This story is part of a major investigation by 番茄社区 and the Milwaukee Journal Sentinel into physicians who had public actions against their licenses in one state, but are able to practice elsewhere with "clean" licenses.
Gemma Cunningham is no stranger to the power of transparency.
Twelve years ago, she and spine surgeon Charles Rosen, MD, sounded the alarm when a new spinal surgery product got the all-clear from the FDA -- based in part on a study done by physicians who received payments from the company selling the product.
Their organization, the Association for Medical Ethics, proposed a law that eventually became the federal Physician Payments Sunshine Act. Now, information about payments made by companies to physicians is released every year.
That success got Cunningham, a medical marketing and public relations executive based in the Los Angeles area, thinking about other medical data that is out of the public's reach.
"It really opened my eyes as to how is the average person ever going to know who their physician is?" she said.
The industry is well aware that there are problems with how physicians are disciplined and how information about those actions is shared.
Last year, the Federation of State Medical Boards (FSMB) held a daylong event, with three dozen experts, to discuss the problem and its solutions. They released a report called "Duty to Report: Protecting Patients by Improving the Reporting and Sharing of Information about Healthcare Practitioners" with their findings, which included a lack of data integration and attitudes toward discipline differing from hospital to hospital and state to state.
The FSMB has stepped in, offering a site where people can look up a physician and see if he or she ever faced discipline in a state where licensed. But that site, docinfo.org, provides no details about the nature of the problems. It also has no information about federal actions or malpractice cases.
Meanwhile, the 30-year-old National Practitioner Data Bank (NPDB), long the gold standard for tracking physicians' transgressions, is closed to the public and derided by many experts for being incomplete.
The lack of a single resource for backgrounding a physician has led to an opening for several companies. Among them are Lexis-Nexis, PreCheck, and Cunningham's TruthMD, which provided data and documents on physicians to 番茄社区 and the Milwaukee Journal-Sentinel for this series.
TruthMD provided reporters with a list of more than 700 physicians who appeared to have public actions in one state that weren't picked up elsewhere. The company also gave reporters access to TruthMD's MedFax database, which provides a mix of primary documents and information collected by its researchers.
Reporters then went about confirming the records and timelines of the cases with the jurisdictions where events occurred, eventually coming up with the more than 500 used in this series.
Cunningham said that while there's no dearth of providers offering physician backgrounds, few are focused on including everything, or intent on getting it right.
"NPI [the National Provider Index registry] and NPDB were done with good intentions, and with the right mindset," she said. "But the problem is how it was implemented and how it works. Put garbage in, garbage comes out. And over time, the whole thing's impacted.
"As a result, here we are."
Cunningham and Rosen, who founded the company along with Kourosh Maddahi, MD, have a team of researchers and programmers who get regular information from state medical boards, federal agencies and thousands of state courts. In addition to getting the information, the company connects the data to the correct physician, sometimes going to great lengths to do so.
Cunningham said TruthMD has investigators in every state they work with in cases where the public record isn't clear.
For example, she said, there are two physicians in Florida -- twin brothers with similar first names. They share a specialty and graduated from the same medical school.
"We are the only people in the world that know that they exist. In everybody else's database, they're one person," she said.
For now, TruthMD's major clients are companies that insure physicians, workers compensation funds, and insurance companies. With reliable data, those companies are able to offer lower premiums to physicians with clean records, she said. Patient insurers are able to "clean up" their provider registries, she said.
But they hope to move into offering the information to consumers and patients, too.
"Dr. Rosen and I truly believe 95% of all physicians are caring, ethical, well-meaning people who want to do the right thing," she said. "It's such a small percentage who have lost their integrity. But when you look at the impact, it's huge."