Most physicians probably recognize that a hospital must report certain professional review actions adversely affecting a physician’s clinical privileges to the National Practitioner Data Bank (NPDB), which can have serious career consequences for a physician.  Physicians may not, however, realize that the recently updated Guidebook for the NPDB sometimes requires such a report be submitted merely because a physician is under investigation, a term that the update Guidebook defines expansively.

Specifically, the Guidebook requires eligible health care entities report acceptance of a physician’s or dentist’s surrender or restriction of clinical privileges while under investigation for possible professional incompetence or improper professional conduct, or in return for not conducting such an investigation or not taking a professional review action that otherwise would be required to be reported.  A reporting obligation is triggered even if the practitioner did not know about the ongoing investigation.

The new Guidebook interprets the word investigation “expansively.”  An investigation includes a formal, targeted process used when issues related to a specific practitioner’s professional conduct or competence are identified.  An investigation must be carried out by the health care entity (rather than an individual), must focus on and concern the professional competence and/or professional conduct of the practitioner in question, and should be the type of activity that is a precursor to a professional review action.  An investigation does not include a routine or general review of cases (i.e., a quality review of a department against clearly defined measures), or a routine review of a particular practitioner.  An investigation begins as soon as the health care entity begins an inquiry and does not end until the health care entity’s decision making authority takes a final action or makes a decision to not further pursue the matter.  In other words, an investigation is not limited to a health care entity’s gathering of facts or limited to the manner in which the term “investigation” is defined in a hospital’s by-laws.

If you have additional questions about the National Practitioner Data Bank, the Guidebook, privileges, peer review actions, or other legal matters involving health care law, please contact Luke Campbell at lcampbell@mpba.com or 206-682-7090.