By Susan Levine
Washington Post Staff Writer
Thursday, December 28, 2006
D.C. patients will someday be able to go online to a city Web site and check their doctors' credentials and experience and whether they have lost malpractice suits or been disciplined.
Under legislation passed by the D.C. Council in its final session this year, District doctors, hospitals and health providers soon will be required to report "adverse medical events" to a centralized database being created by the city medical board, one of several measures that advocates say will help safeguard patients and improve care.
Doctors also will have 60 days to report judgments and settlements arising from malpractice allegations, as well as disciplinary actions imposed in another state. Health care providers will have to do the same for any doctors they employ, and that information, including criminal convictions, will become part of physician profiles the D.C. Board of Medicine plans to put online.
Maryland and Virginia have had such information available online for several years.
The requirements are among the most substantive revisions in more than 20 years to the law governing health occupations. The changes, which were not supported by the District's medical and hospital associations, seek to rectify long-standing criticisms about the board's lack of action against troubled physicians.
"It will take [the law] a light year ahead of where we were," said Health Department administrator Feseha Woldu, who supervises the licensing of health care professionals.
But critics are particularly concerned about its general description of an adverse event as "involving the medical care of a patient by a health care provider that results in death or an unanticipated injury to the patient." They consider it too vague.
"It's absolutely meaningless . . . so poorly defined," said K. Edward Shanbacker, executive vice president of the Medical Society of the District of Columbia, which opposed the final bill. "Physicians are going to have no idea what to report."
The D.C. Hospital Association withdrew an endorsement because of the adverse reporting requirement.
"We felt that it went too far," said association President Robert Malson. The provision covers individuals and institutions, from psychologists to pharmacists and nursing homes to dialysis centers.
The database must be established by July 1 within the Health Department, which is to analyze the events reported to identify patterns or trends, assist in corrective steps and publish an annual summary. It is unclear when the full catalogue of physician profiles will be available for public view online.
The medical board chairman says all of it will build on progress made since 2005, when a series in The Washington Post brought to a head the frustrations over what D.C. Council member David A. Catania (I-At Large) called a broken system. The articles reported that the medical board rarely disciplined troubled doctors and did not publicize punitive actions it did take.
"The speed of enforcement has increased and, I believe, the number of enforcements," said Frederick Finelli, a surgeon at Washington Hospital Center and chairman of the medical board.
In part, that is due to increased staffing and nearly $500,000 more in funding that Catania and other officials got through that year. The Medical Malpractice Amendment Act of 2006, which passed early this month, aims to ensure the board has adequate investigatory and legal assistance.
"The fact that the Board of Medicine worked at all has been a tribute to the people on it," Catania said after the act's unanimous passage on a voice vote. He minimized the medical and hospital groups' reactions, saying their members are adequately protected, and stressed the benefit to the public.
Some people believe the council could have taken even more steps.
"D.C. is still ranked way toward the bottom," said physician Sidney Wolfe, who directs Public Citizen's Health Research Group. From 2003 to 2005 the District took "serious actions" against the equivalent of 2.58 per 1,000 licensed doctors. That was a little less often than in Virginia, though more often than in Maryland. The top states, including Kentucky, Ohio and Arizona, had rates two to four times as great, Public Citizen's figures show.
Yet over the years, Wolfe has seen oversight boards in numerous states "that have gone from terrible to good." Armed with increased resources and information, the District's should, too, he said.
"There is no reason why D.C. shouldn't start disciplining more doctors," Wolfe said.
The legislation also provides for some regulation of malpractice insurance rates to help hold down excessive increases and requires 90-day notification and mediation in medical malpractice lawsuits.