Hospitals Fail to Report Doctor Incompetence

May 27, 2009— -- One would assume that a surgeon whose license had been suspended in Oklahoma and revoked in Texas would not be allowed to operate in Hawaii. But that's what happened in 2001 when the surgeon used a screwdriver in place of a titanium rod for a spine procedure. The patient was left paralyzed and later died, according to a report released today.

These kinds of cases should be flagged more often, according to the consumer advocacy group Public Citizen.

In its report, Public Citizen argues that hospitals are not properly using the database designed to protect patients from physicians who have histories of medical incompetence. The group argues that hospitals are failing to discipline and accurately report sanctions taken against physicians.

"As a patient, if you had a choice to go to a hospital that had never disciplined a doctor in 20 years compared to one that has, you might think twice about going to the hospital that had never disciplined a doctor," Sid Wolfe, director of Public Citizen's Health Research Group, said today.

In setting up the database, called the National Practitioner Databank, nearly two decades ago, the government had predicted 5,000 reports on doctors would be filed each year. The health care industry had predicted the database would house 10,000 annual reports. Despite the forecasts, only an average of 650 annual reports find their way into the system.

"It's cultural," David Swankin, president and CEO of Citizen Advocacy Center, said today. "Nobody likes turning anybody in. People just don't like doing it, doctors don't like doing it. There's a culture in medicine that anybody can make a mistake."

But the American Hospital Association said today the report does not paint a full picture.

"The premise that the number of reports received by the National Practitioner Databank correlates to jeopardized patient care is inaccurate," the association said in a statement. "Hospitals are actively involved in a wide variety of efforts to continuously improve care and talk publicly about the care we provide."

Meantime, the doctor who practiced in Hawaii in 2001 was not monitored by his peers during surgery despite the earlier problems in Oklahoma and Texas. In 2007, the report, titled "Hospitals Drop the Ball on Physician Oversight," found, nearly half of the country's hospitals had not reported any sanction against a physician's hospital privileges.

To compile the data, Public Citizen said it reviewed studies by the Office of Inspector General, work by the Citizen Advocacy Center, medical journal articles and recommendations from an October 1996 national meeting on hospital under-reporting.

Public Citizen contends that under-reporting is not only because hospitals are failing to report sanctions, but also because hospitals often fail to take any action against controversial practitioners.

"Nobody wants to be on a list that's available to other hospitals and to other state licensing boards," Swankin said. "Nobody wants to be on that kind of a list."

Among recommendations compiled in a letter to Health and Human Services Secretary Kathleen Sebelius, the Public Citizen Health Research Group calls for Congress to enact a law that would fine hospitals for failure to report substandard doctors.

But Jean Marie Rocha, vice president of clinical affairs for the Hospital Association of Rhode Island, said that the "biggest incentive for hospitals and physicians is to know they're providing the best care for hospitals and patients." Instead of fining hospitals, Rocha said, reporting to the data bank should "be done on a voluntary rate."

Rhode Island hospitals reported more to the data bank than any other state, according to the report, with about 19 percent of its hospitals in that state failing to ever have filed reports.