Journalism groups protest HRSA restrictions to Sebelius

The Association of Health Care Journalists and six other journalism organizations on Thursday formally protested the Obama administration’s new restrictions on access to the republished Public Use File of the National Practitioner Data Bank.

In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, the groups said that the new restrictions “are ill-advised, unenforceable and probably unconstitutional. Restricting how reporters use public data is an attempt at prior restraint.”

The Health Resources and Services Administration removed the Public Use File of the data bank from its website in September after a complaint from a doctor who complained information on him was used inappropriately. The agency republished the data on Wednesday but put in place restrictions on how the data could be used.

Among the restrictions is a provision that bars users from matching data in the Public Use File with other data sources to identify physicians. If journalists or others are found to have violated the provision, they could be required to return the data and be barred from receiving it in the future.

An excerpt from the letter:

This puts journalists in an untenable position. How can reporters who use the file prove that their identification of a troubled doctor was independent of the Public Use File? If reporters identify doctors in their stories and also have had access to the file, would HRSA ask to see their notes, talk to their sources, confirm that their facts came from other records and not the data bank?

In addition to AHCJ, the letter is signed by the Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press, the National Freedom of Information Coalition and the National Conference of Editorial Writers.

The editorial writers group has recently joined the coalition of media organizations seeking a return of the Public Use File as it was available before September – without restrictions.

Former Practitioner Data Banks official says HRSA ‘erroneously interpreting the law’

A former federal official criticized a decision by the U.S. Health Resources and Services Administration for removing the Public Use File of the National Practitioner Data Bank from the agency’s website – a major development as journalism groups fight to restore access to the important tool.

Robert Oshel, who created the Public Use File in the mid-1990s and managed it until his retirement in 2008, said in a statement released to the Association of Health Care Journalists on Sunday that HRSA is “erroneously interpreting the law” governing the data bank.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

HRSA officials removed the public file from the data bank website last month because a spokesman said they believe it was used to identify physicians inappropriately.

But in his letter to AHCJ, Oshel said HRSA officials have confused the requirements of the law.

“HRSA’s current management seems to confuse the law’s requirement that a public data file not permit use of its records to identify individual practitioners with a very different requirement, and one not in the law: that the file not allow the records of previously identified practitioners to be identified in the file,” Oshel wrote.

Oshel further wrote that HRSA’s view will “seriously hinder use of the file for important public policy research.”

“For example, it will be impossible to identify state licensing boards which are not taking action to protect the public from physicians with records of repeated malpractice payments and serious sanctions against their hospital clinical privileges based on the quality of their care or their behavior,” he wrote.

As he notes in his letter, Oshel served as associate director for research and disputes for HRSA’s Division of Practitioner Data Banks, which operates the National Practitioner Data Bank, from 1997 *(updated) until his retirement in 2008. Among other duties, he personally designed the Data Bank’s Public Use File in about 1995 and oversaw its development and quarterly updating.

AHCJ President Charles Ornstein said Oshel’s letter reaffirmed what AHCJ and five other journalism groups are fighting for. He said the Public Use File has been a vital tool for journalists writing about insufficient oversight of physicians in their states. Without such articles, some unsafe doctors would very likely continue to be practicing with clean licenses and patient protection legislation in several states likely would not have been enacted.

“It is abundantly clear that HRSA made a mistake in taking the Public Use File offline, putting physicians’ interests ahead of patient safety,” Ornstein said. “With Robert Oshel’s detailed statement, we call on HRSA and HHS Secretary Kathleen Sebelius to make the right decision and restore access to the public version immediately.”

In his letter, Oshel also criticized the process that HRSA introduced as an interim way for reporters and researchers to request data from the data bank. To get information, individuals must disclose the focus of their work and HRSA officials must approve – or reject the request. If the request is granted, HRSA officials will be the arbiters of what data fields an individual needs to complete the research.

“I believe HRSA’s current policy is contrary to the law,” he wrote.

* There was a typo in the date in an earlier version of this post.

