The Issue
Not Enough Discipline for Bad Doctors
A recent analysis found that of over 8,000 doctors in the National Practitioner Data Bank with five or more malpractice payouts since 1990, only 25% have ever been disciplined by their state’s medical board.
This low rate suggests that state medical boards often fail to hold bad doctors accountable for patient harm. See our analysis of the trends in state disciplinary actions across the U.S.
In August of 2020, Public Citizen wrote state medical boards demanding they institute a zero-tolerance policy, investigate every complaint, and push for improved state laws.
Meanwhile, several states have mandated caps on damages for medical malpractice that often prevent patients from getting anything close to adequate restitution.
The Players
Congress
Congress established The National Practitioners Database (NPDB) in 1986 ‘to improve health care quality, protect the public and reduce health care fraud’. Since September 1990, state licensing boards, hospitals, and other health care entities, including professional societies, have been required to report certain adverse licensing and disciplinary actions taken against individual doctors.
- All reports are confidential and patients who proactively seek information about potential care providers are unable to access the NPDB for helpful data.
- Hospitals are mandated by federal law to query the NPDB every two years and when they hire a doctor. However, half of all hospitals have made zero reports to the NPDB in the last 20 years.
However, loopholes and disincentives lead to low levels of utilization. For example, even doctors can’t get info from NPDB.
Despite all of theses issues, Congress has not taken decisive action on patient harm in more than three decades.
State Medical Boards
State Medical Boards (SMBs) are responsible for licensing, disciplining and regulating physicians. The system of licensing medical practitioners was designed to protect the public from physicians who are inadequately trained or incompetent or whose conduct is illegal or
abusive towards patients (DocINFO).
- State medical practice acts mandate that medical boards take disciplinary action against licensees who have endangered or injured patients, yet the rates of action taken are low nationwide.
- State medical boards should also be inquiring and reporting to the NPDB, but they rarely take serious disciplinary action.
- At the state level, medical board members are typically physicians, who generally support minimizing transparency and protecting colleagues and practitioners.
Special Interests
The American Medical Association, which currently only represents 30 percent of physicians in this country, plays an outsized role in dictating policy regarding patient safety due to the $20 million annually they invest in lobbying, as well as sizable and bipartisan political contributions.
- The AMA is the strongest advocate of keeping the NPDB closed to the public.
There is a sense that doctors won’t snitch on other doctors, an unspoken code.
Racial Disparities
It should come as no surprise that the system is failing patients of color at greater rates. According to the Journal of Patient Safety, hospital staff are more likely to report patient safety events for white patients than they are for patients of color.
The National Academy of Medicine also reports that with all other variables accounted for, racial and ethnic minorities are more likely to receive lower quality of care. Black patients are less likely to even receive the type of care as their white counterparts.