by Kenneth A. Eisner

Today, patients are encouraged to be knowledgeable and ask questions of their healthcare providers about their conditions. While this line of questioning by patients is considered normal, it is probably not appropriate to ask your physician about his or her competence and more specifically, how many times he or she has been sued for medical malpractice and what were the results. There is limited opportunity for patients to know about the competence of their physicians other than what they have heard from other patients. There are, however, protections to ensure that your physician and other healthcare practitioners are competent. For example, each physician when he or she applies to a medical staff of a hospital in order to practice is required to provide significant information about his experience. The hospital reviews this information and the hospital administrators, along with the medical staff, decide on the competence of the physician. One problem was that confirming this information for its accuracy was previously extremely difficult. That is, until the creation of the National Practitioners Data Bank (“NPDB”).

The NPDB is an electronic data bank that consists of all payments that are made on behalf of physicians in connection with medical malpractice cases, as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other healthcare practitioners. The NPDB became law in 1986. It was enacted because Congress believed that the increasing number of medical malpractice cases and the need to improve the quality of healthcare had become national problems that required more effort than any individual state could provide. At the time, the medical community was relying upon professional peer review to restrict the ability of incompetent practitioners from moving from state to state without disclosing prior performance.

The information available in the NPDB includes:

1. medical malpractice payments made on behalf of a physician, dentist, or other healthcare practitioner;

2. adverse action reports based on a healthcare practitioner’s competence or conduct that adversely affects the practitioner’s medical staff privileges for more than 30 days;

3. disciplinary actions related to competence or professional misconduct against a healthcare practitioner, including revocation, reprimand, probation, suspension and surrender of license;

4. professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society; and

5. Medicare and Medicaid exclusion reports containing sanctions due to fraud and abuse.

The information in the NPDB is not available to the general public.

In fact, there remains limited information available to the general public as to the quality of healthcare practitioners. There are a few web sites that provide limited information for a price. See for example, healthgrades.com, which provides the specialties of a healthcare practitioner and certain instances of professional misconduct. This information is, however, minimal. You may also attempt to contact the State Medical Board to see if any licensure action has been imposed on your healthcare practitioner. However, malpractice and criminal information is typically withheld from state medical boards.

The bottom line is that with the advent of the NPDB and the various other professional peer review protections that exist, you can feel pretty comfortable that your physician is competent and no further background check is necessary. Simply relax and take a deep breath.

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