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More Must Be Done To Expose Bad Doctors

Published on February 15, 2016

A study published last week in the New England Journal of Medicine reported that 1% of physicians accounted for 32% of paid malpractice claims over the past 10 years. Some may spin this as good news, since almost all doctors can be trusted to meet at least the lowest acceptable standard of care. But the ugly truth is that little is being done to hold the dangerous doctors accountable.

The new study analyzed more than 66,000 claims paid against more than 54,000 physicians between 2005 and 2014. Researchers noted that the small number of bad doctors showed “distinctive characteristics,” including having paid previous malpractice claims. This implied that “the ability to reliably identify them at an early stage could guide efforts to improve care.” Put another way, health-care providers could eliminate one-third of medical malpractice—along with patients’ pain and suffering, as well as the added costs of corrective surgeries, long-term care and indemnity payments—by removing the worst 1% of doctors.

The obvious question: Why haven’t they?

The answer lies at least partially in the National Practitioner Data Bank, a clearinghouse for information on medical malpractice that Congress established in 1986 to help state licensing boards police the health-care industry. The New England Journal of Medicine study drew on this database. So did a 2007 report by the advocacy group Public Citizen, which showed that, from 1990 through 2005, “just 2.3 percent of doctors, having three or more malpractice payments, were responsible for 32.8 percent of all payments.”

The national database was supposed to help states identify dangerous doctors and prevent them from harming more patients. But it is virtually useless in holding doctors accountable because, by federal law, none are listed by name. They are assigned a random number to protect their identities.

The Public Citizen study reported that Physician No. 33041 had at least 31 malpractice payments between 1993 and 2005, totaling more than $10 million in damages. Nine of those payments were related to “failure to use proper aseptic technique,” which means the physician did not observe the most basic precautionary measures to prevent infection.

Physician No. 43923 had at least 21 malpractice payments between 1992 and 2003, including eight improperly performed surgeries, three unnecessary surgeries and two surgeries on the wrong body part. Operating on the wrong body part is so egregious that the profession considers it a “never event,” meaning it should never happen.

Neither doctor faced disciplinary action from a state medical board, according to the database.

Even if doctors were identified in the data, as they should be, the public would still be barred by law from accessing the records. So vulnerable, sick patients sit in the waiting rooms of bad physicians without a clue about their poor record of performance.

In most cases, a negligent doctor’s insurance company pays the victim of malpractice, and the doctor goes back to work. If he develops a bad enough reputation in one town, he can move to a new state and continue practicing. Unless patients are lucky enough to live in a state such as Colorado, where medical malpractice is a matter of public record, all people have to go on are testimonies on doctor-review websites.

It’s time for patients and doctors alike to work for real transparency. A start would be to identify the doctors in the National Practitioner Data Bank and open the database up to the public. State licensing boards should also embrace their responsibility by revoking licenses for repeat offenders.

Shielding the very worst doctors not only harms patients. It also casts a shadow on the overwhelming majority of competent, vigilant doctors, and on the reputation of the profession as a whole.

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