Out of curiosity, I visited the National Practitioner Data Bank's (NPDB) website, and I found the "NPDB Summary Report" at
http://www.npdb-hipdb.hrsa.gov/resources/reports/NPDBSummaryReport.pdf
It is actually a good source of information.
The NPDB Summary Report starts by stating: "The following is a summary of reports submitted and accepted into the NPDB for each professional category. This data covers the period from September 1, 1990 through April 2, 2011. Professional categories which were not available for the entire time period are noted."
Then there is a "Data Disclaimer": Reports of adverse clinical privileges and professional society membership actions against practitioners other than physicians and dentists, (e.g., chiropractors, psychologists, podiatrists) are submitted voluntarily.
I pointed my attention then to the column "LICENSURE,CLINICAL PRIVILEGES, PROFESSIONAL SOCIETY MEMBERSHIP, AND PEER REVIEW ORGANIZATION REPORTS. I chose some categories just to have some idea as to how many individuals in which professions are subjected to that career assassination.
Dentists: 20,239
Nurse Midwife: 94
Nurse Practitioner: 921
Hospital Administrator: 0
Licensed Practical or Vocational Nurse: 78,421
Nurse Anesthetist: 337
Osteopathic Physician (DO): 8,129
Osteopathic Physician Intern/Resident (DO): 153
Physician (MD): 82,683
Physician Intern/Resident (MD): 588
So, the safest on that regards is to be a Hospital Administrator. Interesting. And, being a trainee resident or even an intern is no reason for mercy. Career destruction and elimination based on arbitrary criteria is just the way it is, no matter how junior or advanced in the career someone is.
Breakdown of MD by State, from highest to lowest number of physicians (MDs) whose careers, livelihood have been threatened with career capital punishment.
CA 10,019
NY 6,561
OH 4,414
TX 4,111
FL 3,885
IL 3,647
VA 3,411
PA 3,004
AZ 2,591
MI 2,525
NJ 2,481
GA 2,262
CO 2,088
MA 2,074
MD 2,025
WA 1,877
NC 1,832
KY 1,661
LA 1,399
MO 1,377
TN 1,299
AL 1,152
OR 1,116
IN 1,107
MN 1,021
OK 979
WV 972
SC 958
WI 936
IA 918
CT 897
MS 751
KS 748
NV 606
UT 565
AR 539
NM 523
ME 429
DC 393
NE 381
ND 376
NH 354
AK 343
RI 334
VT 296
ID 285
HI 278
WY 178
DE 164
SD 149
PR 44
Notice that these are raw numbers. To transform those into meaningful statistical values, in the very least I need a denominator. Actually deciding what the denominator should be is not easy. Is it the population of the state? The population of a certain age? The number of practicing MDs? If so, the current number of MD"s, realizing that the data cover from 1990 till 2011, so, which MD population would be used, etc.
Regardless, for someone to become a physician, one endures a lot that is well known to everyone. And not too many really would be willing to pursue that route if they know that more than 90,000 were kicked out. And they were not kicked out by an objective, fair or impartial process, but were eliminated and destroyed by a flawed process that is open for exploitation and abuse, executed by their peers and called the"peer review". There is nothing Holy about it.
Tuesday, May 31, 2011
Monday, May 23, 2011
Peer Review Reform (1) - Need objective criteria for Career Capital Punishment
All the discussions everywhere indicate that we have a very flawed medical peer review system that lacks so much that it could be more harmful than beneficial. Coupled with the National Practitioner Data Bank, the combination draws the picture of an unpredictable monster. Let's start thinking of reforming the process, and finally having a set of guidelines that can be promoted for a proposed solution.
First of all, I do not know if there is anyway any set of hospital bylaws, policies and procedures can strike the right balance between the interests of the public in being protected from the rare dangerous provider, and being fair and impartial to the provider. In fact, I do not think that any set of bylaws can be ganging-up proof. Let's face it, even when a hospital clearly breaches its own bylaws, it takes so much litigation, resources and time to seek remedy that the victim may become exhausted or ruined while justice is taking its slow-paced process time. The victim may succumb before any remedy. Then there will be appeals, counter-appeals. Essentially, even winning entails so much loss.
