By MIKE McINTIRE and JACK DOLAN
This information Web-posted April 30, 2000

Congress created the National Practitioner Data Bank as part of the Health Care Quality Improvement Act of 1986. The goal was to create a system to flag problem doctors who move between hospitals or states. State licensing boards, hospitals, professional societies and malpractice payers are required to file a report each time a disciplinary action is taken or a malpractice payment is made affecting a physician or dentist. Only hospitals, HMOs, licensing boards and certain professional societies can use the data bank to check a physician's background. Civil and criminal penalties apply to unauthorized release or accessing of data bank information. The federal government says there has been no known leak of information from the data bank since it went online in September 1990.

The Courant obtained from the U.S. Department of Health and Human Services a 'public use file,' containing a censored version of the data bank's contents, with identifying information about individual practitioners removed. The file includes malpractice payment amounts and type; disciplinary action type and duration; year in which the payment or action occurred; the practitioner's rough age (40s, 50s, etc), decade of medical school graduation, and the states in which the practitioner is licensed, works and lives. For purposes of the public use file, the department assigns each practitioner a unique identification number in order to link multiple entries to the same individual. However, the ID numbers change with each quarterly update of the public use file, so it is not possible to use the ID's to track future additions to a physician's record.

By matching data on the unnamed doctors to public information about disciplined or sued physicians, it was possible to identify many of them. The Courant examined reports of licensure actions, court records or news archives in all 50 states, and conducted dozens of interviews with trial lawyers, patients and physicians. In addition to seeking comment by telephone or in person, The Courant sent certified letters to each doctor, informing them of the newspaper's findings and requesting comment.

The Courant focused its investigation on the less than one percent of physicians in the data bank who have 10 or more reports on file. To create a list of those who have paid the most in malpractice payments and have large numbers of data bank entries, the list was narrowed to include doctors who each had a minimum of 25 entries including at least one state licensure action--and $3 million in payments. Most malpractice payments represent separate acts of alleged negligence, although it is possible for more than one payment to involve the same patient.