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February 16, 2000

The National Practitioner Data Bank and the Quality of Peer Review

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):886-887. doi:10.1001/jama.283.7.882

To the Editor: The article by Dr Baldwin and colleagues1 and the accompanying Editorial by Dr Brennan2 fail to note that in small hospitals where physicians wear many hats (peer review, credential committee, service chiefs), physicians must hide behind the curtain of confidentiality by either perjuring themselves or making credentialing a sham. As a member of a credentials committee, one is required to state that there is no knowledge of information that might have an adverse effect on the application. Since the board of trustees ultimately determines privileges based on recommendations of the credentials committee (whose decisions reflect administrative or peer review recommendations), withholding peer review information will reduce the reporting to the National Practitioner Data Bank (NPDB). This is particularly true when peer review involves retrospective evaluations over periods longer than 2 years. In such instances, a physician may be recredentialed twice without jeopardy and no reporting to the NPDB will occur.

The Health Care Quality Improvement (HCQI) Act is flawed and real-time reporting to the NPDB will not occur until it is amended. Quality oversight in the future must include changes in the HCQI Act so that physicians who are in small hospitals are not placed in the untenable position in which they now find themselves. Brennan knows that his statement, "As with all tort law, malpractice is intended to deter poor-quality care by fixing economic sanctions onto practitioners who injure patients as a result of negligence" is fallacious. Tort law is designed to improve the economic condition of those who practice it. The record speaks for itself.

Baldwin  LMHart  LGOshel  REFordyce  MACohen  RRosenblatt  RA Hospital peer review and the National Practitioner Data Bank: clinical privileges action reports.  JAMA. 1999;282:349-355.Google Scholar
Brennan  TA Hospital peer review and clinical privileges actions: to report or not report.  JAMA. 1999;282:381-382.Google Scholar