Patient advocacy groups are protesting the government’s shutdown of public access to data on malpractice and disciplinary actions involving thousands of doctors nationwide.
The National Practitioner Data Bank maintains confidential records that state medical boards, hospitals and insurance plans use in granting licenses or staff privileges to doctors.
Although records naming physicians aren’t available to the public, the data bank for many years provided access to its reports with the names of doctors and hospitals and other identifying information removed.
That changed Sept. 1 when the data bank removed these public-use files from its website. The action came shortly after it learned The Kansas City Star planned to use its reports.
The story, about doctors with long histories of alleged malpractice but who have not been disciplined by the Kansas or Missouri medical boards, was published on Sept. 4.
The Star linked anonymous data bank reports to a Johnson County neurosurgeon by matching its information to the contents of court records of malpractice cases. Journalists often use this technique to glean additional information about doctors from the data.
“We’ve seen (The Star’s) reporting and others that show your ability to triangulate on data bank data. We have a responsibility to make sure under federal law that it remains confidential,” said Martin Kramer, spokesman for the Health and Human Services Department’s Health Resources and Services Administration, the agency that oversees the data bank.
Kramer said his agency may make the public-use files available again after a “thorough analysis of the data field.” But that process probably will take at least six months and the files may not return in the same format as they had been.
Previously, the files could be downloaded from the data bank website as massive spreadsheets. Names of doctors were replaced by arbitrarily assigned practitioner numbers.
The ages of doctors and patients, as well as the dollar sums of malpractice payments, were presented as ranges, such as a doctor age 40 to 49, rather than as specific numbers.
The bank is not mandated to make public files immediately accessible on its website, but is required to respond to information requests.
“Whatever they do will probably make it more difficult to use the files in meaningful ways,” said Alan Levine, a health care researcher with Public Citizen’s Health Research Group, which advocates for patient safety
On Tuesday, Public Citizen sent a letter to the Health Resources and Services Administration objecting to the removal of the public-use files.
“The continued availability of this data is crucial to patient safety and research aimed at informed public policy decisions concerning malpractice, tort reform, peer review, and medical licensing. There simply is no substitute for the NPDB Public Use Data File if this vital research is to be continued,” the letter said.
The Association of Health Care Journalists also opposes removal of the files.
“We’re really disturbed by this,” said Charles Ornstein, president of the medical writer group. “We’ve seen our members do terrific work (with the files) that protects the public.”
Ornstein pointed to stories by the Hartford Courant in Connecticut and the Raleigh News & Observer in North Carolina citing the data bank’s public use files as a source on doctors whom they named.
“If it were not for this information used by reporters, their stories would not have been as strong,” he said.
“Why are they picking on this (Star) article?” asked Lisa McGiffert, director of Consumers Union’s Safe Patient Project. Consumers Union, which wants greater public disclosure by the data bank, will be asking the agency to put its files back online, she said.
“This administration (of President Barack Obama) has been touting their position for open government,” she said. “I see this action as totally counter to that.”
Kramer said the data bank was alerted to The Star’s reporting by Robert Tenny, a physician the newspaper was reporting upon. In order to provide Tenny with an opportunity to respond, The Star notified Tenny’s lawyer on Aug. 16 of specific information it intended to publish, including several matters contained in the data bank.
In a letter Aug. 26, the bank’s director Cynthia Grubbs advised The Star that violations of data bank confidentiality provisions are subject to a civil monetary penalties. (Read the letter here.) The Star, however, used only publicly available information from the Data Bank.
“A federal agency should not be intimidating reporters for using information that they put on their own website,” Ornstein said.
But Kramer said his agency must investigate any potential breaches of confidentiality.
“Once we became aware that this information may be made public, we had a responsibility to make sure that it remains confidential,” he said.
In an interesting development on open data access HHS removed public access to malpractice data that had previously been published online in anonymous form.
The Kansas City Star newspaper took the publicly available information and using well known and commonly used data matching techniques to link the data to individuals an in particular outing doctors with longstanding histories of alleged malpractice. This was followed by some strong arm tactics threatening the newspaper with legal action.
As the commentators note this is not welcome development and runs counter to the spirit of open government. It does not bode well for the proposed public rating system of healthcare facilities and clinical practice for patients.