Therefore, my biggest idea for today is that a reform should set rules as to the exact conditions under which the extreme measure of restricting or diminishing a physician's privileges should be considered. That is my one focused idea for today. The subjective criteria do not work too well. For example, what could be not acceptable by the one medical staff in small hospital A (eg, for financial or reputation reasons) and portrayed as being a danger to the patients, may be very well a reasonable expectation of the average practice in hospital B. Hospital A may be essentially protecting its financial bottom-line by discouraging its providers from treating sicker patients (who normally would have higher incidence of complications by nature of their disease) under the disguise of quality and avoiding complications. So, hospital B should really not be bound by an adversarial decision against a physician whose privileges are revoked or reduced in Hospital A. Hospital B should be willing to accept that physician to practice, particularly he/she is willing to and is experienced in treating more complicated medical problems . But, the reality is that once Hospital A made their decision, and that is reported to the National Practioner Data Bank (NPDB), the regulators in Hospital B system (not the professionals aka physicians) may not even give that physician a chance to be considered. In essence, a physician's fault may not be what she/he did, but where that physician practiced. This is because really there are no critera as to when to apply the death penalty (career capital punishment) to a physician's career.
So, my plea is that the major career-destroying disciplinary actions must be considered as serious decisions and therefore there has to be clear and objective (not subjective) criteria before applying them to a certain physician as a last resort.
First of all, I do not know if there is anyway any set of hospital bylaws, policies and procedures can strike the right balance between the interests of the public in being protected from the rare dangerous provider, and being fair and impartial to the provider. In fact, I do not think that any set of bylaws can be ganging-up proof. Let's face it, even when a hospital clearly breaches its own bylaws, it takes so much litigation, resources and time to seek remedy that the victim may become exhausted or ruined while justice is taking its slow-paced process time. The victim may succumb before any remedy. Then there will be appeals, counter-appeals. Essentially, even winning entails so much loss.
Therefore, my biggest idea for today is that a reform should set rules as to the exact conditions under which the extreme measure of restricting or diminishing a physician's privileges should be considered. That is my one focused idea for today. The subjective criteria do not work too well. For example, what could be not acceptable by the one medical staff in small hospital A (eg, for financial or reputation reasons) and portrayed as being a danger to the patients, may be very well a reasonable expectation of the average practice in hospital B. Hospital A may be essentially protecting its financial bottom-line by discouraging its providers from treating sicker patients (who normally would have higher incidence of complications by nature of their disease) under the disguise of quality and avoiding complications. So, hospital B should really not be bound by an adversarial decision against a physician whose privileges are revoked or reduced in Hospital A. Hospital B should be willing to accept that physician to practice, particularly he/she is willing to and is experienced in treating more complicated medical problems . But, the reality is that once Hospital A made their decision, and that is reported to the National Practioner Data Bank (NPDB), the regulators in Hospital B system (not the professionals aka physicians) may not even give that physician a chance to be considered. In essence, a physician's fault may not be what she/he did, but where that physician practiced. This is because really there are no critera as to when to apply the death penalty (career capital punishment) to a physician's career.
So, my plea is that the major career-destroying disciplinary actions must be considered as serious decisions and therefore there has to be clear and objective (not subjective) criteria before applying them to a certain physician as a last resort.
Should Studying Law Be Mandatory for Physicians?
My understanding is that medical school is supposed to prepare medical students to be good doctors. That has translated to teaching basic sciences, clinical sciences and clinical applications of the knowledge. Also included is exposure to the healthcare system and its delivery, some medico-legal aspects, and medical ethics. That indeed has prepared generations of fine physicians to the challenges of clinical medicine, where the challenges Time has changed. The knowledge and skills taught in medical school do not give the prospective physician a clue as to many real challenges. Not the challenges that will intrigue the clinical abilities, but challenges that will threaten the career entirely. The environment of practicing medicine in the US is morbidly so highly litigated, that the legal aspects are making a very significant part of the mental energy, time and financial resources of physicians and their practices. I dare say that the MD or DO degree alone is not sufficient to be a good doctor. A good doctor has to be able to survive legally against many odds. I believe that extensive exposure to the law, even with a modified JD degree, would be the least that is necessary to bring some sanity. A disadvantage is that you will have doctors who know some of the law and may over-estimate their knowledge and legal capabilities, and get themselves in trouble. But, I think there will be a big advantage in knowing the basics, to be able to navigate some of the witch-hunts against doctors. Every doctor needs to learn law. But, in case their are legal issues, still retaining counsel is absolutely necessary. But, then, the physician will be a well-informed customer.
