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.
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.
The process of hospital peer review has been called "one of the pillars of quality assurance in the United States" by the Journal of the American Medical Association, according to the Public Citizen report.
But hospitals across the country have devised new ways to avoid reporting, according to a medical board member who requested anonymity in e-mails to Public Citizen earlier this year. That person said hospitals dodge the rules by having physicians take a "leave of absence" or changing their bylaws.
"About half the hospitals in the country have never reported one doctor out of the couple hundred thousand doctors that are on the staffs of those hospitals," Public Citizen's Wolfe said. "It's just not believable. The only answer is the hospitals aren't doing their job disciplining doctors."
The allure of profit also means hospitals may fail to report things they should, the report says.
A 2002, an FBI raid on California's Redding Medical Center found two physicians had conducted unnecessary cardiac procedures on more than 600 patients since 1995. Because of the revenue generated by the surgeries, the physician was able to "block hospital peer review," according to the FBI affidavit.
Reporting varies by state, according to Public Citizen. More than 70 percent of hospitals in North and South Dakota, for instance, never reported information for the database, compared to Rhode Island's 19 percent that did not.
The Public Citizen report indicates there are several ways to rebuild hospital peer review in the United States, making it more beneficial and accountable for patients.
In addition to fining hospitals, the group would like to give the federal Centers for Medicare and Medicaid Services the authority to sanction hospitals and physicians who do not complete peer reviews.