Physician, Reveal Thyself

Let the buyer beware, goes the old saw. But consumers have an easier time tracking down safety information about sport-utility vehicles than about the doctors they entrust with their lives.

To help patients in managed care plans who increasingly must choose from among unfamiliar names in a physician directory, more than 20 states, led by Massachusetts, are providing physician profiles to consumers.

But the profiles can be sketchy. Only a few states augment records of a doctor’s education and credentials with a list of disciplinary actions, medical malpractice and criminal convictions.

“I am the consumer. I should have the ability to learn all the facts to make a decision by myself,� said Julianne D’Angelo Fellmeth, a San Diego lawyer and consumer activist who favors broader public access to physician records. When medical boards, which are responsible for disciplining doctors, leave out information, “they look like they’re trying to cover up for a bad doctor.�

More frustrating to those who favor fuller disclosure of doctor records is the fact that the single national repository for such information is off-limits to the public. Housed in a commercial office building outside Washington, D.C., the National Practitioner Data Bank holds more than 229,000 electronic files on discipline and malpractice of doctors, dentists and other health professionals. The data, compiled over 10 years, is provided by state medical boards, hospitals, professional societies and malpractice insurers.

Only physicians, hospital administrators, medical boards, professional societies and plaintiffs’ attorneys are given access to the data. Your local hospital routinely checks it when, for example, a new anesthesiologist applies for hospital privileges--and is required every two years to check on staff doctors or others who admit patients.

When Congress created the data bank in 1986, it acceded to the demands of organized medicine and agreed to keep the contents confidential. The American Medical Assn., for example, argued that doctors would be harmed if the public could access data on malpractice awards and disciplinary actions that lacked sufficient context to be meaningful. They pointed out that some physician specialists, such as those who treat lots of very high-risk cases, are more likely to be sued for malpractice. But the data bank was not set up to provide comparisons of the malpractice history of, say, an obstetrician-gynecologist to others in that specialty.

Consumer advocates counter that the public’s right to know the history of their doctors outweighs the concerns that a doctor may be judged unfairly.

They also argue that the data bank is only a partial compilation of physician problems, because it does not include criminal convictions, and because disciplinary actions from hospitals and medical boards are sometimes not reported promptly or at all. For that reason, activists say, some bad doctors could escape detection.

Congressman Wants Data Open to Public

Some consumer activists and legislators say it’s now time to unlock the data bank, originally designed to make it more difficult for doctors with problem histories to move their practices to another state, hoping that their records wouldn’t follow them. Rep. Thomas J. Bliley Jr. (R-Va.), chairman of the House Commerce Committee, has been an outspoken proponent of opening the data bank and is drafting legislation that would give the public access to the data bank. Such a move, he has said, “may be one of the best and quickest ways to improve patient safety.�

In a recent letter to Bliley, Health and Human Services Secretary Donna Shalala wrote that she agreed consumers need more information to help them choose medical professionals, but she said Congress voted to keep the databank confidential because of “potentially incomplete negative information.�

The AMA, in the meantime, continues to oppose opening the data bank to the public.

“We do not feel this malpractice information has anything to do with competency or quality of care,� said AMA President Dr. Thomas Reardon, a general practitioner in Portland, Ore.

The AMA, however, is supporting adoption by other states of a physician profiling system similar to the one Massachusetts started in 1996. The system, backed by the influential Massachusetts Medical Society, lists information on education, malpractice, criminal convictions and sanctions by hospitals or the medical board. The malpractice information allows consumers to compare a doctor’s history against those in the same specialty. Instead of listing the dollar amounts of malpractice awards, the profile tells consumers whether the amount was average or not for doctors in that specialty.

California does not provide the comprehensive physician history that Massachusetts offers. However, the state has bolstered its profiles with information on hospital disciplinary actions, such as suspending a doctor’s ability to admit patients. The state still excludes malpractice settlements reached out of court and misdemeanor crimes.

The Medical Board of California will likely take up the subject of adding out-of-court settlements and misdemeanors to the public files later this year, said Ronald Joseph, the board’s executive director.