Another potential shortcoming is if the curriculum is designed to program the future physician to promote the current miserable state of affairs without actually preparing them for the real dangers (bad medical staff bylaws, lack of constitutional rights for physicians, etc). Therefore, the course needs to be carefully designed to prepare the student to practice in the jungle of healthcare in the US, and to give a strong sense as to which areas need reform.
Another potential shortcoming is if the curriculum is designed to program the future physician to promote the current miserable state of affairs without actually preparing them for the real dangers (bad medical staff bylaws, lack of constitutional rights for physicians, etc). Therefore, the course needs to be carefully designed to prepare the student to practice in the jungle of healthcare in the US, and to give a strong sense as to which areas need reform.
Thursday, May 19, 2011
Article: How Courts Protect Unjustified Hospital Peer Review Actions
I have recently read a very inetersting article that I wanted to share with you, and you can reach at: http://www.jpands.org/vol16no1/kadar.pdf
Published in the Journal of American Physicians and Surgeons - Volume 16 Number 1. Spring 2011.
How Courts Are Protecting Unjustified Peer Review Actions Against Physicians by Hospitals
The author: Nicholas Kadar, M.D., J.D.
"Nevertheless, courts have consistently misinterpreted the legal effect of HCQIA’s presumption of immunity as increasing the physician’s burden of proof, and as creating an almost insurmountable obstacle to prove that the hospital’s actions did not meet the standards of § 11112(a). For example, a panel of the Third Circuit, which included future Supreme Court Justice Samuel Alito, declared: “The HCQIA places a high burden on physicians to demonstrate that a professional review action should not be afforded immunity.” This is simply not true. A physician’s burden to rebut the presumption of immunity is the lowest known to the civil law -
For the full article, go to: http://www.jpands.org/vol16no1/kadar.pdf
Nicholas Kadar, M.D., J.D., LL.M. is a gynecologic oncologist and member of the New Jersey Bar.
Published in the Journal of American Physicians and Surgeons - Volume 16 Number 1. Spring 2011.
How Courts Are Protecting Unjustified Peer Review Actions Against Physicians by Hospitals
The author: Nicholas Kadar, M.D., J.D.
"Nevertheless, courts have consistently misinterpreted the legal effect of HCQIA’s presumption of immunity as increasing the physician’s burden of proof, and as creating an almost insurmountable obstacle to prove that the hospital’s actions did not meet the standards of § 11112(a). For example, a panel of the Third Circuit, which included future Supreme Court Justice Samuel Alito, declared: “The HCQIA places a high burden on physicians to demonstrate that a professional review action should not be afforded immunity.” This is simply not true. A physician’s burden to rebut the presumption of immunity is the lowest known to the civil law -
For the full article, go to: http://www.jpands.org/vol16no1/kadar.pdf
Nicholas Kadar, M.D., J.D., LL.M. is a gynecologic oncologist and member of the New Jersey Bar.
More Suicides Among Surgeons Aged 45 and Older
On April 4 I tweeted: Depression and suicide among physicians — Current Psychiatry Online http://t.co/yZ9q4Yk
Now a new article on the website of Physician's Weekly reports on a recent study from the Archives of Surgery.
The members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life.
“We know the lifetime risk of depression among physicians is similar to that of the general population, which suggests factors other than depression may be contributing to increased risk of suicide among physicians,” Tait D. Shanafelt, MD, tells Physician’s Weekly. “The influence of professional characteristics in forms of distress and depression, such as burnout, has been largely unexplored.”
Physician's Weekly reported that "According to Dr. Shanafelt, in addition to burnout, there appear to be occupational risks for having suicidal thoughts: A three-fold increased risk for suicidal thoughts was reported for surgeons who made a recent major medical error."
Now a new article on the website of Physician's Weekly reports on a recent study from the Archives of Surgery.
The members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life.
