Consumers in dozens of states have led successful efforts to gain easier access to the information state medical boards gather about physicians.
But on the national level, patient advocacy groups and well-meaning lawmakers have failed to crack open the National Practitioner Data Bank, the granddaddy of all physician databases.
House Commerce Committee Chairman Thomas Bliley Jr. (R-Va.) has said he would like to change that. As early as this week, Bliley plans to introduce legislation that would revamp the databank to allow patients to view physician information previously available only to hospitals and HMOs for their credentialing procedures (Aug. 28, p. 8).
Calls for comment to the Commerce Committee were not returned by deadline.
Congress established the National Practitioner Data Bank when it passed the Health Care Quality Improvement Act of 1986. In operation since 1990, the databank tracks malpractice judgments and certain disciplinary actions taken against doctors, dentists and other healthcare professionals.
Hospitals, HMOs, professional societies and state medical boards query the databank when credentialing physicians so they can be aware of any actions taken against a physician in another state.
According to the databank's 1999 annual report, it has collected 227,500 reports over the 10 years it has existed.
However, evidence suggests that as many as half the nation's hospitals are not reporting any disciplinary actions to the databank--raising questions about its effectiveness in ensuring quality care. Between 1994 and 1999, at least three studies found that many hospitals were not reporting adverse actions against physicians to the databank (Aug. 9, 1999, p. 46). Hospitals are required by law to report some, but not all actions to the databank. One of the three studies, dating to 1994, indicated that hospitals changed the way they disciplined doctors so they wouldn't have to report to the databank.
The American Hospital Association, the American Medical Association and many other physician groups oppose opening the databank to the public. The AHA argues that opening the databank would undermine the peer-review process and lead healthcare professionals to hide information about physician misconduct or medical errors.
The AMA did not return a call for comment by deadline. In testimony before Congress, AMA officials have said that the databank was not designed as a mechanism for providing patients with information about physicians but rather as a system by which hospitals and other organizations can flag questionable doctors. Providing information to consumers should be the responsibility of state medical boards, not the federal government, according to the AMA.
Bliley cast the first stone last March when he called for a House Commerce Oversight and Investigations Subcommittee hearing to discuss opening up the databank (March 6, p. 2).
Two weeks later, the subcommittee held another hearing. An official from HHS' Health Resources and Services Administration, which operates the databank, was its sole witness. Since then, Bliley's committee has done little publicly on the matter.
However, the committee has been working behind the scenes on the issue. On April 3, Bliley wrote to HHS Secretary Donna Shalala. In particular, Bliley wanted to know why the Clinton administration had changed its position on opening up the databank.
"As you surely must know, this administration proposed public access to the NPDB as part of its 1993 healthcare reform legislation," Bliley wrote. "It would appear that--at least back then--the Clinton administration was strongly in favor of public access to the NPDB.
"However, in a response to Commerce Committee correspondence on Nov. 2, 1999, you enumerated several concerns with opening the databank to the public. I am interested to learn what has altered the administration's view on this matter since 1993."
Bliley followed that with another letter on May 23 "to express my concern over the failure of (HHS) to respond in a timely manner" to the April 3 request.
Just over a week later, on May 31, HHS Assistant Secretary for Legislation Richard Tarplin sent a response, saying that the provision opening access to the databank "was proposed in the context of the broad reforms in the healthcare system that were contained in the Health Security Act," which Congress voted down in 1994.
"My understanding is that in considering this issue independently, and in greater depth, we have become aware of important concerns raised by public access to the NPDB data, including privacy issues and fair treatment of healthcare professionals," Tarplin wrote.
That wasn't the end of the matter for the commerce committee, which still plans to hold a third hearing, sources say.
"They were supposed to have it in July, then they moved it back to August, and now it's September, but there's no date scheduled," says Sidney Wolfe, M.D., director of the health research group of Public Citizen, a Washington-based consumer advocacy group. Wolfe says Bliley's staff asked him to testify at the third hearing.
Also asked to testify was James Stewart, a New York-based writer who penned the book Blind Eye: the Terrifying Story of a Doctor Who Got Away with Murder. The book details the case of Michael Swango, M.D., a suspected serial killer (Nov. 8, 1999, p. 76).
In a blistering editorial that appeared in the Wall Street Journal on July 19, Stewart expressed his ire that an alleged lobbying effort led by the AMA succeeded in thwarting two House Commerce Committee hearings during which he was supposed to testify.
Among other remedies, opening up the databank "would go far in improving patients' trust in their doctors," Stewart wrote.
A source who asked not to be named told that the Commerce Committee will hold a briefing on the bill Sept. 5 for providers and consumer groups to boost support for the measure.
Both Public Citizen and the People's Medical Society, a consumer group based in Allentown, Pa., confirmed that they had been invited to a Commerce Committee briefing on the Bliley bill. The groups support opening up the databank.
Whether the databank will be opened in whole or in part to the public this year remains to be seen, consumer groups say.
"I have no idea whether the bill will get passed," Wolfe says. "If you're a smart member of the House, and this bill is introduced, you'll sign onto it. How can you not? It's an election year."