Federal law requires that a hospital report to the National Practitioner Data Bank (NPDB) if it accepts a physician’s resignation of privileges while the physician is “under an investigation” relating to professional conduct or competence. Disagreements regarding what constitutes an “investigation” have led to litigation in the past. In the latest reported court decision, the First Circuit Federal Court of Appeals upheld HHS’ interpretation of “investigation.”  

Facts Of The Case  

The hospital privileges of the physician plaintiff in this case were temporarily suspended for allegedly threatening a nurse in the hospital. An ad hoc committee was appointed to investigate the allegations and reported to the Medical Executive Committee that the nurse’s allegations were well-founded. The MEC proposed to allow the plaintiff to resume practice at the hospital if he agreed to certain conditions, including proctoring and psychological evaluations. The physician rejected the MEC’s conditions and resigned his privileges.  

The Court’s Decision  

Both HHS (as part of its internal appeal process) and the court of appeals rejected the plaintiff’s argument that the “investigation” ended when the ad hoc committee presented its report to the MEC. Instead, the court upheld HHS’s decision that an investigation continues “until a health care entity makes a final decision or formally closes the probe, even if the entity is no longer gathering facts, but is merely deliberating about what course of action it will follow.” The court noted that the narrow definition of “investigation” proposed by the plaintiff would thwart congressional intent that information regarding serious disciplinary actions be available in the NPDB. If a hospital were to include in its medical staff bylaws an unreasonably narrow definition of “investigation,” the court stated it would not be bound by the hospital’s definition, but instead would attempt to enforce a logical and uniform definition of the term.  

Conclusion  

Proper interpretation of the term “investigation” is one of the ambiguities faced in deciding when a NPDB report is required. (Michigan’s reporting statute includes a similar standard for reporting medical staff matters to MDCH.) When faced with this issue, a hospital needs to be familiar with the relevant standards in the NPDB Guidebook and the handful of reported court decisions on point.