“We know the lifetime risk of depression among physicians is similar to that of the general population, which suggests factors other than depression may be contributing to increased risk of suicide among physicians,” Tait D. Shanafelt, MD, tells Physician’s Weekly. “The influence of professional characteristics in forms of distress and depression, such as burnout, has been largely unexplored.”
Physician's Weekly reported that "According to Dr. Shanafelt, in addition to burnout, there appear to be occupational risks for having suicidal thoughts: A three-fold increased risk for suicidal thoughts was reported for surgeons who made a recent major medical error."
Saturday, May 14, 2011
Rules of Commenting on Shammed Doc Blog
I am receiving comments that I need to moderate, in order to publish in my blog comments' section. I value everyone's input and am particulary grateful for the interest in my blog and taking the time to comment. I think this is time for me to make some observations. Also, I thought I should post some general rules for comments, which will keep evolving as time goes by:
Preamble: I am not a member of, I am not affiliated with, and I am not friends with, any , society, center, association, or organization. The only reason I publish here articles that are authored by others who belong to societies, centers, or organizations is that I found the content to be worthwhile, and adding value to the readership.
Using the "Blogger" platform, I cannot edit a comment before publishing. A comment has to be rejected in its entirity if only one sentence does not conform. A comment that is rejected will have to be re-submitted after complying with the rules and spirit if the interested individual desires to do so.
1. The "Comments"section is meant to educate and increase awareness with the issue of the abuse of the current hospital peer review system, provisions, and immunity afforded.
2. The "Comments" section would achieve the above through being an open forum for discussions focused on this issue, with freedom to be anonymous if needed.
3. The blog, and the "Comments" section, are not to be exploited to advertise any business, whether directly or by making claims of achievements or favorable results in helping peer review victims. If any entity has solid data to publish, including substantiating their own claims of achieving results in helping peer review victims, I am always looking for value content and will be willing to publish those data only if they meet a high standard of credibility and only under the full responsibility of the person who authors the article or data. The Shammed Doc blog is not a platform for advertising, even under the name of helping shammed peer review victims.
4. Any personal attacks against any individual person will lead to an automatic rejection of a comment. This does not limit whatsoever the pure discussion of ideas, thoughts, concepts and innovative approaches.
Enforcing the above rules for posting on the "Comments" section will start immediately with the new submissions which I will review, and I apologize in advance for any rejected comment. All comments have great elements in them, but it is the elements that violate those common sense rules that lead to rejection of an entire comment. When I have the time, I will go back in retrospect and remove any previous comments that do not follow the same rules.
I have quoted articles from elsewhere and other websites. I have also posted articles that were submitted to me and the author was given a limited privilege of being a guest for that one submission. I am not affiliated with, nor am I a member of any organization, society, center, support group, or any similar entity, that is connected with any of those whose articles have been posted on my blog. I do not have any "friendship" (even if on facebook every connection is called "friend") with any member of those entities. I am not a member of the Center for Peer Review Justice, the Semmelweis Society, the Alliance for Patient Safety , AAPS (Association of American Physicians and Surgeons), or of any society whatsoever, nor am I known to any member of those or any other societies or individuals. I do not support any causes or values advocated by any of those entities to any extent beyond the limited scope of the peer review process and closely related topics.
Preamble: I am not a member of, I am not affiliated with, and I am not friends with, any , society, center, association, or organization. The only reason I publish here articles that are authored by others who belong to societies, centers, or organizations is that I found the content to be worthwhile, and adding value to the readership.
Using the "Blogger" platform, I cannot edit a comment before publishing. A comment has to be rejected in its entirity if only one sentence does not conform. A comment that is rejected will have to be re-submitted after complying with the rules and spirit if the interested individual desires to do so.
1. The "Comments"section is meant to educate and increase awareness with the issue of the abuse of the current hospital peer review system, provisions, and immunity afforded.
2. The "Comments" section would achieve the above through being an open forum for discussions focused on this issue, with freedom to be anonymous if needed.
3. The blog, and the "Comments" section, are not to be exploited to advertise any business, whether directly or by making claims of achievements or favorable results in helping peer review victims. If any entity has solid data to publish, including substantiating their own claims of achieving results in helping peer review victims, I am always looking for value content and will be willing to publish those data only if they meet a high standard of credibility and only under the full responsibility of the person who authors the article or data. The Shammed Doc blog is not a platform for advertising, even under the name of helping shammed peer review victims.
