Cracking the "public use" version of the National Practitioner Data Bank — the secret national repository for records of adverse actions against doctors since 1990 — took ten percent CAR skills and 90 percent shoe leather.
The data file has the barest of identifying information attached to more than 200,000 records including malpractice payments made on behalf of medical practitioners, state license actions and disciplinary measures taken by hospitals. The practitioner's names are replaced by random ID numbers generated by Department of Health and Human Services computers. Ages and medical school graduation dates are given to the nearest decade.
So, before you start trying to attach names to the anonymous records of 100,000 doctors in the databank, make some careful choices about whom you think is worth tracking down.
For our "White Coats, Dark Secrets" series, The Hartford Courant focused on doctors with at least 25 entries overall, at least $3 million in total malpractice payments and at least one disciplinary action taken by a state licensing board. We ignored dentists and podiatrists since their screw-ups, although a great inconvenience for the injured patient, aren't likely to be life threatening.
Be prepared for strong resistance from the medical community to almost any criteria you select. They will argue that the number of malpractice suits a doctor faces depends more on his specialty than his skill. They'll also say certain areas of the country are simply more litigious than others. The truth is, they are right on both counts.
Our criteria were so broad, however, that nobody from the American Medical Association or on the staff of the NPDB seriously argued that we were unfairly skewering good doctors who had caught a few bad breaks.
Once you've picked your targets, the real work begins. State disciplinary actions are almost always public, but that doesn't make them easy to find. Most states have Web sites with some information about regulatory actions. Some, such as Massachusetts, New York and Florida, let you look up physicians by name. When working with the NPDB, however, you don't have the name.
Instead, we found ourselves working through a tedious process of elimination. For example, if one of the anonymous doctors on our list had a six-month suspension in New York in 1996 and a reprimand in Massachusetts in 1998, we'd go to the records from those states and compare the lists. Most of the time that left us with a shorter list of only a handful of doctors who fit both criteria. Then we checked each doctor's date of birth and year of graduation from medical school (both conveniently provided by the AMA's Web site in most cases) to see which matched the decades listed in the NPDB.
When we needed records from a state that didn't have a decent Web site, we turned to Public Citizen's "Questionable Doctors" series. This hefty, three-volume paperback catalogue lists license surrenders, revocations, suspensions and licenses put on probation from fifty states and the District of Columbia. But it's not cheap. The 2000 version, with actions from 1990 through 1999, costs $400.
Another drawback to the books, aside from the expense and the paper, is that the doctors are listed alphabetically by state and name. That makes a lot of sense if you are looking up your family practitioner. But when you are going from the NPDB you'll be searching for a type of action taken in a given year. We nearly went blind doing this in the Public Citizen books.
Once you have a couple of possible names, however, the Public Citizen books are a great resource. Instead of going from Web site to Web site to make sure all of the actions against a doctor match in each state, you have each doctor's full regulatory history at your fingertips. That means you can quickly pick the right doctor from a lineup of three or four possibilities. If you exhaust the leads provided by state disciplinary actions, and