Earlier coverage

• AHCJ, other journalism organizations protest removal of data from public website
• Journalism organizations offer data government blocked from public
• More journalism groups join effort to restore access to National Practitioner Data Bank
• Agency declines to restore public data
• Journalists turn to Sebelius for access to National Practitioner Data Bank file

Journalists turn to Sebelius for access to National Practitioner Data Bank file

The Association of Health Care Journalists and five other journalism groups appealed to Health and Human Services Secretary Kathleen Sebelius to intervene in the dispute over the Public Use File of the National Practitioner Data Bank and restore access to this important data tool.

AHCJ was joined in its letter to Sebelius by Investigative Reporters and Editors, the Society of Professional Journalists, the National Association of Science Writers, the Reporters Committee for Freedom of the Press and the National Freedom of Information Coalition. The groups have more than 15,000 members.

The U.S. Health Resources and Services Administration removed the Public Use File (PUF) from the data bank website earlier this month because officials believe it was used to identify physicians inappropriately.

The National Practitioner Data Bank is a confidential system that compiles malpractice payouts, hospital discipline and regulatory sanctions against doctors and other health professionals. For years, HRSA has made a public version of it available without identifying information about the health providers.

The groups took issue with a letter written last week by HRSA administrator Mary Wakefield, in which she defended the decision to remove the Public Use File from the agency’s website.

“We believe the stance taken by administrator Wakefield and HRSA staff is overly restrictive based on the law governing the data bank. We do not dispute that federal law precludes the administration from sharing confidential information from data bank reports, including the person being reported and the institution filing the report. We disagree with HRSA that the Public Use File, removed from the web earlier this month, did this.”

The letter also criticized HRSA’s research protocol under which reporters can now request data from the data bank as intrusive and unfair. The agency’s new web page about the Public Use File and how to make requests for data says: “At this time, a researcher must provide a proposal (including table shells) for their need of data. DPDB will review the request and approve or deny the request for data. DPDB will provide only the variables needed to complete the research.”

“We find it troubling that a federal agency now wants to judge the quality of reporters’ stories and make individual decisions about which one is worthy –perhaps putting officials in the position of denying requests that may make HRSA or the data bank look poor,” the letter said. “We don’t see any provisions in the act governing the data bank that gives HRSA the authority to deny research data as long as it doesn’t identify individuals.”

The groups said they stood ready to meet with Sebelius and work with her on a solution that will provide continued access to the Public Use File.

“Reporters have exposed dangerous lapses in oversight by state medical boards, prompting legislation to increase transparency and improve patient protections,” the letter said. “We hope you will agree that this is a matter of public concern and that you will urge HRSA to change course and immediately restore the Public Use File of the data bank.”

The letter to Sebelius followed a request for assistance to members of Congress last week.

HHS releases guidelines for handling media requests

The U.S. Department of Health and Human Services has adopted a set of guidelines on how it will provide information to the media. The guidelines reaffirm that employees’ contacts with the media must be cleared by a public affairs office, but call on media officials to respond promptly and accurately.

AHCJ had no part in writing the guidelines but had pushed for a media policy that would promote consistency among all HHS agencies and allow reporters to know the ground rules.

Although the guidelines are in force, Richard Sorian, HHS assistant secretary for public affairs, called them a “living document” and said he welcomed feedback.

AHCJ members are encouraged to read the six-page document and share their thoughts with Felice Freyer, Right to Know Committee chair at felice.freyer@cox.net.

Among the key features are:

• An emphasis on timely response and respect for reporters’ deadlines
• Putting bloggers on equal footing with mainstream journalists
• Encouraging, but not requiring, HHS employees to consent to interviews
• Requiring that employees arrange such interviews through media offices
• Allowing employees who speak at conferences or other public events to answer reporters’ questions at that time
• Specifying that “media interviews should be on-the-record and attributable to the person speaking to the media representative, unless an alternate attribution arrangement is mutually agreed upon in advance.”

Although employees are required to arrange their contacts with the media through the public affairs offices, they do not need to seek approval for scientific, technical or policy articles or commentaries written for peer-reviewed journals.

The guidelines also extend to all HHS agencies the policy on embargoes recently adopted by the Food and Drug Administration. That policy permits reporters to share embargoed materials with sources, provided the sources promise to honor the embargo.

