The National Practitioner Data Bank (“NPDB”) has been in
operation since 1990, its quirky reporting mandates exceptional even amongst myriad regulatory
hassles imposed on physicians. NPBD finalized
changes to its Guidebook (www.npdb.hrsa.gov/resources/NPDBGuidebook.pdf) warranting changes in medical staff bylaws to
prevent needless, irreparable damage to physicians.
Investigation The Health Care
Quality Improvement Act requires reporting a physician’s surrender of medical
staff membership or privileges while under investigation, to prevent forced
resignation in lieu of a NPDB report as a plea bargain. The new Guidebook expands the investigation
timeline, stating “An investigation begins as soon as
the health care entity begins an inquiry and does not end until the health care
entity’s decision-making authority takes a final action or makes a decision to
not further pursue the matter.” Thus, a section chief checking a physician’s
file following a patient’s complaint could trigger reportability.
Notice This expanded
definition of investigation becomes more dangerous given that the Guidebook
repeatedly states that the physician need not have any notice, indeed, need not
even be aware, of an investigation. Further, the physician’s resignation is
reportable even if it is just coincidental, and wholly unrelated, to the
reasons for the secret investigation.
Surrender Surrender of
membership or privileges is interpreted to include opting not to reapply, or even
exercising the right to a leave of absence. Surrender and investigation do not have to be
related. Thus, deciding to forego a
minor privilege on the biannual reapplication would cause a report, if an
“investigation,” although unrelated to that privilege, is underway. A 6-week
maternity leave could result in a NPDB report if, unbeknownst to the pregnant
physician, any inquiry into her practice has begun.
MEDICAL STAFF BYLAWS CHANGES WARRANTED
Investigation Although the
Data Bank ultimately determines when an investigation began, delineating in
bylaws what is and is not an investigation should set practical parameters.
Notice Bylaws should
stipulate that physicians receive written notice of any investigation.
Surrender Physicians
should be authorized to receive a written statement as to whether there is an
ongoing investigation prior to resigning any privileges, reapplying, or taking
any leave of absence longer than 30 days.
The Guidebook addresses other NPDB reporting and querying requirements
for malpractice payments and licensure and medical society actions. For further information, contact Libby
Snelson at easesq@snelsonlaw.com.
