Six states may offer doctor profiles that include malpractice claims on Internet
Dr. Profiles on Internet
Six states are collaborating on a new effort to offer profiles of physicians over the Internet in what could eventually become a national clearinghouse for disciplinary actions and malpractice claims against individual doctors.
Following the launch of a physician profiling system in Massachusetts, medical licensing boards in Arizona, California, Iowa, North Carolina, Texas and Vermont plan in April to unveil "DocFinder" a centralized database accessible on the World Wide Web.
The joint effort is part of a new wave of physician profiling via the Internet or dial-up computer bulletin boards. Florida, New York and Maryland are among other states whose regulators are pursuing their own initiatives.
"Basically, what we want to be able to do is have people be as close as possible to their homes and to look up and print out as many profiles as they want for free," says Barbara Neuman, vice president of Administrators in Medicine (AIM), the national association for directors of state licensing and disciplinary boards. The service also would be useful to physicians, hospitals and licensing boards, she says.
AIM plans to roll out "DocFinder" officially at its annual meeting in California in April. The site is already accessible on the Internet at http://206.67.216.45. Three of the six pilot states already use the Web site to offer profiles on physicians, and in some cases, on allied health care professionals. The profiles include basic biographical information as well as the status of the practitioner’s license, the date the license was first granted, the license expiration date, the provider’s education and specialties, and disciplinary actions.
Ms. Neuman says consumers also deserve to know about malpractice cases and criminal convictions, although it remains unclear whether licensing boards in other states would eventually agree to disclose that information. Its release would require legislative approval in many states, she says.
States are finding that the greatest obstacles to the development of a physician profiling system include the costs of gathering and verifying data, and an uneasiness or outright opposition among physicians to the disclosure of medical malpractice claims, awards or settlements.
When Massachusetts began providing physician profiles, including malpractice information, over toll-free telephone lines in November, the Board of Registration in Medicine, which licenses 26,000 physicians and osteopaths, was overwhelmed with calls. Staff responded to more than 400 requests and processed more than 1,100 profiles a day at the program’s outset. Calls came from as far away as Tokyo.
The office had to double its telephone lines and staff to answer calls and mail or fax reports. To be sure, some of the early activity was believed to be pent-up demand and simple curiosity. Many doctors were requesting their own profiles.
But, as of mid January, the Board reported that activity had dropped to an average of about 245 calls and 386 profiles a day. Each caller can receive as many as 10 profiles free of charge.
"It’s calmed down to a dull roar instead of a roaring roar," says Alexander Fleming, the Board’s executive director. "We’re rather pleased with it." By statute, the Board cannot begin electronic distribution of physician profiles until May 1.
Malpractice data a concern
Physicians generally express support for the disclosure of general profiles, including disciplinary actions by state licensing boards, but they tend to object to the release of malpractice information. The American Medical Association says the disclosure of malpractice payments does not
necessarily tell consumers whether a doctor is good or bad. Some doctors with great bedside manner and plenty of low-risk patients may, in fact, be poorly qualified but never sued, an AMA official says.
"We’ve been very concerned about malpractice (claim disclosure) because the raw data doesn’t really give patients very much information," says Dr. Thomas Reardon, a general practitioner in Portland, OR., and vice chairman of AMA’s board of trustees. "Even the very best physician can have a lawsuit."
Disclosure of malpractice claims
Each Massachusetts’ profile includes a lengthy list of caveats about the malpractice information, including the statement: "Some studies have shown that there is no significant correlation between malpractice history and a doctor’s competence. At the same time, the Board believes that consumers should have access to malpractice information."
In Maryland, the Board of Physician Quality Assurance (BPQA) is taking a second look at its plan to include malpractice information in a direct dial-up physician profiling system. The Board has been holding hearings about its plan with consumers and the state’s medical society.
Although the Medical and Chirurgical Faculty of Maryland strenuously objected to disseminating malpractice information electronically, a recent legal opinion from the Maryland Office of the Attorney General says malpractice claims are public records and that the Board can disclose them electronically. Malpractice claims in Maryland are first filed with the state’s Health Claims Arbitration Office, which routinely forwards them the BPQA.
"The BPQA was not set up to shield physicians from access by the public to possibly derogatory public information," said the opinion, dated Jan. 30, from Carolyn Brennan Wescott, a staff attorney in the attorney general’s office.
Dr. Suresh Gupta, the BPQA’s chairman, says the licensing panel was looking to balance the public’s right to know with the disclosure of malpractice claims in a way that’s fair to physicians and useful to consumers.
Meanwhile, in Florida, the Agency of Health Care Administration (AHCA)
plans within weeks to begin releasing a quarterly "Consumer Medical Guide"
a 300-page document that will list physicians and osteopaths who:
• paid or settled three or more malpractice claims in the last five years;
• have been disciplined by a licensing board in the past five years;
• have been disciplined by a hospital or HMO in the last two years;
• have pending disciplinary complaints or emergency orders filed against them; or
• have no medical malpractice insurance, which is not required under Florida law.
For now , the reports will be available to anyone who asks for them, and also will be placed in public and state libraries and in 22 regional AHCA offices across the state, says Nina Bottcher. By spring, Ms. Bottcher says, the AHCA plans to build a Web site that discloses the same information.
Other health professionals
Some states are beginning to use the Internet to disclose disciplinary actions against not only doctors, but other allied health care professionals. On Jan. 31, New York began listing licensing and disciplinary information on more than 610,000 professionals in 38 regulated professions, including acupuncture, chiropractic, dentistry and dental hygiene, nursing, massage therapy, optometry, physical therapy, psychology and podiatry, among others. The web site is http://www.nysed.gov.
Last August, New York began posting to a separate Web site (http: //www.health.state.ny.us) on disciplinary actions but not malpractice claims against physicians and physician assistants, including the penalty and the nature of the misconduct.
Ms. Neuman, the AIM vice president, and other medical board officials say electronic profiling can save regulators time answering the phones and sending out information. But, they warn that collecting the information, verifying it and making it readily accessible from a database can take
extensive amount of work.
"It’s not a trivial task," says Douglas Laue, deputy director of the Medical Board of California, which regulates 110,000 doctors and other medical professionals, and is part of the six-state collaborative effort "And the more telling question is, what is the cost for ongoing maintenance."
—Bryan Pfeiffer
Contact Ms. Bottcher at 904-922-5871 or Mr. Compton at 410-764-4757.
Corrections and Clarifications
A page 1 headline last month, "Six states join forces to offer doctor profiles that include malpractice claims on Internet" overstated the case. While several states would like to include malpractice information, legislative approval would be required in many states first.
A page 7 article in our January issue, "NY gives community health centers more funds to protect safety net during hospital deregulation," reported that under the state’s law regulating mandatory Medicaid managed care, 25% of auto-assignments would go to community health centers in the first year. According to a trade group representing the health centers, they would end up with a substantial number of the auto-assignments, but other organizations would also qualify under the law. That percentage is gradually phased down in subsequent years.
Six states may offer doctor profiles that include malpractice claims on Internet
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