The guidelines do not state whether a media representative must or should listen in on interviews with HHS employees. They also do not address whether reporters from large and small media outlets should be treated equally.

Sorian released the new guidelines Wednesday, after the second quarterly phone conversation between AHCJ and HHS public affairs officers. Freyer and AHCJ President Charles Ornstein spoke with Sorian and others as part of a continuing effort to improve HHS responsiveness to reporters’ requests for information.

Asked whether reporters would ever be allowed to contact and interview federal employees on their own, Sorian said that HHS has no plans to change the policy requiring interview requests to be cleared by a public affairs office. But he emphasized that public affairs officers are supposed to be helpful and should not “shape the interview.” If a reporter feels that press officer has been heavy handed, “we definitely want to hear about that,” he said. Sorian can be reached at Richard.Sorian@hhs.gov.

Journalism organizations offer data government blocked from public

Another development in the protest by three key journalism groups to the Obama administration’s decision to block public access to a public database of physician discipline and malpractice: Now, Investigative Reporters and Editors, working with the Association of Health Care Journalists and the Society of Professional Journalists, has posted the data for download, free to the public.

The data are posted for the entire U.S. in the original text format with documentation. IRE has also made available state-by-state Excel spreadsheet files.

On Thursday, the groups sent a letter protesting the decision to pull offline a the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

The public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

“We applaud IRE for making this data available for free to the media, researchers and the public,” said Charles Ornstein, AHCJ’s president. “While the government has decided that this ‘public use file’ should no longer be public, our organizations believe that it continues to be a critical resource. I encourage reporters, even those who have never used it before, to look for stories within it now.”

Journalists have used the data for years to draw attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and The Kansas City Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

The U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

Several news outlets - The New York Times, Los Angeles Times, Reuters and the St. Louis Post-Dispatch - are following the story.

AHCJ, other journalism organizations protest removal of data from public website

The Association of Health Care Journalists, joined by the Society of Professional Journalists and Investigative Reporters and Editors, sent a letter to the Obama administration today protesting its decision to pull offline a public database of physician discipline and malpractice payments.

AHCJ, SPJ and IRE called for the government to immediately restore access to the Public Use File of the National Practitioner Data Bank. The government has made this file available online for years, and reporters have used it to call attention to lax oversight of physicians across the country.

Pursuant to the law, the public version of the database does not identify physicians by name or address, but it does provide other useful information about hospital sanctions, malpractice payouts and state disciplinary actions against every doctor in the country.

As an example, the database would allow a reporter or researcher to discover that certain, unnamed physicians have been sanctioned repeatedly by their hospitals but never were disciplined by their state’s medical board. It would also be possible to find doctors with lengthy trails of malpractice who continued to enjoy clear licenses.

The groups also expressed their deep disappointment that the U.S. Health Resources and Services Administration threatened a reporter from The Kansas City Star with financial penalties if he proceeded to write a story about a local neurosurgeon using information he gleaned from the public version of the database on the agency’s website. The newspaper published its story anyway on Sept. 4. The doctor’s attorney complained to the agency, prompting officials to remove the database from its website on Sept. 1.

The government said that it had to act now because reporters were able to link information in the data bank to specific doctors, and the law prohibits the public use file from identifying doctors. A HRSA spokesman said the data bank will be offline for at least six months and may never return unless the physician privacy concerns are adequately addressed.

AHCJ President Charles Ornstein said he was puzzled by HRSA’s sudden action because reporters have used the public version of the data bank for years to assist in their reporting and learn additional details about physicians they already had been researching.

“We are troubled that the Obama administration appears to have placed the interests of physicians ahead of the safety of patients,” Ornstein said. “Attempting to intimidate a reporter from using information on a government website is a serious abuse of power.”

Stories written by reporters using the public version of the National Practitioner Data Bank have drawn attention to troubled physicians and state inaction. Recent examples include the St. Louis Post Dispatch, the Duluth (Minn) News-Tribune and the Star. Other examples over the years have included The Hartford (Conn.) Courant and the Raleigh, N.C., News & Observer.

Some of these stories have resulted in new legislation and other steps that protect patients, by increasing transparency and sometimes toughening requirements on doctors.

