Hospitals and other health care entities (including entities that provide health care services and engage in professional review activities through a formal peer-review process for the purpose of furthering quality health care and professional societies of health care practitioners that engage in professional review activity through a formal peer-review process for the purpose of furthering quality health care) must report any involuntary restriction, modification, curtailment, or suspension of clinical privileges that exceeds 30 days in length. Any voluntary modification of clinical privileges by the clinician while under investigation must additionally be reported to the NPDB. This would include situations whereby the physician or dentist resigns while under investigation for incompetence or improper professional conduct (eg, claims of verbal abuse). An agreement to resign in exchange for the health care entity not performing an investigation would also fall within this reporting requirement.
Sanctions for Failing to Report to NPDB
Any malpractice payer that fails to report medical malpractice payments is subject to a civil money penalty of up to $11,000 for each such payment involved.
Any hospital or other health care entity that fails substantially to report adverse actions will have its name published in the Federal Register, and the organization will lose its immunity from liability under Title IV with respect to professional review activities for three years.
Any professional society that fails substantially to report adverse membership actions can lose immunity protections provided under Title IV for three years.
Any health plan failing to make a required NPDB report on an adverse action shall be subject to a civil money penalty of up to $25,000 for each adverse action not reported.
The NPDB is not just a repository for medical malpractice misadventures anymore. A criminal conviction, pattern of emotional lability in the workplace, or abrupt resignation following a bad clinical outcome could very well justify a mandatory reporting to the data bank. I would encourage all emergency physicians to at least be familiar with the NPDB guidelines, as inclusion in the data bank can adversely affect future job prospects and malpractice insurability.
NOTE: No information within this report should be construed as medical or legal advice. Independent medical and/or legal advice should be sought based on each individual’s particular circumstances.
Dr. Totz is facility medical director at First Choice Emergency Room at Adeptus Health in Texas.