Agency’s restrictions on data about disciplined doctors continue to get attention
Filed under: Government, Health data, Health journalism, Public records
The Kansas City Star and The Sacramento Bee ran editorials over the weekend to denounce the recent decision by the U.S. Health Resources and Services Administration to place restrictions on the public use file of the National Practitioner Data Bank.
The Star says the restrictions “display an appalling disrespect for journalists and researchers and for the public’s right to gain information about the doctors to whom they entrust their health and safety.”
It calls the move a “clumsy attempt to restrict access to public information [that] promotes nothing but confusion and darkness.”
Meanwhile, The Bee says the Obama administration has “positioned itself on the side of protecting the privacy of doctors who maim patients.” It also suggests that President Obama reread the First Amendment.
On Sunday, the Society of Professional Journalists hosted AHCJ President Charles Ornstein, SPJ President John Ensslin and Kansas City Star reporter Alan Bavley for a discussion of the data bank and the importance of its information being open to the public without restrictions.
As regular Covering Health readers know, the public use file has been used regularly by reporters who have covered lax oversight of troubled doctors. When Bavley was working on such a story, however, a doctor he was investigating contacted HRSA and complained the data was being used improperly. That doctor’s complaints led to HRSA threatening Bavley with a fine, which it later backed down from, and pulling the data off of the website.
After protests from journalism organizations, consumer groups, academic researchers and U.S. Sen. Charles Grassley, the agency republished the data file last Wednesday but placed restrictions on how it was to be used. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, the journalism groups called the new restrictions “ill-advised, unenforceable and probably unconstitutional. Restricting how reporters use public data is an attempt at prior restraint.”
Grassley also has expressed his disappointment in the restrictions: “HRSA is overreaching and interpreting the law in a way that restricts the use of the information much more than the law specifies.”
For more background, this timeline tracks the story:
Journalism groups protest HRSA restrictions to Sebelius
Filed under: Health data, Health journalism, Public records
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’
Filed under: Government, Health data, Health journalism, Public records
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.
Timeline: National Practitioner Data Bank Public Use File
Letter and statement from Robert Oshel (PDF)
Letter to Sebelius (PDF)
See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors
Letter to members of Congress (PDF)
HRSA letter to Bavley (PDF)
Articles, editorials about public access to the NPDB public use file (PDF)
Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website
Get the NPDB public use file
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.
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
Filed under: Government, Health data, Health journalism, Public records
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.
HHS Sec. Kathleen Sebelius spoke to journalists at Health Journalism 2010 in Chicago.
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.
Letter to Sebelius (PDF)
See how reporters have used NPDB’s public use file to expose gaps in oversight of doctors
Letter to members of Congress (PDF)
HRSA letter to Bavley (PDF)
Articles, editorials about public access to the NPDB public use file (PDF)
Sept. 15, 2011: AHCJ, other journalism organizations protest removal of data from public website
Get the NPDB public use file
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 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 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.
Slow-to-pay insurers may become national issue
Filed under: Health care reform, Health journalism, Hot Health Headline
For The News Journal of Wilmington, Del., Hiran Ratnayake dug through more than 100 complaints filed last year against the state’s insurers for undue delays in payment. In them, he finds some key anecdotes and little hope that companies’ responses would speed up in the future.
State law requires that claims be paid within 30 days, and at least three insurers who do business in the state were handed significant fines for a “pattern of delays.” Ratnayake tells the stories of patients whose claims have been approved but who have made dozens of calls when their insurance companies don’t receive payment and other tactics that appear to be intended to delay payments.
Furthermore, Ratnayake quotes an expert who predicted that “delays will become more frequent as more people become insured under the [health care reform] act.” The act does not address prompt payment regulations, Ratnayake reports.
In addition to his local reporting, Ratnayake used HHS Secretary Kathleen Sebelius’ speech at Health Journalism 2010 to provide national context.
Sebelius said recently that the federal government would engage in “hand-to-hand combat” with health insurers over problems related to policyholders’ plans.
Journalists attend two-day CDC flu briefing
AHCJ has sponsored 12 journalists to take part in a two-day workshop at the CDC about covering seasonal influenza and the A-H1N1 flu virus, now grabbing the headlines.
