The National Practitioner Data Bank -- the government-sponsored repository for records of medical malpractice judgments and certain other adverse actions -- has always been a boogeyman for physicians, a secretive list where you don't want your name to appear.
But at least one regulatory group isn't paying that much attention to whether physicians are named in it or not.
In 2017, 30 state medical boards in the U.S. backgrounded a physician using the database fewer than 100 times, according to numbers from the Health Resources and Service Administration.
Thirteen boards didn't even check it once.
While there are other tools for boards to learn about troubles faced by the physicians they license, experts say the NPDB -- despite its limitations -- is a key part of any backgrounding process.
A 番茄社区/Milwaukee Journal Sentinel investigation identified more than 500 physicians who have had problems in one jurisdiction but were allowed to practice with clean licenses in another. Among them: Physicians with prescription drug problems; who performed unsafe or unnecessary surgeries; or had sex with patients.
Several states said they hadn't heard of a physicians' problems until they were contacted by reporters, raising questions about how the available tools are being put to use.
Congress created the National Practitioner Data Bank in 1986, saying it would improve healthcare quality and reduce fraud and abuse.
The database was designed as a central repository for recording malpractice payments, state disciplinary actions, restrictions from health plans or hospitals and other limits on any healthcare professional -- physicians, nurses, dentists, physical therapists and others.
The database now has more than 1.3 million records of "adverse actions" going back to 1990. It's open to hospitals, insurers, and state medical boards. In 2016, the data bank logged 7.5 million searches from those groups.
But state medical boards accounted for just 137,000 searches last year, based on an analysis of data obtained from the Health Resources and Service Administration.
That's far less than even the number of renewals. In Texas, for example, with 78,000 licensed physicians, licenses are renewed every two years. Assuming half those licenses came up for renewal last year, the state would have fallen far short -- performing less than 3,700 checks of the data bank altogether.
Two-thirds of all the medical board searches last year came from Wyoming and Florida.
Only 12 state boards use the data bank's "continuous query" feature, which sends updates on filings involving their physicians within 24 hours of any new report.
Kevin Blohnenblust, executive director of the Wyoming Board of Medicine, said since the state signed up for the service the number of cases regulators have flagged for follow-up reviews has risen 10%, as they are learning about actions that otherwise would have escaped notice.
"What it does is it eliminate the unknown," he said. "It takes away the concern of 'What else is out there that we don't know about?'"
Few boards take full advantage of the program.
Most boards that use the continuous query service sign up for updates on a few specific physicians -- so they only get information on physicians that are already a concern, not new cases that may emerge.
In Florida, state law requires the Department of Health to check the data bank when physicians apply for licenses, and again when they seek renewal.
To satisfy that requirement, the state uses Continuous Query, adding the name of each of their nearly 84,000 physicians to a list of names monitored. The service costs $2 per name, said Brad Dalton, a spokesman for the department.
Other approaches
There are other avenues medical boards can use to find adverse actions against their licensed physicians.
The Federation of State Medical Boards offers its own database about physicians' records to its members.
The federation's Physician Data Center overlaps with the national data bank in some areas, but each contains information the other doesn't.
For example, the federation's list has an entry on all physicians, while the data bank is limited to those who have some negative action. Thus the federation list can be used to tell where a physician has been licensed throughout his career, while the data bank cannot. The federation list also contains information on such things as medical specialties and educational background.
Meanwhile, the data bank has information about malpractice lawsuits and clinical privileges that aren't covered by the federation list. It also has the authority of the law -- medical boards, hospitals and malpractice insurance companies are required to report infractions to the federal data bank.
There is no such requirement with the federation's list.
A physician like William McCutchen III, about whom we wrote last week, would show up on the NPDB because he lost his hospital privileges as a result of his problems with alcohol. That same problem would not appear in the PDC.
Lisa Robin, chief advocacy officer for the Federation of State Medical Boards, said the two datasets work best when used together.
"They're complementary," she said. "We would recommend they're both utilized."
Among the states that didn't use the federal data bank at all last year was Illinois.
A spokesman for the Illinois Department of Financial & Professional Regulation (IDFPR), Terry Horstman, said the department is able to get information from other sources. Hospital actions or malpractice payments within the state are reported under federal law. They also background using the PDC. Horstman noted the NPDB has a fee for every search.
"With these requirements in place, IDFPR does not find it necessary to utilize the additional fee-based NPDB query," he said.
Robert Oshel, the data bank's former associate director of research, said that approach could allow a lot to go unnoticed.
"If one of their licensees had a report from outside Illinois, they wouldn't automatically get a copy. This would be a significant omission for Illinois because they probably have a lot of physicians who are also licensed elsewhere, especially in Missouri, Wisconsin, and Indiana," he said.
The Federation of State Medical Boards offers its registry to state boards for free, though boards pay annual membership dues of $2,400.
Some information from the federation's list has been online and open to the public since 2001, said Robin, the organization's advocacy officer. At first, there was a charge to access the information, but it's now free.
A profile on the site -- docinfo.org -- lists states where a physician is licensed and states where a doctor has faced discipline.
But to see details of the actions taken against a doctor, patients still have to visit the state board website of that state. And then, based on the 番茄社区/Journal Sentinel investigation, patients will find the available information varies widely by state. Some states have exhaustive details of infractions, while others may not list them at all.
Robin said the approach was aimed at respecting each state's differing rules about public disclosure of disciplinary action.
"State laws vary on how they report data," she said, noting the links are "to make sure we're sensitive to how those state rules and regulations are," she said.