http://www.iht.com/articles/21341.html
U.S. Doctors Are Escaping Oversight
Robert Pear New York Times Service Wednesday, May 30, 2001
WASHINGTON A U.S. government program to protect patients from incompetent
doctors is failing because health-maintenance organizations and hospitals
rarely report those doctors to the authorities as they are required to do,
federal investigators say.
.
Under federal law, health-maintenance organizations (HMOs) and hospitals are
supposed to inform the government of any disciplinary actions taken against
doctors for incompetence or misconduct. But in the last decade, 84 percent
of HMOs and 60 percent of hospitals never reported a single "adverse action"
to the government, a report by the inspector general of the Department of
Health and Human Services said.
.
This low level of reporting occurred even though a government study found
that tens of thousands of Americans die each year because of medical errors.
.
Information on incompetent doctors is included in a computer system known as
the National Practitioner Data Bank, created by Congress to protect patients
against doctors who move from state to state without disclosing that they
have been censured or disciplined.
.
But the report, based on an 18-month study, said that from 1990 to 1999,
when managed care became the dominant form of health care in the United
States, health-maintenance organizations "reported only 715 adverse
actions."
.
Officials offered these examples of incompetence and misconduct: performing
surgery on the wrong side of a patient's body; providing a fatal overdose of
drugs; performing unnecessary surgery; engaging in sexual relations with
patients; prescribing narcotics for the doctors' own use, and repeatedly
billing Medicaid, a government-financed medical program for low-income
Americans, for services never provided.
.
The inspector general's explanation was stark. In a market more concerned
with price than quality, the report said, HMOs have evolved into
"bill-paying organizations" and managed care plans "often have little
incentive to devote many resources to quality assessment and improvement."
.
Carmella Bocchino, vice president of the American Association of Health
Plans, said many HMOs did not realize they were required to tell the
government when doctors were disciplined.
.
But Margaret O'Kane, president of the National Committee for Quality
Assurance, which evaluates and accredits health plans, said, "Health plans
are very nervous about reporting to the data bank because they are afraid of
being sued by doctors."
.
Sometimes, some HMO executives said, they work out quiet deals with inept
doctors. Under such arrangements, a doctor resigns from a health plan, and
in return the health plan promises not to file a report with the federal
data bank.
.
Senator Ron Wyden, Democrat of Oregon and author of the 1986 law creating
the National Practitioner Data Bank, said the low level of reporting was
unacceptable. "The inspector general's study sounds an alarm bell," he said.
.
The data bank is for the use of hospital and other health-care providers,
and federal law prohibits disclosing information on a specific doctor to the
general public. Federal investigators said HMOs and hospitals frequently
consulted the data bank to check on doctors' qualifications, but rarely
contributed any information.
.
Discussion of the data bank is part of a larger debate over medical errors
and the quality of care. In November 1999, the National Academy of Sciences
estimated that 44,000 to 98,000 Americans die each year as a result of
medical errors, and it called for "a nationwide mandatory reporting system."
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< < Back to Start of Article WASHINGTON A U.S. government program to protect
patients from incompetent doctors is failing because health-maintenance
organizations and hospitals rarely report those doctors to the authorities
as they are required to do, federal investigators say.
.
Under federal law, health-maintenance organizations (HMOs) and hospitals are
supposed to inform the government of any disciplinary actions taken against
doctors for incompetence or misconduct. But in the last decade, 84 percent
of HMOs and 60 percent of hospitals never reported a single "adverse action"
to the government, a report by the inspector general of the Department of
Health and Human Services said.
.
This low level of reporting occurred even though a government study found
that tens of thousands of Americans die each year because of medical errors.
.
Information on incompetent doctors is included in a computer system known as
the National Practitioner Data Bank, created by Congress to protect patients
against doctors who move from state to state without disclosing that they
have been censured or disciplined.
.
But the report, based on an 18-month study, said that from 1990 to 1999,
when managed care became the dominant form of health care in the United
States, health-maintenance organizations "reported only 715 adverse
actions."
.
Officials offered these examples of incompetence and misconduct: performing
surgery on the wrong side of a patient's body; providing a fatal overdose of
drugs; performing unnecessary surgery; engaging in sexual relations with
patients; prescribing narcotics for the doctors' own use, and repeatedly
billing Medicaid, a government-financed medical program for low-income
Americans, for services never provided.
.
The inspector general's explanation was stark. In a market more concerned
with price than quality, the report said, HMOs have evolved into
"bill-paying organizations" and managed care plans "often have little
incentive to devote many resources to quality assessment and improvement."
.
Carmella Bocchino, vice president of the American Association of Health
Plans, said many HMOs did not realize they were required to tell the
government when doctors were disciplined.
.
But Margaret O'Kane, president of the National Committee for Quality
Assurance, which evaluates and accredits health plans, said, "Health plans
are very nervous about reporting to the data bank because they are afraid of
being sued by doctors."
.
Sometimes, some HMO executives said, they work out quiet deals with inept
doctors. Under such arrangements, a doctor resigns from a health plan, and
in return the health plan promises not to file a report with the federal
data bank.
.
Senator Ron Wyden, Democrat of Oregon and author of the 1986 law creating
the National Practitioner Data Bank, said the low level of reporting was
unacceptable. "The inspector general's study sounds an alarm bell," he said.
.
The data bank is for the use of hospital and other health-care providers,
and federal law prohibits disclosing information on a specific doctor to the
general public. Federal investigators said HMOs and hospitals frequently
consulted the data bank to check on doctors' qualifications, but rarely
contributed any information.
.
Discussion of the data bank is part of a larger debate over medical errors
and the quality of care. In November 1999, the National Academy of Sciences
estimated that 44,000 to 98,000 Americans die each year as a result of
medical errors, and it called for "a nationwide mandatory reporting system."
