Effective March 1, 2010, the Code of Federal Regulations has been amended to substantially broaden the scope of information reported to the National Practitioner Data Bank (“NPDB”) by state licensing boards.

Under the prior version of 45 CFR Part 60, only licensure actions taken by Boards of Medical Examiners against physicians or dentists were reported to the NPDB. Under the new, expanded regulations, disciplinary actions taken by professional boards against all healthcare practitioners will be reported.  

Moreover, negative findings by Peer Review Organizations (“PRO”) and Private Accreditation Organizations (such as The Joint Commission), against both healthcare practitioners and hospitals and other facilities, will now be reported to the NPDB.  

Background

Healthcare providers and facilities in New Jersey and Pennsylvania are painfully aware of the infamous case of nurse/serial killer Charles Cullen who worked at a series of hospitals and nursing homes before his murderous conduct was brought to light. His case led to New Jersey’s passing of the Health Care Professional Responsibility and Reporting Enhancement Act, N.J.S.A. 26:2H-12.2b (the “NJ Reporting Enhancement Act”), which expanded the reporting obligations of New Jersey healthcare facilities (such as hospitals, long-term care facilities, and home health agencies) to report misconduct by healthcare practitioners (such as physicians, nurses, and physical therapists). However, unlike the broad requirements of the NJ Reporting Enhancement Act, the scope of reporting requirements under the NPDB was limited.

Therefore, it was difficult to obtain information regarding healthcare practitioners who were not doctors or dentists. Absent self-disclosure by the practitioner, it may have been difficult for a healthcare facility/employer to determine all of the states where the practitioner had worked and to obtain pertinent background information.

The NPDB regulatory amendments begin to remedy this problem by centralizing adverse information regarding healthcare practitioners issued by state licensing authorities, PROs, and Private Accreditation Organizations.

However, even after the new NPDB amendments, healthcare facilities and entities (such as hospitals) are still not required to report disciplinary actions taken against healthcare practitioners who are not doctors or dentists, thus leaving such reports to the discretion of the facilities. See 45 CFR § 60.9(a)(2).

Background Checks/Hiring

The new regulations improve the ability of healthcare facilities to conduct background checks on potential employees. Hospitals will be able to query the NPDB and obtain information on a wide array of medical professionals such as pharmacists, physician assistants and nurses. As more information is reported, this should improve the ability of healthcare facilities to screen out undesirable applicants.

On the other side of the coin, in medical malpractice cases and other litigation, the expanded information available via query to the NPDB will make it more difficult for a hospital to argue that it was ignorant of an employee’s checkered past in a distant state.

Thus, healthcare facilities should now make it a practice to conduct a NPDB query on applicants for all professional positions (not just doctors and dentists).

Reports by PROs and Accreditation Organizations

The stakes have been raised somewhat in reviews by PROs and Accreditation Organizations. These organizations will now have to report to the NPDB negative findings that they make against individual healthcare practitioners, as well as hospitals and other facilities.

The national exposure of such negative findings could dramatically effect the reputations of healthcare facilities and practitioners alike. Thus, proper preparation for interaction with PRO and Accreditation Organizations is more essential than ever.

Ensuring Accurate Information Via Self-Queries

With more sources reporting more information to the NPDB than ever before, it is advisable for hospitals and practitioners to periodically self-query the NPDB to ensure that any information reported therein is accurate, as well as to ensure that it is aware of any new information. Much like a consumer is urged to annually monitor his or her credit report to make sure it is accurate, so too should hosptials monitor the NPDB for new information regarding the institution and its employees.