The potential value of the public disclosure of private settlements can be seen in a high-profile case of several years ago.

Had the state database included out-of-court settlements, prospective patients could have learned much about Culver City urologist Melvyn Rosenstein long before he stopped practicing. Rosenstein was the nation’s biggest practitioner of controversial penile enhancement surgeries when the board began receiving reports of substandard care. Patients continued streaming to his office until the board halted his practice in early 1996. At the time, Rosenstein already faced dozens of patient lawsuits alleging infection, scarring and impotence following the surgery. Rosenstein surrendered his license later that year.

Keeping out-of-court settlements under wraps only encourages doctors to quietly settle “because none of them will ever be disclosed by the medical board,� said Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego School of Law.

Fellmeth said the board’s decision in 1993 to list only felony convictions left a loophole for misdemeanors, such as drunk driving, or felony cases that prosecutors may decide to reduce to misdemeanors, such as stealing drugs from hospitals.

“This is not bedside manner. This is not rudeness. This is a crime,� Fellmeth said.

She supports the Medical Board’s decision in 1998 to begin disclosing hospital disciplinary actions of at least 14 days (a tougher threshold than the 30-day or longer suspensions that must be reported to the National Practitioner Data Bank). But she said hospitals and peer review bodies aren’t taking as many of those actions as they should.

Since California began disclosing hospital disciplinary actions against doctors, the number of reports has dropped, Joseph said. He is concerned that tougher reporting requirements could drive bad behavior further behind closed doors.

Fellmeth suspects one factor contributing to reduced reporting may be that some managed care companies are quick to drop a doctor from the payroll once they get wind of an investigation. That, in turn, may prompt hospital peer review committees and medical staffs to think twice before imposing sanctions. She said the solution isn’t to weaken the reporting system, but to make changes within managed care that are more fair to member doctors.

Another Way to Check Records May Be Possible

While the future of the National Practitioner Data Bank is debated, consumers may have another opportunity to check out their doctors.

The Federation of State Medical Boards, the umbrella group for U.S. physician licensing agencies, is creating a national database that will consolidate files kept by each medical board. Each doctor will have a single record with their medical education, licensure, disciplinary history and basic biography.

The database, scheduled for a year-end debut, should close some reporting gaps by providing immediate notice of new actions taken against doctors, said Dale Austin, deputy executive vice president. The federation currently takes weeks to disseminate monthly reports to its member boards.

Austin hopes that with the full federation’s support, the database can become a primary source for public information on doctors. That would require some rejiggering because it currently takes several pieces of information a consumer is unlikely to have--the doctor’s medical school and graduation year, birth date and Social Security number--to locate a record in the existing database.

For now, though, consumers’ best option for checking out a doctors’ background is their state medical board.

The federation, which is encouraging states to follow the Massachusetts model, has issued recommendations for what a physician profile should include. Among the group’s recommendations to states is that criminal convictions be included in physician profiles; the National Practitioner Data Bank does not include such information. However, the federal government has moved to close that gap with the Healthcare Integrity and Protection Data Bank, which may be in place in June or July of this year, said Kay Templeton Garvey, a spokeswoman for the federal Health Resources and Services Administration.

Nancy Achin Sullivan, executive director of the Massachusetts Board of Registration in Medicine, encourages patients to read the profiles before interviewing a doctor and then ask whether any of the malpractice cases involved the same procedure they may be contemplating and how the doctor may have modified his or her practice since the incident.

Patients “learn more by how the doctor answers than by the content of the answer.�

Sullivan, a cancer patient who has labored to locate good doctors for herself, is convinced by interviews with consumers that most of them look at the big picture when evaluating doctors. However, she said patients would be denied valuable information if Massachusetts excluded malpractice settlements from its profiles. And, she said, leaving out that data would skew comparisons between doctors in various specialties.

“It’s very important to the consumer,� she said, “that they have a sense that everything is fair game.�

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Checking Out Their Doctors

A model program in Massachusetts that gives consumers broad access to information about their doctors has generated a steady rise in the number of profiles requested by consumers.