The workshop, taking place today and tomorrow, includes a series of on-the-record sessions with CDC experts to prepare front-line journalists for the upcoming flu season. Public health experts are providing a primer on the flu, examine how it is being tracked, expectations for vaccines and antivirals, and what communities can do to deal with the fallout.
On Monday, HHS Secretary Kathleen Sebelius, joined by CDC director Thomas R. Frieden, was a surprise addition to the schedule.
The AHCJ-sponsored journalists are:
- Erin Allday, San Francisco Chronicle
- Ran An, China Newsweek
- Kim Archer, Tulsa World
- Lorna Benson, Minnesota Public Radio
- Blythe Bernhard, St. Louis Post-Dispatch
- Don Finley, San Antonio Express-News
- Jeff Hansel, Rochester Post-Bulletin
- Sandra Jordan, St. Louis American
- Alma Martinez, Radio Bilingue
- Pohla Smith, Pittsburgh Post-Gazette
- Fred Tasker, The Miami Herald
- Eric Whitney, Colorado Public Radio
Collins unanimously confirmed as head of NIH
Francis S. Collins, M.D., Ph.D., has been unanimously confirmed as director of the National Institutes of Health, HHS Secretary Kathleen Sebelius announced today.
“Dr. Collins is one of our generation’s great scientific leaders. A physician and geneticist, Dr. Collins served as Director of the National Human Genome Research Institute, where he led the Human Genome Project to completion,” said Secretary Sebelius. “Dr. Collins will be an outstanding leader. Today is an exciting day for NIH and for science in this country.”
Francis S. Collins
Collins, a geneticist, had received some attention when he was nominated because of his religious beliefs. The evangelical Christian wrote a book, “The Language of God: A Scientist Presents Evidence for Belief.”
Jacob Molyneux, senior editor at the American Journal of Nursing, examined some of what was written about Francis at the time and looked at the then-nominee’s statements and records, including those about the use of embryonic stem cells for research. He concluded that “for Collins, science and the potential for alleviation of human suffering trump moral or religious absolutism and blind adherence to the sanctity of life issue.”
The Los Angeles Times ran a point-counterpoint piece about the topic, Newsweek’s religion editor weighed in, and The New York Times ran an op-ed by an author who is “uncomfortable” with Francis’ nomination. Eric Berger of the Houston Chronicle did a Q&A with Josh Rosenau from the National Center for Science Education, which defends the teaching of evolution in public schools.
Food safety initiatives will be subject of online chat
The Obama administration has created a deputy food commissioner position to coordinate safety in the case of an outbreak of salmonella and is creating a better system to track and identify the origins of foodborne illnesses.
U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Department of Agriculture Secretary Tom Vilsack will discuss the initiatives in a live online chat today (July 7) at 2:15 p.m. ET. To participate, visit http://apps.facebook.com/whitehouselive/.
A press release sas that “Sebelius and Vilsack will discuss the continuing work of the Food Safety Working Group - a recently established partnership between HHS and the Department of Agriculture tasked with upgrading food safety laws, fostering coordination throughout government, and ensuring the safety of America’s food supply.”
Tip sheets
Lifting the shroud: Using multiple-cause-of-death data
Melamine: A primer on the contamination of food
AHCJ article
Fatal Food: A study of illness outbreaks
Recent news
Loophole allows E. coli-tainted meat to be sold
Meat, dairy products transported in unsafe temperatures, overlooked by inspectors
Airlines delay testing of onboard water
Salmonella outbreak: A selection of recent stories
N.Y. school districts not meeting federal guidelines on cafeteria inspections
Private companies, not the FDA, increasingly perform food safety inspections
Web sites
Center for Infectious Disease Research & Policy
Outbreak Alert! Database
Sebelius to present HHS budget at 1 p.m. ET
Health and Human Services Secretary Kathleen Sebelius will provide an overview of the HHS budget for fiscal year 2010 at 1 p.m. ET on Thursday, May 7. She will be joined by leaders from across the department who will provide a full briefing on the HHS budget after Sebelius delivers remarks.
The briefing will be webcast at www.hhs.gov. All budget-related materials, including the FY 2010 HHS Budget in Brief, will be available online at or shortly after 1 p.m. ET.
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