Hospitals reject audit’s claims

By Emily Richmond (contact)

Tuesday, Dec. 9, 2003 | 9:14 a.m.

An audit of the state Board of Medical Examiners says hospitals aren't doing enough to report doctors involved in malpractice cases, a claim the Nevada Hospital Association rejected Monday.

The audit, presented at the state board's meeting Friday, stated that of the 1,154 malpractice investigations undertaken from Jan. 1, 2002, to Nov. 3 of this year less than 2 percent came from hospital sources. Since the majority of the incidences occurred at hospitals, the auditors concluded that either "hospitals are not reacting to these malpractice cases with limitations on privileges, (or) there is under-reporting of hospital actions, or both."

Bill Welch, president and chief executive of the Nevada Hospital Association, said all Nevada hospitals have some form of checks and balances, including regular re-assessment of a doctor's credentials and peer review of outcomes of medical treatment.

"We have no hospital in violation of any legal requirement for collecting, for tracking, for monitoring, for resolving or for reporting incidences to the appropriate authorities," Welch said. "And when it is appropriate and necessary, hospitals do adjust physicians' privileges."

Welch said he has asked for a meeting with Larry Lessly, executive director of the state Medical Examiners Board, to discuss the audit's findings. The audit has also been added as a discussion topic for the next meeting of the hospital association's board, Welch said.

The association's attorney is determining what legal responsibilities the state's hospitals have in light of the audit's findings and is also reviewing recent changes to the state's statutes, Welch said.

Hospitals are supposed to notify the Medical Examiners Board when a doctor's privileges are suspended or revoked. A new law, which took effect July 1, levies $10,000 fines against hospitals that fail to report.

Richard LeGarza, legal counsel for the medical board, said Saturday: "The hospitals over the years have not been good at reporting." But he said they have improved since a new law took effect in July.

But, Lessly said, his board would not know if a hospital took action against a doctor and never informed anyone.

"How would we know if they fail to report?" Lessly said. "We don't have jurisdiction over hospitals."

The board plans to follow the audit's recommendations, which called for regular reminder letters to hospital officials about the reporting requirements. In fact, a letter went out this summer in advance of the law taking effect, Lessly said.

Reporting suspension of hospital privileges "should not be an afterthought," the letter said. "In addition, and perhaps as an indication as to the serious intent by our Legislature to have loss of hospital privilege reports be complete and timely (the bill) adds that physicians themselves must also report to the Board of Medical Examiners any loss or change in hospital privileges."

The new law also requires physicians to report within 45 days when they have been served with a malpractice suit. If doctors fail to report, they can be fined up to $5,000 and have their licenses suspended or revoked.

The hospital setting provides perhaps the most crucial source of information about physician performance, said Dr. Sidney Wolfe, director of the consumer watchdog Public Citizen's Health Research Group.

"If a hospital isn't a place where physicians have the ability to judge other physician's abilities and raise factually grounded questions about performance, I don't know what is," Wolfe said Monday.

But hospitals are often reluctant to hand out punishments to their own staff, a fact reflected in the low numbers of revocations and suspensions reported across the country, Wolfe said.

"If you're a hospital, you depend on doctors for your income," Wolfe said. "If you alienate them by restricting privileges, you risk millions of dollars in profits from admissions."

Confidentiality laws prohibit a hospital or the state from revealing whether a physician has had his privileges revoked. Even the total number of revocations or suspensions is confidential, according to officials with the state board.

In addition to notifying state authorities, hospitals are supposed to report changes in physician privileges to the National Practitioner Data Bank, created by Congress in 1986.

Only hospitals, managed care organizations and state licensing boards have access to the data bank -- patients, individual physicians and the general public do not.

Congress needs to change the law and make the data bank open to the public, Wolfe said.