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The Reporter Who Kicked the Doctor's Nest

The Reporter Who Kicked the Doctor's Nest

Picture of William Heisel

malpractice, alan bavley, national practitioner data bank, william heisel, antidote blog, reporting on health, health journalism

Alan Bavley at the Kansas City Star was just doing his job.

He wrote a great, in-depth examination of how state medical boards on Kansas and Missouri handle physicians who have had repeated malpractice judgments and settlements. He found that they don't always make good use of the wealth of information afforded them in court files, which are full of medical records, pharmaceutical records and sworn testimony.

The cornerstone of Bavley's reporting, as Antidote noted on Wednesday, was the , run by the (HRSA). In response to his stories, HRSA pulled the NPDB's public file from its website and .

Hospitals and government agencies can query the NPDB to check a physician's record in states across the country. The NPDB was created in part to stop dangerous doctors from hopping from state to state, always able to start with a clean record once they crossed the border.

The American Medical Association , so that patients would not be able to see the same information that governments and hospitals are able to see. This makes the NPDB unlike most oversight databases, including those created by medical boards in most states. Can you imagine going to a state medical board website and seeing a list of alphanumeric codes instead of doctors' names? (Now, many of them may as well provide alphanumeric codes because they provide very little beyond the doctors' names. But that is another matter.)

Bavley followed in the footsteps of reporters over two decades who have used the NPDB and matched information from it to information gathered in his own reporting to write about dangerous doctors. The Association of Health Care Journalists (AHCJ) has that have used the NPDB.

AHCJ, the Society of Professional Journalists and Investigative Reporters & Editors this week protesting the removal of the NPDB public file and the threat against Bavley:

By releasing the Public Use File, HRSA must have concluded under 42 USC 11137 (the Health Care Quality Improvement Act of 1986, section 437) that it didn't permit identification of anyone. By simply using the material HRSA had put online, Bavley did not violate any regulations and should not have been subject to such blatant intimidation.

We hope HRSA embraces these watchdog efforts and puts patient safety atop its list of concerns. We believe HRSA's previous Public Use File struck the appropriate balance in making information available to the public while protecting the identity of doctors. If anything, the agency erred on the side of physician privacy.

Finally, if HRSA now believes that the public use file could lead to the inappropriate identification of physicians, we encourage HHS leadership to seek a change in the law to allow for this information to be disclosed.

The letter was signed by Charles Ornstein, president of AHCJ, Manny Garcia, president of IRE, and Hagit Limor, president of SPJ. If you care about in-depth health reporting, you should sign your name to a similar letter. Send the letter to:

Mary K. Wakefield
Administrator
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857

And please be polite.

Have a question or a comment? Write [email protected] and follow @wheisel on Twitter.

Related Posts:

Secret History: Five Tips from the Kansas City Star's Malpractice Investigation

Comments

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The joint letter is correct. I was responsible for creating the NPDB Public Use File years before my retirement from HRSA in 2008. We did, indeed, conclude after extensive study of other government public use files created from confidential data sets and established standards for creating such files that "under 42 USC 11137 (the Health Care Quality Improvement Act of 1986, section 437) that it [the NPDB Public Use File] didn't permit identification of anyone. The file has been posted for at least 15 years without any comment that it somehow constitutes an illegal disclosure of confidential information.

If someone already had considerable detailed information about a targeted practitioner, they might be able to figure out which records in the NPDB Public Use File likely pertained to that practitioner. But we did not consider that fact to mean the Public Use File could be considered to have identified the practitioner. The person trying to find the practitioner in the file already had to have identified the practitioner with detailed and extensive information from other sources. The release of the Public Use File and all the information in it was considered to be fully in compliance with the confidentiality requirements of the law.

In my opinion the only thing that has changed is that current HRSA management seems to have taken an extreme and erroneous position as to what the confidentiality requirement means in relation to the Public Use File. They seem have gone out of their way to reduce the information available to the public ... in an administration that purports to support openness.

Picture of Barbara Feder Ostrov

The author of the comment below is Robert Oshel, PhD, formerly of the Practitioner Data Banks Branch of HRSA.

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