WASHINGTON A U.S. government program to protect patients from incompetent
doctors is failing because health-maintenance organizations and hospitals
rarely report those doctors to the authorities as they are required to do,
federal investigators say.
.
Under federal law, health-maintenance organizations (HMOs) and hospitals are
supposed to inform the government of any disciplinary actions taken against
doctors for incompetence or misconduct. But in the last decade, 84 percent
of HMOs and 60 percent of hospitals never reported a single "adverse action"
to the government, a report by the inspector general of the Department of
Health and Human Services said.
.
This low level of reporting occurred even though a government study found
that tens of thousands of Americans die each year because of medical errors.
.
Information on incompetent doctors is included in a computer system known as
the National Practitioner Data Bank, created by Congress to protect patients
against doctors who move from state to state without disclosing that they
have been censured or disciplined.
.
But the report, based on an 18-month study, said that from 1990 to 1999,
when managed care became the dominant form of health care in the United
States, health-maintenance organizations "reported only 715 adverse
actions."
.
Officials offered these examples of incompetence and misconduct: performing
surgery on the wrong side of a patient's body; providing a fatal overdose of
drugs; performing unnecessary surgery; engaging in sexual relations with
patients; prescribing narcotics for the doctors' own use, and repeatedly
billing Medicaid, a government-financed medical program for low-income
Americans, for services never provided.
.
The inspector general's explanation was stark. In a market more concerned
with price than quality, the report said, HMOs have evolved into
"bill-paying organizations" and managed care plans "often have little
incentive to devote many resources to quality assessment and improvement."
.
Carmella Bocchino, vice president of the American Association of Health
Plans, said many HMOs did not realize they were required to tell the
government when doctors were disciplined.
.
But Margaret O'Kane, president of the National Committee for Quality
Assurance, which evaluates and accredits health plans, said, "Health plans
are very nervous about reporting to the data bank because they are afraid of
being sued by doctors."
.
Sometimes, some HMO executives said, they work out quiet deals with inept
doctors. Under such arrangements, a doctor resigns from a health plan, and
in return the health plan promises not to file a report with the federal
data bank.
.
Senator Ron Wyden, Democrat of Oregon and author of the 1986 law creating
the National Practitioner Data Bank, said the low level of reporting was
unacceptable. "The inspector general's study sounds an alarm bell," he said.
.
The data bank is for the use of hospital and other health-care providers,
and federal law prohibits disclosing information on a specific doctor to the
general public. Federal investigators said HMOs and hospitals frequently
consulted the data bank to check on doctors' qualifications, but rarely
contributed any information.
.
Discussion of the data bank is part of a larger debate over medical errors
and the quality of care. In November 1999, the National Academy of Sciences
estimated that 44,000 to 98,000 Americans die each year as a result of
medical errors, and it called for "a nationwide mandatory reporting system."
WASHINGTON A U.S. government program to protect patients from incompetent
doctors is failing because health-maintenance organizations and hospitals
rarely report those doctors to the authorities as they are required to do,
federal investigators say.
.
Under federal law, health-maintenance organizations (HMOs) and hospitals are
supposed to inform the government of any disciplinary actions taken against
doctors for incompetence or misconduct. But in the last decade, 84 percent
of HMOs and 60 percent of hospitals never reported a single "adverse action"
to the government, a report by the inspector general of the Department of
Health and Human Services said.
.
This low level of reporting occurred even though a government study found
that tens of thousands of Americans die each year because of medical errors.
.
Information on incompetent doctors is included in a computer system known as
the National Practitioner Data Bank, created by Congress to protect patients
against doctors who move from state to state without disclosing that they
have been censured or disciplined.
.
But the report, based on an 18-month study, said that from 1990 to 1999,
when managed care became the dominant form of health care in the United
States, health-maintenance organizations "reported only 715 adverse
actions."
.
Officials offered these examples of incompetence and misconduct: performing
surgery on the wrong side of a patient's body; providing a fatal overdose of
drugs; performing unnecessary surgery; engaging in sexual relations with
patients; prescribing narcotics for the doctors' own use, and repeatedly
billing Medicaid, a government-financed medical program for low-income
Americans, for services never provided.
.
The inspector general's explanation was stark. In a market more concerned
with price than quality, the report said, HMOs have evolved into
"bill-paying organizations" and managed care plans "often have little
incentive to devote many resources to quality assessment and improvement."
.
Carmella Bocchino, vice president of the American Association of Health
Plans, said many HMOs did not realize they were required to tell the
government when doctors were disciplined.
.
But Margaret O'Kane, president of the National Committee for Quality
Assurance, which evaluates and accredits health plans, said, "Health plans
are very nervous about reporting to the data bank because they are afraid of
being sued by doctors."
.
Sometimes, some HMO executives said, they work out quiet deals with inept
doctors. Under such arrangements, a doctor resigns from a health plan, and
in return the health plan promises not to file a report with the federal
data bank.
.
Senator Ron Wyden, Democrat of Oregon and author of the 1986 law creating
the National Practitioner Data Bank, said the low level of reporting was
unacceptable. "The inspector general's study sounds an alarm bell," he said.
.
The data bank is for the use of hospital and other health-care providers,
and federal law prohibits disclosing information on a specific doctor to the
general public. Federal investigators said HMOs and hospitals frequently
consulted the data bank to check on doctors' qualifications, but rarely
contributed any information.
.
Discussion of the data bank is part of a larger debate over medical errors
and the quality of care. In November 1999, the National Academy of Sciences
estimated that 44,000 to 98,000 Americans die each year as a result of
medical errors, and it called for "a nationwide mandatory reporting system."
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