It would also be possible to find doctors with lengthy trails of malpractice who continued to enjoy clear licenses.

The groups also expressed their deep disappointment that the U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency's website. The newspaper published its story anyway on Sept. 4. The doctor's attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.
The government said that it had to act now because reporters were able to link information in the data bank to specific doctors, and the law prohibits the public use file from identifying doctors. A HRSA spokesman said the data bank will be offline for at least six months and may never return unless the physician privacy concerns are adequately addressed.

AHCJ President Charles Ornstein said he was puzzled by HRSA's sudden action because reporters have used the public version of the data bank for years to assist in their reporting and learn additional details about physicians they already had been researching.

"We are troubled that the Obama administration appears to have placed the interests of physicians ahead of the safety of patients," Ornstein said. "Attempting to intimidate a reporter from using information on a government website is a serious abuse of power."

Stories written by reporters using the public version of the National Practitioner Data Bank have drawn attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and the Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

Some of these stories have resulted in new legislation and other steps that protect patients, by increasing transparency and sometimes toughening requirements on doctors.

The groups wrote that if HRSA determines the public version of the database violates the law in any way, it should seek swift legislative changes to remedy the problem and once again make the database available.

"In one stroke, the very administration that promised greater transparency not only excludes information of obvious public value to patients across this country but threatens legal action against a reporter for using public records," said SPJ President Hagit Limor. "This is clearly outrageous."

IRE President Manny Garcia said, "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.

"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, but in this instance the response is: get lost or get fined."

Doctors with histories of alleged malpractice often go undisciplined