Most physicians reported by hospitals, medical societies, and malpractice insurers to the National Practitioner Data Bank (NPDB) for sexual misconduct have never been disciplined by their state medical board for that behavior, according to a new study by the consumer watchdog group Public Citizen.
To be sure, medical boards frequently discipline such physicians and report them to the NPDB. However, the Public Citizen study suggests that many hospitals and other groups that are required to report sexual misconduct to the database do not share that information with their state medical board, as required by federal law, as well as the laws of most states.
A spokesperson for the Federation of State Medical Boards (FSMB) told Medscape Medical News that “boards are dependent on the information they receive.” Lead study author Azza AbuDagga, PhD, MHA, a researcher for Public Citizen’s Health Research Group, counters that state medical boards should take the trouble to check the NPDB for red flags about sexually misbehaving physicians.
“We’re talking about major unethical behavior,” said Dr AbuDagga in an interview with Medscape Medical News. “They need to do better.”
Exploiting the Physician-Patient Relationship
The Public Citizen study, published February 3 in PLOS ONE, looked at physicians reported to the NPDB for all causes from January 1, 2003, through September 30, 2013. This clearinghouse collects licensing-board actions taken against clinicians and healthcare organizations, as well as negative actions or findings by hospitals, peer review organizations — which include HMOs and medical societies — and private accreditation groups. In the case of a hospital, a negative action can be the denial, revocation, voluntary surrender, or restriction of clinical privileges. Malpractice insurers also tell the NPDB when they’ve made a payment on behalf of a physician.
During the study’s time frame, Public Citizen found that 1039 physicians, or roughly 1% of all physicians, had at least one NPDB report of sexual misconduct. Of this group, 786, or 76%, were reported solely by a state medical board on account of a disciplinary action.
The remaining 253 physicians were reported for at least one clinical-privileges sanction or a malpractice payment related to sexual misconduct, but only 30% of them had a medical-board license action in their file as well. The fact that 70% had not been reported by a medical board was the galling discovery for Public Citizen.
The authors note that they could not identify the sex and specialty of physicians with NPDB reports of sexual misconduct, owing to the information made available. However, they note that previous studies have shown that such physicians tend to be men, with psychiatrists accounting for a disproportionately high share of cases, and that cases involving family physicians and obstetrician-gynecologists are on the rise.
Another study limitation, the authors say, was that NPDB reports based on clinical-privilege sanctions and license actions did not identify whether the victim of sexual misconduct was a patient or not. However, on the basis of a previous study as well one of the author’s prior experience as an NPDB research executive, the authors believe that most victims are in fact patients.
“Physician sexual misconduct dangerously exploits the physician-patient relationship,” the authors write, pointing to evidence that such conduct harms patients and endangers their medical care.
A History of Hospital Underreporting
The Health Resources and Services Administration, the federal agency that operates the NPDB, observed as far back as 1999 that hospitals underreported clinical-privilege sanctions for physicians to their state medical boards, despite federal and state mandates to do so. However, “the rate of compliance is better, from what we understand,” said Lisa Robin, the FSMB’s chief advocacy officer.
One reason for improvement is that the NPDB now reminds anyone who reports a physician to the database to also notify the state medical board.
These same boards also have encouraged hospitals to share information, said Robin. However, medical boards exercise no legal jurisdiction over hospitals, so their influence is limited.
Medscape Medical News asked the American Hospital Association to comment on the issue of hospitals not reporting physician sexual misconduct to state medical boards. An AHA spokesperson said no one was available to review and comment on the PLOS ONE study.
Theoretically, if a hospital or medical society reports a physician to the NPDB over sexual misconduct, the state medical board can find out. These boards routinely query the NPDB on any physician who applies for a license, said Robin. And they’re free to make queries any time after they license a physician, especially if they have a reason to do so, such as a news account of a physician accused of sexual harassment.
A few years back, the NPDB introduced what it calls a “continuous query” service for entities such as medical boards that, unlike the general public, are privy to databank records. The service can automatically alert a medical board whenever the NPDB receives a report on a physician it has licensed, setting the stage for disciplinary action.
Robin said some state medical boards use NPDB continuous query, but that she doesn’t know how many. The annual cost — $3.25 per physician — could deter some boards that are strapped for cash, she said. “We see more and more states with financial issues that are cutting budgets for medical boards,” she said.
For a midsized state such as Tennessee, which has roughly 21,000 physicians with active licenses (as of 2014), the cost of NPDB continuous query would come to about $68,000.
For her part, lead author Dr AbuDagga said that state medical boards indeed face funding limitations, but nevertheless they are obliged to ferret out physicians engaged in sexual misconduct with patients, which violates their Hippocratic Oath.
This behavior appears to be grossly underreported, she said. She pointed to a 2011 study showing that sexual misconduct was the leading reason why Canadian physicians were disciplined by provincial licensing authorities from 2000 through 2009, representing 20% of violations. In contrast, sexual misconduct accounted for only 1% of physicians reported to the NPDB in the Public Citizen study.
“We’re calling for more attention to this issue, and more research,” Dr AbuDagga said.