The National Practitioner Data Bank
Section NineThe National Practitioner Data Bank (NPDB), which opened in 1990, is a web-base repository of reports containing information on medical malpractice payments and certain adverse actions related to clinical privileges and licensure of physicians, dentists, and other licensed health care practitioners, providers and suppliers. Federal regulations authorize eligible entities to report to and/or query the NPDB. Individual and organizations who are subjects of these reports have access to their own information. The reports are confidential and not available to the public. Medical Malpractice Payment Reports to the NPDB are only made if a payment is made, not merely if a tort claim or suit is filed, and the submitted report must be made "for the benefit of" (on behalf of) an individual provider, not an institution or health care program.
The NPDB and the Federal Sector: The law establishing the NPDB did not require that federal programs be included in reporting and querying requirements. However, the Department of Defense, the Department of Veterans Affairs, and the Department of Health and Human Services (HHS) all stated that they would participate fully in both NPDB reporting and querying. Therefore, the rules and regulations of the NPDB published in the Federal Register (and found on the NPDB website) that govern how individual civilian practitioners are to be reported do not apply to the federal sector. In regards to practitioners working for operating divisions of the HHS (and Tribal organizations), practitioners involved in an FTCA medical malpractice claim settlement will only be reported to the NPBD if the MRCP finds that they did not meet the standard of care.
National Practitioner Data Bank Reporting: The IHS has been submitting reports only on cases where it was determined by the HHS Medical Claims Review Panel (MCRP) that the standard of care was not met. No reports have been submitted by the IHS for any case where it was determined by the Panel that the standard of care was met, or that the adverse outcome was a result of a "system failure."
To prepare a NPDB report, mandatory provider information, payment information, and clinical information has to be identified. Often, it is necessary to consult with the service unit risk manager, credentials coordinator, or clinical director to collect missing provider information. Before a report is submitted, the IHS makes every possible attempt to first notify the provider about this pending administrative action, even when the providers have long left governmental or Tribal employment.1
Once a NPDB report has been submitted, there are additional processes available to the reported individual in regards to dispute resolution. Also, the provider has the opportunity to electronically submit a "subject statement" that will be added to the NPDB report. Many providers will submit additional information further explaining their decision- making or actions relevant to the case in hand. Once reported, an individual practitioner is responsible for disclosing this information to the credentialing office of the facility or facilities where they practice, and to their State licensing board(s).
Issues Regarding NPDB Reporting:
- Particularly for older cases, it was a common finding that practitioners were either altogether unaware that a claim had been filed, or they were never offered the opportunity to participate in the claim review process. The IHS RM Program has taken steps to ensure that all providers are now given every opportunity to explain to the Panel their degree of involvement in a case.
- Also in the past, practitioners involved in tort claims were often not kept abreast of the progress of a tort claim as it worked its way through the OGC, DOJ and MCRP. This process often takes years to come to a conclusion. The IHS RM Program encourages the local site risk managers to make renewed effort to maintain contact with practitioners during the various stages of claim and suit negotiations.
- The IHS cannot name to the NPDB individuals who are not covered under the Federal Tort Claims Act. Therefore, non-personal services contractors working in IHS or Tribal facilities cannot be considered for NPDB reporting, even when the care they provided was clearly below the standard of care and was responsible for the adverse outcome. These individuals must be covered by their own medical malpractice insurance policies and are subject to be sued individually. If the independent contractor’s malpractice insurance company makes a payment on behalf of its policy holder, it is that company's responsibility to submit a NPDB report.
- Not uncommonly, providers and service unit officials do not understand the role that the Panel’s decision has in the overall claim review process. There is confusion over the roles of the OGC, the DOJ, and the MCRP in determining which providers are named to the NPDB. It is important to realize that the OGC and the DOJ are defending the Federal Government and are not involved in NPDB reporting decisions. In accordance with HHS policy, the MCRP is the sole entity with the responsibility for identifying which practitioners will be named to the NPDB for a particular claim or suit.
It is the sole responsibility of the IHS and Tribal local sites to report directly themselves to the NPDB any other certain and final adverse actions taken against providers that do not involve FTCA medical malpractice payments.
1 Neither the HHS reporting policy nor the NPDB regulations require practitioner notification before a payment report is submitted.