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August 20, 2014

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Do No Harm: Hospital Care in Las Vegas:

Nevada hospitals rarely sanction physicians

Nevada may have more surgical mishaps than should be expected, based on national benchmarks, but it's almost unheard of for hospitals to sanction a physician.

Doctors' privileges were revoked or suspended 73 times in Nevada from January 2007 to July 1, 2010 — an average of 21 actions a year, according to Doug Cooper, executive director of the Nevada State Board of Medical Examiners, which licenses physicians.

Nevada has about 10,000 active medical doctors, so about 1 in 475 has some action taken against his or her privileges in any given year.

Cooper said he thinks such moves are rare because doctors are doing a good job.

Dr. Sidney Wolfe, director of health research for the advocacy group Public Citizen, sees poor oversight, not high quality, in the numbers.

Wolfe said hospitals nationwide woefully oversee physicians, which is reflected in the number of facilities reporting to the National Practitioner Data Bank, a clearinghouse on disciplinary actions against doctors. Hospitals must report suspensions or revocations of doctors' privileges to state licensing boards and the Data Bank.

About half of hospitals nationwide had not submitted a single sanction since the Data Bank started in 1990, Public Citizen said in a 2009 report.

In Nevada, the absence of disciplinary reports was even more stark, with 58 percent of hospitals never reporting suspension or revocation of physicians' privileges, Public Citizen found.

(It is impossible to identify the reporting record for individual hospitals because of the confidentiality of the Data Bank, which is intended to prevent incompetent health care providers from moving from state to state without anyone knowing their history.)

Hospitals aren't the only ones failing in their oversight role, according to Wolfe. Doctors, who largely police themselves on hospital committees or through licensing boards, are violating the public trust, he said.

"They're not doing peer review and (are) thereby endangering patients," Wolfe said.

Several factors inhibit the disciplining of doctors. Hospitals don't want to turn away surgeons who can generate millions of dollars in revenue because they might take their business elsewhere, Wolfe said.

"The hospital doesn't want to curry disfavor with them by doing something that would be reportable to a databank," Wolfe said.

Hospitals' inability to discuss peer-reviewed cases also complicates the disciplinary process, said Dr. Jim Christensen, an allergist who has sat on the physician oversight committees of local hospitals and oversees the quality program at Spring Valley Hospital.

Peer review is confidential by law and doctors often work at several facilities, he said. So even hospitals owned by the same company aren't able to share findings of substandard care, he said.

The threat of litigation also discourages aggressive action, doctors told the Sun. It's easier, and common, to pressure the problem physicians into moving on without taking action against their privileges, said a doctor who has worked on several physician oversight committees. But that merely pushes the problem onto someone else — putting more patients at risk.

Confidential peer review also impedes the Medical Board, Cooper said. When the board receives a complaint about a doctor, it has no access to information uncovered by hospitals' peer reviews, he said.

The law that governs hospital credentials favors individual physicians, making it difficult to suspend those with problems, several doctors told the Sun.

"It is virtually impossible to get a physician kicked off a medical staff," said Dr. John Ruckdeschel, CEO of Nevada Cancer Institute.

Alex Richards contributed to this story.

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