Disclosure Trumps NPDB

March 7, 2011
The database – it’s an issue. It’s always been an issue for physicians, and in some ways it has become more of an issue with the disclosure movement taking root.

“But, is my name going to go on the database?” is the worried question asked by nervous doctors following a Sorry Works! presentation.

Many ways to think about this topic.

In cases where the physicians are employees of the hospital or part of the hospital’s captive, the hospital will often get the physician dismissed from the case, the claim paid on behalf of the hospital, and the physician’s name does not go to the NPDB – most of the time.

In cases where the physician is covered by an independent carrier, if disclosure is done quickly and pro-actively enough to head off a written demand for money, some folks feel that a report to the NPDB is not necessary.

Others will say if a doctor does make a mistake – commit malpractice – his/her name should be on the database….and shouldn’t we be worrying more about the injured/dead patient or grieving family than whether or not the doc gets put on the NPDB?!!

Here’s my thoughts on the matter…

I think in light of the disclosure movement, distinctions need to be made at the NPDB for physicians who make honest mistakes and disclose them versus docs who make horrific errors and cover them up. Perhaps, we even develop a system whereby if you make a mistake and promptly disclose, the NPDB is notified but the report is not officially on the database and will never go on the database so long as you don’t make the same mistake twice within a certain period of time. Kinda like going to traffic school for a speeding ticket – sin no more and we forget about it. But, I’m not holding my breath that this will happen anytime soon. Maybe, just maybe with all the federal politicians hungry for another go at the med-mal debate in Washington, DC, perhaps someone could slip some language in to make this happen…but, again, I won’t be holding my breath.

So, until this happens, ethically speaking I think the importance of disclosure and need for acceptance of disclosure trumps the NPDB. You may not agree with me, but that’s my opinion. And I bet more than a handful of docs, nurses, and healthcare executives would agree with me – as well as a few patient safety advocates. Disclosure comes first! Unfortunately, I think the NPDB is perceived – rightly or wrongly – as part of the shame and blame culture in medicine that has created our current predicament. The benefits of rapid uptake of disclosure far outweigh the needs of the NPDB or any perceived benefits of the NPDB. And if the NPDB is serving as an impediment to disclosure, we need to think around it within the bounds of the law.

First, I fully support – where possible – hospitals settling cases on behalf of employed physicians, even when malpractice occurred and a written demand was made. We’ve said all along, that as more physicians become hospital employees, that disclosure’s uptake will increase. The perceived problems of the NPDB are one of the reasons hospital-employed physicians is a good thing when it comes to disclosure. However, hospitals must work with their carriers/captives to understand this nuance and not report physicians who were dismissed from cases, lest disclosure will be greatly chilled among doctors (and for good reason).

Second, I fully support independent carriers – when possible – moving aggressively with disclosure to possibly head off written claims or demands for money — even in serious cases. Work quickly to get everyone – including the docs – what they need, including financial and emotional support and ongoing medical care (all needed items) versus the NPDB, which I’m not sure helps anybody.

Thirdly, we’re not going to prevent every doc’s name from going to the database. So, we need to help docs think through these situations. If you didn’t make a mistake, we can empathize, maintain the relationship with the patient/family, and do rapid service recovery, none of which is reportable to the NPDB, and we will fight the claim with the best of lawyers. If, however, you made a mistake, a written claim was made, and you’re not a hospital employee, you’re going on the database. We’re sorry. The only question is by which route will you get there? After a long, bloody fight where no one feels good at the end, or by doing the right thing? And we can include written commentary to be included with the NPDB report about how you did the right thing post-event.

For more information on Sorry Works!, including Sorry Works! presentations for your physicians and staff, please call 618-559- 8168 or e-mail doug@sorryworks.net.

Sincerely,

– Doug