Even though federal law requires it, nearly half of all U.S. hospitals fail to report to the National Practitioner Data Bank (NPDB) when a physician's admitting privileges have been revoked or restricted for more than 30 days, according to a report from consumer watchdog group Public Citizen.

The failure of hospitals to adequately discipline doctors or to report cases of physician discipline to the NPDB deprives state medical boards of critical information needed for regulatory oversight and creates the potential for patient harm, Public Citizen said in a May 27 report and in a letter sent today to Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS).

When the database was first created more than 17 years ago, federal officials estimated that hospitals would report approximately 5,000 cases a year. But since it began 1990, the database has averaged only 650 reports a year, the organization found.

"It is impossible to justify the fact that thousands of hospitals, which collectively have granted admitting privileges to hundreds of thousands of doctors, have not reported a single discipline case in 17 years," said Sidney Wolfe, MD, Public Citizen's acting president and director of its Health Research Group. "Our report shows there is an urgent need for the Obama administration to step in and hold hospital administrators accountable as well as ensure that hospital medical staffs hold their own physicians accountable for patient safety."

The report points to two factors behind the low number of hospital discipline reports:

1. Lax peer review, including a culture among doctors of not wanting to "snitch" on a colleague;
2. hospital administrators evading reporting requirements by doing things such as imposing discipline of less than 31 days, thereby evading the reporting requirement or giving doctors a leave of absence in lieu of suspensions.

The Washington, D.C.-based Pubic Citizen said it reviewed studies by the Office of the Inspector General, medical journal articles, work by the nonprofit Citizen Advocacy Center and recommendations from an October 1996 national meeting on hospital underreporting attended by hospital administrators, government officials, medical associations and consumer advocates, including Public Citizen. Public Citizen also analyzed the NDPB to examine the relationship between hospital reports and actions taken by state medical boards on the same physicians.

Public Citizen's recommendations included amending the Health Care Quality Improvement Act of 1986 to add fines for each instance of a hospital's failure to report and tying compliance with the act to the hospital accreditation process and Medicare conditions of participation.

"Hospital peer review has been called one of the pillars of quality assurance in the U.S. healthcare system," said Al Levine, the Public Citizen researcher who compiled the report. "Based on all the data and reports we analyzed, it appears to be a questionably effective form of self-regulation that needs more accountability and better oversight. We hope our report is the tipping point for action by Congress and the Department of Health and Human Services."