4. Any personal attacks against any individual person will lead to an automatic rejection of a comment. This does not limit whatsoever the pure discussion of ideas, thoughts, concepts and innovative approaches.
Enforcing the above rules for posting on the "Comments" section will start immediately with the new submissions which I will review, and I apologize in advance for any rejected comment. All comments have great elements in them, but it is the elements that violate those common sense rules that lead to rejection of an entire comment. When I have the time, I will go back in retrospect and remove any previous comments that do not follow the same rules.
I have quoted articles from elsewhere and other websites. I have also posted articles that were submitted to me and the author was given a limited privilege of being a guest for that one submission. I am not affiliated with, nor am I a member of any organization, society, center, support group, or any similar entity, that is connected with any of those whose articles have been posted on my blog. I do not have any "friendship" (even if on facebook every connection is called "friend") with any member of those entities. I am not a member of the Center for Peer Review Justice, the Semmelweis Society, the Alliance for Patient Safety , AAPS (Association of American Physicians and Surgeons), or of any society whatsoever, nor am I known to any member of those or any other societies or individuals. I do not support any causes or values advocated by any of those entities to any extent beyond the limited scope of the peer review process and closely related topics.
Saturday, May 7, 2011
So What Is a Sham Peer Review? A MedGenMed Article
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681729/
History
This immunity has been abused by hospitals and physicians to harm “disruptive” physicians (ie, whistleblowers) or financial competitors. All one must say is: “Dr. Joe Blow is a bad doctor, which is my professional opinion in this peer review, and this hospital should get rid of him.” And poof! Dr. Joe Blow, patient advocate, financial competitor, is gone! And the accusing physician is immune!
A wonderful series has recently been written by Steve Twedt of the Pittsburgh Post-Gazette called the “Cost of Courage,” detailing a number of physicians who have suffered from sham peer review and the consequences they have had to pay (http://www.post-gazette.com/pg/03299/234499.stm).
So What Is a Sham Peer Review?
Roland Chalifoux, Jr, private practice; West Virginia School of Osteopathic Medicine.
History
One of the first notable sham peer reviews took place in Oregon in the early 1980s. The physician who took it up with the courts was Dr. Patrick, and the Supreme Court ruled in his favor. As a result of the publicity surrounding this case, the Healthcare Quality Improvement Act (HCQIA) was enacted in 1986. One of the concerns that arose from the Patrick case was a fear that no physician would want to participate in peer review if he or she could be potentially liable for a bad report. The HCQIA gave immunity to hospitals and reviewers participating in peer review.
This immunity has been abused by hospitals and physicians to harm “disruptive” physicians (ie, whistleblowers) or financial competitors. All one must say is: “Dr. Joe Blow is a bad doctor, which is my professional opinion in this peer review, and this hospital should get rid of him.” And poof! Dr. Joe Blow, patient advocate, financial competitor, is gone! And the accusing physician is immune!
A wonderful series has recently been written by Steve Twedt of the Pittsburgh Post-Gazette called the “Cost of Courage,” detailing a number of physicians who have suffered from sham peer review and the consequences they have had to pay (http://www.post-gazette.com/pg/03299/234499.stm).
So What Is a Sham Peer Review?
A sham peer review exists when a practitioner undergoes chart review during which “serious” deficiencies are determined to exist and, therefore, “the practitioner must be prevented from being a risk to the public safety.” This conclusion is obtained by either:
- Declaring that the practitioner does not practice within the guidelines of the standard of care – regardless of whether that is true. (Several examples include the panel rejecting literature to support a position and being told, “We don't care what the literature shows” and “That institution doesn't know what they are doing.” In essence, a new standard of care is established – because that is not what the victim does.)
- Commissioning an outside review with prearranged outcomes. There are peer-review firms with dubious reputations who will perform a review that reflects the desired outcome of the employer.
For the full text of this article, go to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681729/
MedGenMed. 2005; 7(4): 47.
Published online 2005 November 15.
Copyright ©2005 Medscape
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