Patients in the United States may soon be able to access currently protected information about their doctors, including malpractice data, if a bill about to be introduced through Congress is passed.
Representative Tom Bliley, chairman of the House commerce committee, is spearheading controversial legislation that will allow the public to have access to the National Practitioner Data Bank. The legislation enters delicate territory, as it must balance the consumer's right to knowledge against a doctor's right to privacy and protection against libel.
The data bank was set up by Congress in 1986. Its aim was to facilitate both peer review and the process for licensing doctors. Access to the database has been limited to hospitals, insurance companies, state medical boards, and doctors seeking information about themselves.
Currently, the database collects information such as adverse disciplinary actions taken by state medical and dental boards, suspensions of clinical privileges by hospitals, medical malpractice liabilities, exclusions from participating in Medicaid and Medicare programmes and actions taken by the Drug Enforcement Agency against the practitioner.
In the United States permission to practice medicine is granted on a state by state basis, not a national one. Doctors must apply to and be approved by each state in which they want to practise.
Doctors who lose their licence in one state can cross state lines and practise in another state. The data bank allows states to find out if a licence to practise has been revoked by another state and thus facilitates the licensing process. Although access to the bank is restricted, over 30 state medical boards allow consumers to query them on the status of doctors practising in their states.
The drive to make the national database public comes on the heels of several recent well publicised exposures of disturbed or incompetent doctors who were still practising.
Chief among these was the case of a neurosurgeon who operated on the wrong patient and removed healthy tissue instead of the patient's tumour. Another case was that of Dr Alan Zarkin, an obstetrician and gynaecologist, who carved his initials on a patient's abdomen after performing a caesarean section and continued to practise for five months afterwards despite dismissal from his hospital.
Proponents of a public database argue that it will allow consumers to make more informed decisions when choosing their doctors. Doctors' groups, such as the American Medical Association and the American Osteopathic Association, however, point out that the information in the database is useless for this purpose as it is out of context.
Three quarters of the information in the data bank concerns malpractice suits. Malpractice information can be misleading as the number and size of settlements does not necessarily reflect a doctor's competence.
Moreover, recent studies in the New England Journal of Medicine (NEJM 1991; 325; 245-51 and NEJM 1996; 335: 1963-67) found that only one in five malpractice suits are settled with an admission of the doctor's negligence. Insurance companies often settle suits to avoid costlier court cases and thus the mere existence of a suit or settlement does not reflect the merits of the litigation.
Doctors in high risk specialties, such as surgeons and obstetricians and gynaecologists, or those who take on sicker patients and conduct cutting edge clinical research, may also face higher malpractice rates than the average general doctor. Consumers who screen out such doctors on the basis of a high number of suits deprive both themselves and the doctors, the organisations say.
An Associated Press review of the data bank earlier this year found about 500 doctors and dentists who had been slapped with at least 10 disciplinary actions or malpractice suits in the past decade. After that, the New York Daily News featured several of these doctors in a front page article.
In a Congressional hearing on the matter Dr Charles Norwood, a surgeon and Congressman, voiced his concerns: "Making the National Practitioner Data Bank [NPDB] public is an asinine idea because it attaches a level of sophistication to the database which is not appropriate and ignores state based approaches that make more sense and are already in place today. The NPDB is simply gathered information. It has no context. Information does not in any way explain the conditions behind judgments made in specific cases."
Others are concerned that if the data bank is made public, doctors will be discouraged from self reporting their errors and those of their peers.
Despite these concerns, efforts to open the bank continue. Congressman Bliley hopes to model the public version on the Massachusetts Physician Profiles project that allows consumers access to information about doctors' malpractice suits and criminal actions (www.massmedboard.org) and to push the bill through Congress before the end of the year.