The groups wrote that if HRSA determines the public version of the database violates the law in any way, it should seek swift legislative changes to remedy the problem and once again make the database available.

“In one stroke, the very administration that promised greater transparency not only excludes information of obvious public value to patients across this country but threatens legal action against a reporter for using public records,” said SPJ President Hagit Limor. “This is clearly outrageous.”

IRE President Manny Garcia said, “The removal of the Public Use File - whose very name means for public use - eliminates a valuable tool for journalists whose goal is to educate and protect the public. This database has allowed reporters to uncover flaws that have toughened legislation, and without a doubt, saved the lives of patients across the country.

“We are also stunned that a public servant has the hubris to threaten a health care reporter for doing his job. HRSA should be delighted that journalists are using public information to help saves lives, but in this instance the response is: get lost or get fined.”

Follow up on $95 million just awarded to school-based clinics

Periodically, I get an email or press release from a well-intentioned organization telling me why I should be writing about school-based clinics, and I make a mental note to myself or file the email and say, yes, this is something I don’t know that much about, and there’s probably a good story – or stories – there, including how the clinics will be affected by health reform.

Well, this week I (and many of you) got a press release from the Department of Health and Human Services telling me quite a bit about funding for school clinics and health reform.  Before I tuck it away or put it on the never-ending “to do” list, it’s worth sharing some thoughts and some resources.

First of all, school-based clinics are not the same thing as the “school nurse” some of us remember – the lady (and it was a lady in those days) who kept us company when we ran a fever or had a tummy ache and were waiting for our mom (and it was mom in those days) to pick us up, take us home, and tuck us in. These school-based clinics are where about 790,000 patients get their health care – sometimes including dental care. The $95 million in awards announced this week (July 14) will allow for a 50 percent expansion to cover another 440,000 patients.

Here’s the list of clinics getting the grants. For more details, here’s the HHS press release and background from the Health Resources and Services Administration, an under recognized federal health agency. The HRSA page includes a link to an eight-page national school clinic census that provides a lot more detail on what services are offered in what setting and to what populations).

As usual, there are politics and funding fights. As Jane Norman of CQHealthbeat reported, the new grants go for the physical plant – not for medical care itself. The law allows for Congress to also appropriate money for care and operating expenses, but Congress hasn’t done so, given the current budget pressures. Republicans have backed repealing the clinic expansion, saying there isn’t money right now. HHS says the clinics getting the new expansion funding, however, have to show they have a way of paying for the other clinic expenses.

If someone has reported on these clinics, or seen good stories, please comment and share the links below. But some of the questions I’d ask of any clinic, in the context of health reform, would include:

• How early do they open and how late do they close? (i.e. how easy is it for working parents to stop by the clinics?)
• What kind of wellness programs and preventive care do they offer? What is their approach to childhood obesity?
• Are those that serve adolescents getting caught up in any of the abortion/abstinence/contraceptive politics?  (HRSA has some data on how many clinics offer some of these services to teens.)
• What kind of outreach are they doing for immunization?
• What kind of relationship do they have with other health providers in the community, including specialists? As regions and communities develop interoperable health information technology, are the school-based clinics linked in?
• Who are the health care providers - doctors, nurses, nurse practitioners? Do state laws allow them to practice “at the top of their license” or are they unable to fully use their training? Is there a move underway to change that?
• How do they care for young people with chronic diseases (asthma, diabetes, etc) and how does this compare to the sometimes fragmented and uncoordinated care people get elsewhere? Are they keeping their patients well enough to avoid unnecessary emergency room visits (and how solid is the data they have to support that?)
• How do they integrate primary care and mental health care? (The clinics also do some substance abuse counseling, I do not know how or where they refer for further treatment or counseling or what kind of follow up they can provide.)
• What role do they anticipate in 2014, when more people have access to health insurance and Medicaid?
• All these questions, I suppose, could add up to one bigger question. Can we think of school-based clinics as medical homes? And if so, what can we learn from them?

Related

A panel at the 2007 Urban Health Journalism Workshop explained school health programs, while a field trip at the 2008 Urban Health Journalism Workshop allowed journalists to visit school-based clinics.

