Secrecy  Iatrogenic

20 years of malpractice data still mostly closed to public
By GAVIN OFF, World Data Editor
More than 20 years ago Congress created a federal database to track incompetent and unprofessional health-care practitioners.

The database, compiled by the U.S. Department of Health and Human Services, includes some 460,000 records of malpractice lawsuits whose judgments total $69.7 billion.

It includes information on 23,788 patient deaths, 8,100 major permanent injuries and 3,896 cases that resulted in quadriplegics, brain damage or lifelong care.

But much of the data is closed to the public.

Although the full database is open to hospitals, managed care organizations and state licensing agencies, the public can view only limited information, such as the lawsuit's allegation and the patient's health.

Meanwhile, the doctors' names remain hidden, preventing patients from using the data to look up information on their practitioner.

"I can certainly see the advantage to the general public or the patients to have all the information available," said Lyle Kelsey, director of the Oklahoma Board of Medical Licensure and Supervision. "The other side of that is not all of that information may be correct. There's a lot of criticism that some of the information is misleading."

For years, the American Medical Association has argued that the data bank should remain closed to the public. The data are incomplete and unreliable, association representatives said.

A 2000 Government Accountability Office report found 30 percent of the data it surveyed was submitted late and 11 percent contained false or misleading information about the severity or number of times a practitioner was disciplined.

"As a physician, there is not an interest in having the database open because it is a flawed program," said Oklahoma City pediatrician and American Medical Association member Mary Anne McCaffree. "We support patients having access to reliable information."

That information is already open and available through a state's medical board, McCaffree said.

The Oklahoma Board of Medical Licensure and Supervision publishes disciplinary actions taken against health-care practitioners on its Web site, . Some of that information comes from that national data bank, which Kelsey said the state uses almost daily to check background information on license applicants and targets of an investigation.

Therein lies part of the problem, said Sidney Wolfe, a physician and director of the Health Research Group for Public Citizen, a nonprofit consumer advocacy organization out of Washington, D.C.

If the data bank is reliable enough for state medical boards to use on a daily basis, why should it be considered too incomplete for curious patients, Wolfe asked.

"It's a silly argument," he said. "That's just a way to protect doctors."

Wolfe said that most of the problems cited in the GAO report have since been corrected, and, if there is a problem with the data, it's under-reporting.

Despite possible under-reporting, Oklahoma doctors had to pay a combined $394 million following malpractice lawsuits since 2000, according to the data bank's public use file.

Reasons for the lawsuits vary. They include everything from giving an incorrect diagnosis and failing to order the appropriate medication to prescribing the wrong dosage and performing an unnecessary procedure.

They also include more uncommon allegations.

For example:

* 28 lawsuits in Oklahoma concerned a procedure on a wrong body part and totaled $2.9 million in payments.

* Nine suits concerned sexual misconduct and totaled $166,000.

* Three suits concerned assault and battery and totaled $300,000.

* One suit concerned failure to resuscitate a patient and totaled $175,000

"There's some extraordinary information," said Wolfe, who added that it would take a Congress willing to battle the medical association for the data bank to become open.

Kelsey said he wouldn't mind seeing that happen.

"If you want to make a decision, you ought to have as much information as you can," Kelsey said. "Based on that, it's hard to say that it wouldn't be of some value."