Lawmaker seeks to open data bank to public scrutiny

Doctors and hospitals have much to fear if Rep. Tom Bliley (R-VA), chairman of the powerful House Commerce Committee, manages to bulldog his plan to open up the National Practitioner Data Bank (NPDB) to the public. Fortunately for health care providers, Bliley’s idea is likely to be watered down considerably.

Bliley’s scheme to open the NPDB was the subject of a contentious hearing before the House Commerce Oversight and Investigations Subcommittee March 1 that pitted Republicans against Democrats, Republicans against Republicans, and health care providers staunchly against the notion of making the data bank accessible to consumers.

Bliley contended that opening the NPDB is a matter of public safety. "It is unconscionable that consumers have more comparative information about the used car they purchase or the snack foods they eat than the doctors in whose care they entrust their health and well-being," he asserted.

But Bliley had few backers. "When we created the [data] bank, we assured doctors that we would not open up the bank to the general public because the information requires interpretation and could result in an explosion of malpractice suits," argued Rep. Fred Upton (R-MI). "If we break this commitment, how can we expect doctors and other health care providers to trust us when we tell them that if they come forward and report errors they will not be singled out for punishment or open themselves up to malpractice suits?"

Democrats charged that the hearing was retribution for the American Medical Association’s support for a Patient’s Bill of Rights bill introduced in the last session.

"This subcommittee should not be used as an instrument of retaliation for political agendas," demanded Rep. Bart Stupack (D-MI).

Rep. John Dingell (D-MI), the ranking Democrat on the subcommittee, listed a host of potential minefields associated with opening up the NPDB, including "ample evidence" that entities already required to report have not done so on a consistent basis, and that there are considerable variations across states and hospitals regarding reporting frequency. He pointed out that the NPDB’s own executive committee reported last November that 60% of all hospitals had yet to file a single adverse action report to the data bank.

Bliley’s scheme is not short on detractors outside Congress, either. "I think there are a lot of problems attendant to it," asserts Mark Kadzielski, the partner in charge of the West Coast health care practice of Akin Gump in Los Angeles.

"This is going to give out false, misleading, inaccurate information, which is going to be difficult for the public to judge," Kadzielski argues, "particularly in light of the very salient fact that 60% of the hospitals have never filed a report since the data bank was initiated ten years ago."

"If you looked in there and don’t see your doctor, it does not give you much confidence," explains Kadzielski. "On the other hand, if you look in there and find your doctor, it does not mean he is a bad guy. Either way, the concern is that misleading conclusions will be drawn from this amalgam of data, which in itself is not very comprehensive or complete," he adds. "If it is going to be used to judge competency, it needs much more sophisticated questions before you can come up with that determination."

Dick Davidson, president of the Chicago-based American Hospital Association (AHA) contends that certain types of information can and should be made public, including criminal convictions and actions taken by the state licensing boards. But he adds that malpractice information that does not distinguish between physicians sued for unnecessary care and those who settled for expediency will only sow confusion.

Davidson also says the internal hospital peer review process, which allows health care practitioners to candidly review the performance of their peers, could be undermined by Bliley’s proposal.

"It’s not that we don’t think some of the information should be open to the public," argues AHA spokeswoman Dionne Dougal. "It’s just that we want accurate information they can understand."

Dougal also questioned the NPDB committee’s estimate that 60% of hospitals have never reported. Rather, she says, hospitals have other systems in place to take action regarding physicians before they are required to report those incidents.