AHCJ gets contact list of senior HHS media officials

AHCJ now has an up-to-date list of the senior media officials at each division of the U.S. Department of Health and Human Services.

These are the people reporters should contact when they are not getting meaningful and timely responses from lower-level media officials. If your deadline is approaching and you still don’t have what you need, call a contact on this list.

The HHS public affairs office provided the names, email addresses and direct phone lines in response to AHCJ’s continuing efforts to improve reporters’ access to information from the federal government.

The list includes agencies that reporters frequently contact, such as the Centers for Disease Control and Prevention, the Center for Medicare and Medicaid Services and the Food and Drug Administration.

Richard Sorian, HHS assistant secretary for public affairs, provided the list after a conference call last week between AHCJ and four members of the public affairs office. The call – which included Charles Ornstein, AHCJ president, and Felice Freyer, chair of AHCJ’s Right to Know Committee – was the first of what are expected to be quarterly conversations between AHCJ and Sorian’s office. It followed an in-person meeting in March in Washington, D.C.

During the call, Freyer summarized a few examples of recent unsuccessful efforts to get information from HHS agencies, drawn from information provided by AHCJ members. Sorian asked for written descriptions, saying he hoped to improve responsiveness.

Sorian’s interest in those anecdotes demonstrates the importance of providing specific examples as we work for better access. Please keep them coming to felice.freyer@cox.net. Write as soon as an incident occurs, while memory is fresh and emails still handy.

“We’re grateful that Richard Sorian and his staff are willing to work with us,” Ornstein said. “With this line of communication now open, we hope that in time AHCJ members will see an improvement.”

Related

• U.S. Department of Health & Human Services News Media Contacts, June 2011

HHS unveils ‘National Prevention Strategy’

Today, in a live webinar and a companion piece in the New England Journal of Medicine, the Department of Health and Human Services released its “National Prevention Strategy,” a broad effort to realize the preventive care goals set forth in the Affordable Care Act. The specifics of implementation are still taking shape, but the release centered around four primary talking points:

• The ACA seeks to “remove cost as a barrier” to “clinical preventive services,” by requiring new private plans to cover preventive services in the “strongly recommended” and “recommended” categories (examples include certain vaccines and screening procedures) with no cost to the beneficiary. Medicare will take a similar approach, and state Medicaid plans will be incentivized to do the same.
• It promotes workplace wellness initiatives through new grants and a re-evaluation of existing programs.
• It seeks to involve communities and local governments through community-based efforts. “Community Transformation Grants,” for example, “promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.”
• It makes preventative health a federal priority through “a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies,” which “will develop a prevention and health promotion strategy for the country.” It also promises a “national strategy to improve the quality of health care,” and “improved data collection on health disparities.”

In addition to the four big messages, HHS officials pointed to initiatives designed to address specific, salient concerns such as smoking, obesity and the looming shortage of primary caregivers.

Presidents of AHCJ, SPJ call for more openness from Obama administration

The presidents of the Association of Health Care Journalists and the Society of Professional Journalists published an op-ed in The Washington Post this morning, criticizing the lack of openness within the Obama administration and calling on officials to improve the flow of information to journalists and the public.

“Democrats criticized the Bush administration for not making decisions based on the best science,” wrote AHCJ’s Charles Ornstein and SPJ’s Hagit Limor. “But the Obama administration now muzzles scientists and experts within federal agencies. When they are allowed to talk about important public health issues, a chaperone often supervises every word. These constraints keep the public from learning whether decisions are science-based or politically motivated.”

AHCJ has been very active in advocating for government openness, including a recent series of meetings in Washington, D.C., with officials from the U.S. Department of Health and Human Services and its related agencies. The organization has urged the FDA to re-examine a policy that prohibits reporters from sharing embargoed materials with sources before the embargo lifts for the purpose of obtaining outside comment and context. Board members from AHCJ also have worked with state health directors to encourage dissemination of more information during public health outbreaks.

“We remain hopeful that our ongoing conversations with HHS and its agencies will help improve the current climate, which isn’t working for journalists or the public,” Ornstein said. “Our members are interested in timely, meaningful responses to their questions, additional access to scientists and health experts, and speedier responses to their Freedom of Information Act requests.”

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