The Steep Decline in Reporting to the National Practioner Data Bank, and a Look at Reporting Levels from "Plaintiff-Favorable" and "Defendant-Favorable" States.

The establishment of the National Practitioner Data Bank (NPDB) was authorized in the Health Care Quality Improvement Act of 1986, and it mandated a federal database to collect information related to adverse actions initially against just physicians and dentists throughout the United States, including payments from malpractice lawsuits, restrictions on clinical privileges by hospitals, and medical licensure limitations and revocations by state licensing boards. The aggregate data reports made by this federal data bank began in 1991. The reporting level for the first ten years remained relatively stable in the nationwide range of 16,000 to 18,000 reports per year, but then a steady decline occurred over the second and third decades to under 8,000 reports per year by the year 2021. The researchers in this study explored a theory that might explain at least part of the drop in the states' reporting levels. That is, states that could be called "Plaintiff-Favorable" (Arizona, Kentucky, New York, Pennsylvania, and Washington) would demonstrate a lesser rate of decline or even an increase in the reporting levels, and states that could be characterized as "Defendant-Favorable" (California, Michigan, Nevada, North Carolina, and Texas) would demonstrate a comparatively greater rate of decline in the reporting levels. The decline in reporting to the NPDB proved fairly consistent for both Plaintiff-Favorable and Defendant-Favorable states. The larger question as to why there occurred an overall negative trend in reporting to the NPDB across the United States during the second and third decades remains an intriguing area for future exploration.

Retaliatory Termination of Physician Employment by Hospitals: The Case of Zelman versus Cape Cod Hospital.

A disturbing problem in the United States is that of illegal termination by hospitals of professional employees. Nurses, for example, have consistently decried poor staffing levels and, more recently in times of COVID-19, inadequate Personal Protective Equipment (PPE) that places both nurse and patient at high risk. For the most part, hospitals do little to correct these issues. The complaints have usually been kept "in house" and the nurses were expected to "stand down" once they'd complained. Physicians, who are now employees in growing numbers, have also filed formal complaints with professional associations, States' licensing authorities, and also with States Boards of Health. When this happens, it is not unusual to hear that the physicians who were in good standing and who filed the complaints have been dismissed from their employment even in cases where the physicians have been long term employees of hospitals. Terminated medical employees have sued their former employers. This paper examines the issue of employment of professionals by hospitals, in particular physicians, and causes for termination that are legal. The paper will also examine, by means of analyzing a current case (Zelman), the termination of employment of a physician that appears to be illegal/retaliatory. The paper concludes by demonstrating civil penalties that can attach to the successful proof of retaliatory termination by reviewing of some recent cases that are illuminating in their outcomes.

When Surgeons Are "Too Old" to Practice Surgery: Recommendations to Balance the Imperatives of Public Safety and Practical Necessity.

Few countries have legally set a maximum age for practicing surgery. This is difficult to sustain as surgeon shortages in many localities require hospitals to grant surgical privileges based on internal peer review systems. This approach is not without problems. Some hospitals and medical societies have developed competency assessment programs. Based on the literature and the experience of various jurisdictions, the authors recommend a policy approach that does not mandate a retirement age for surgeons, but rather a mandatory age of 65 at which surgeons shall be legally subject to periodic assessment of physical dexterity, eye/hand coordination, and cognitive skills.

Criminal Liability for Nursing and Medical Harm.

There is a ubiquitous problem with medical errors and the concomitant costs it brings in terms of human suffering and financial loss for patients, families, and caregivers. Professional caregivers, including physicians, nurses, and others who have made clinical errors normally will fall under the risk management and quality improvement policies of the organization at which they are employed and subsequent investigation and response occurs internally. Sometimes further consequences can entail the caregiver being named as a defendant or codefendant in a civil lawsuit, and sometimes the caregiver can have professional licensure restricted or even revoked. More rarely, a caregiver can be prosecuted in a criminal legal action. When criminal prosecution occurred, it was usually for purposeful wrongdoing such as fraud, diversion of drugs, or even the intentional or reckless killing of elderly or other vulnerable people. The recent criminal prosecution of a Tennessee nurse for the reckless series of mistakes that led to the death of a single patient opens new considerations for nurses, physicians, and all caregivers, along with hospitals and healthcare systems that employ and/or work with them. The "dynamic tension" of encouraging all caregivers to own up to mistakes with patients as quickly as possible in healthcare organizations seems to be especially challenged now by the Vaught decision. This was mitigated somewhat by a relatively lenient sentence ordered by the judge in this noteworthy case.

Telemedicine licensure in the United States: the need for a cooperative regional approach.

The extraordinary successes and refinement of modern telemedicine applications in recent years have been diminished somewhat by the anachronistic licensure laws of the 50 state jurisdictions that limit the practice of medicine to specific state geographic boundaries. This approach is deficient when applied to telemedicine because, with the advent of the Internet and modern technological advances, differences in space and time are rendered nearly meaningless. It is recommended in this paper that the practice of telemedicine be handled differently than the practice of face-to-face medicine, as related to licensure. Although it may be argued persuasively that a national licensure model for telemedicine should be advanced, the political and constitutional hurdles may be too great to overcome. It is therefore recommended that a voluntary, regional geographic approach be instituted by jurisdictions already demonstrating a commonality of interests, such as through the Southern Governors' Association or the Western Governors' Association. The benefits to be derived from this approach would include improving access to healthcare and medical specialists, enhancing the quality and timeliness of care, cutting medical costs by moving information instead of people, securing patients' access to medical records and information, and facilitating commercial export of American telemedicine services.

Robbing Peter to pay Paul: smarter re-allocation of dollars bring relief!

The dynamic tension facing health care organizations today is that of lower third-party payments and higher costs. The ever-present financial squeeze results in daily stressors for health care executives attempting to provide services with diminishing resources. How can one continue to "rob Peter to pay Paul," to make ends meet and stretch every dollar?