Seriously Flawed Federal Database Subject of Intense Investigation: Many Sanctioned or Unlicensed Care Givers Missing.

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Some weeks back I wrote on a report of nurses crossing state lines to continue practicing medicine even though they had lost their licenses or had been disciplined in another jurisdiction.  This evening we get a report  done by ProPublica and the Los Angeles Times of a horribly defective database established by Congress in 1990 – Section 1921 of the Social Security Act – The Medicare and Medicaid Patient and Program Protection Act of 1987 as amended by the Omnibus Budget Reconciliation Act of 1990. 

In this investigative story, Dangerous Caregivers Missing From Federal Database – ProPublica, we get insight into a very broken national database system established to track incompentent care givers in the interest of public safety.  Here are some random samples provided by the reporters:

Numerous disciplinary records appear to be missing from a federal database. Indiana, for example, didn’t report hundreds of disciplinary actions in 2004 and 2005 – including the nearly 100 nurses who were indefinitely barred from caring for patients. In one case, a nurse had put a knife to a co-worker’s throat.

Some of the missing cases involve providers who have harmed patients – a nurse, for instance, whose license was pulled after she injected a patient with painkillers in a drugstore parking lot and improperly prescribed methadone to an addict who later died of an overdose.

The Act as amended was “designed to protect program beneficiaries from unfit health care practitioners . . . .  Section 1921 . . . requires each State to adopt a system of reporting to the Secretary of HHS certain adverse licensure actions taken against health care practitioners . . . and entities.  It also requires each State to report any negative actions or findings that a State licensing authority, peer review organization, or private accreditation entity has concluded against a health care practitioner or health care entity.”  (Quotation from The Federal Register, Thursday, January 28, 2010).

The implementation of this new rule, authorizing use of the national database, is to be effective March 1, 2010.  Perhaps this database is not quite ready for ‘prime time’ yet!

As the reporters for ProPublica and the LA Times point out, the reporting to the database over these past decades has been random and gravely flawed at best.  Numerous discrepancies have been found by a team of investigative reporters.  When state records of licensure actions have been cross-checked against this national database, shockingly numerous omissions of reporting are evident.  This has been brought to the attention of the government officials.  Here are some of their responses:

The omissions took federal health officials by surprise. Only last month, a spokesman for the agency that oversees the database told reporters that “no data is missing.” Another official said the agency had been “constantly” checking its data against state licensing board websites.

But Friday, the head of the Health Resources and Services Administration (HRSA) acknowledged that records were missing. She said her agency had launched a “full and complete” review to determine what is wrong and how to fix it.

“We take this very seriously,” administrator Mary Wakefield said.

The new information will still go online as planned – but with a warning that it is incomplete, she said.

Wakefield and Health and Human Services Secretary Kathleen Sebelius sent a letter Friday to the nation’s governors asking for their immediate help fixing gaps in the database [4]. It was a matter of “protecting the safety of patients across this country,” they wrote.

So, the question remains: how many more previously determined incompetent and dangerous health care providers are going to be rendering care while the government figures out who is missing from the database?  How long will it take the government to fill-in the void of information?  Maybe they should hire the investigators for ProPublica and the LA Times, who apparently have a lot better information that our federal government in its database.  Will there finally be significant penalties for states that fail to report as they should have been doing for years and years?  Where does this incompetence end?  When will public safety take some precedence? 

A law has been ‘on the books’ for two decades.  Only now we discover that it is defective at best.  Hopefully it will take less than two more decades for those who should be listed among the ‘dangerous caregivers’ to become included in this ‘book of shame’ database.

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