HHS, which is supposed to make sure all U.S. hospitals report malpractice payments to the National Practitioner Data Bank, violated its own rules by failing to acknowledge 474 of these cases from three of its agencies, according to an investigation by HHS' inspector general's office.
Among the principal violators: the Health Resources and Services Administration, which runs the databank and is supposed to police U.S. hospitals in gathering this key data.
"Underreporting of the department's own medical malpractice cases lessens the usefulness of the NPDB and undermines departmental efforts to regulate private- and public-sector compliance with NPDB requirements," a report by the inspector general concludes.
In a review that spanned the period between June 1997 and September 2004, the report found that the agencies violated a directive that "all settled or adjudicated HHS medical malpractice cases must be reported to the NPDB." The underreporting included 290 cases from the Indian Health Service, 179 from HRSA and five from the National Institutes of Health.
The NPDB, a division of HHS, collects information about malpractice cases as well as instances of hospital-based disciplinary actions against U.S. physicians. It has come under sharp criticism in recent years as a result of the relatively infrequent reporting of disciplinary action against physicians by hospitals. When it debuted in 1990, the databank was expected to annually generate about 10,000 such reports, which are required when a physician loses privileges or is suspended for more than 30 days. Instead, the databank has collected only about 11,000 of these reports since 1990 (July 25, p. 6).
Information in the databank is used by many hospitals in determining medical privileges. During the first nine months of 2004, the databank received more than 2.6 million requests for information.
The inspector general, Daniel Levinson, blamed the underreporting on several factors, including lost medical-malpractice files, incomplete information in some files and a decision by HHS to withhold the identify of practitioners who were sued but who met the standard of care. That decision, by the HHS Medical Review Panel, was not consistent with the agency's long-standing policy, the inspector general said. The report is the latest significant action from Levinson, who was confirmed in June (See profile, p. 32).
"Failure to report medical malpractice cases," the inspector general's report said, "has the effect of depriving healthcare organizations, such as hospitals and state licensure boards, of potentially useful information for their credentialing and regulatory activities, respectively."
The report, which called for the three agencies to take corrective action and improve internal controls to beef up the reporting process, drew a strong reaction from Sen. Ron Wyden, the Oregon Democrat who authored the legislation that created the databank in 1986. "It is imperative that the federal government fully comply with the reporting requirements," he wrote in a letter to Elizabeth Duke, the HRSA administrator.
An HRSA spokesman said the agency had no comment aside from Duke's written response in August to the inspector general's office. In that response, she said, the agency has established "revised procedures" to track reports of malpractice payments to help prevent "future backlogs" in reporting these cases to the NPDB.