A year-long investigation by the Milwaukee Journal Sentinel and MedPage Today turned up several egregious cases illustrating a now-familiar national pattern: many physicians sanctioned for misconduct or incompetence in one state are often never discovered to have been disciplined by other states where they hold a license. Summarizing their findings in a series of newspaper articles in February and March, the investigative team wrote: “Like traveling medicine hucksters of old, doctors who run into trouble today can hopscotch from state to state staying ahead of regulators.”
But along with the accounts of doctors who eluded practice limitations despite a history of discipline elsewhere, the newspaper series reported that the federal National Practitioner Data bank (NPDB), which has collected more than 1.3 million records of “adverse actions” against health professionals going back to 1990, is barely used by the nation’s medical boards.
Hospitals and insurers, which have access to the data bank, log millions of searches each year, but state medical boards searches are only a “small share” of the total number, the Journal Sentinel reported—averaging 10 to 20 searches each per year.
The newspaper series covered a five-year period from 2011 to 2016 and uncovered up to 500 physicians who were disciplined for medical errors or oversights, sexual misconduct, and other misbehavior but continued practicing with unblemished credentials in other states.
Physician Jay Riseman was a notable example. In Illinois, the state Department of Financial and Professional Regulation temporarily suspended his license in 2002 for “incapacity or incompetence” in pediatric surgery, following multiple instances of overdosing patients and ignoring critical symptoms, resulting in some patient deaths. Despite restrictions when he was on probation, Riseman performed 14 surgical procedures without supervision in Illinois, according to a 2004 complaint by the department. But his indefinite probation was lifted in 2007 anyway.
Colorado later denied his license application but Missouri granted him a license, while Kansas approved him with a ban on practicing surgery. Pressed to have the limitation lifted, Kansas agreed, with the proviso that he not actually perform any surgeries. Today Riseman is registered in Illinois as a partner in a medical marijuana dispensary with a license noting that he has never been disciplined in that state, the investigative team found.
The reporters quoted a former overseer of the data bank, Robert Oshel, who said, “It was very unusual [for the data bank] to get queries from a state board. There were states that maybe didn’t submit any queries at all, or one or two.” Although the data bank offers automatic updates of any adverse action every 24 hours, only 13 of 64 state medical boards (20%) subscribe to that service, the reporters found.
While other compilations of discipline data are available, including one sponsored by the Federation of State Medical Boards, the NPDB is the only one to which entities imposing discipline are federally required to report their adverse actions against physicians.
However, the information in the NPDB is not open to the public—a feature that has drawn repeated criticism. In fact, the Journal Sentinel and MedPage Today had to turn to the private company TruthMD, which has compiled about 1 million physician dossiers based on information from the courts, medical boards, and federal agencies, to obtain data for the investigation.
Oshel told the Journal Sentinel investigative team that he believed the advantages of making the adverse actions public would “far outweigh the disadvantages.” In the meantime, private information services from companies like TruthMD, LexisNexis, and PreCheck, drawing on the vast resources now available online, are increasingly filling the gap.