National Practitioner Data Bank (NPDB) - help! need advice please

[doritos]

Hello,
In residency, I was put on probation for an adverse surgical outcome. I completed the remediation program and completed residency in good standing.

Because of the probation, I initially had challenges getting a job. It was a very difficult period in my life to say the least. Eventually, I found an excellent fellowship program that gave me a chance. I successfully credentialed and completed the fellowship program without incidents and in good standing. I also recently successfully credentialed and joined a private practice and have been enjoying the experience thus far.

Several years have passed since the incident and just when I thought the past was finally behind me, I received a letter from the hospital where the incident occurred basically saying that I was involved in an episode of care that led to a paid medical malpractice claim and that I *may* be reported to the NPDB . and that "Reporting to the NPDB is based on the conclusions of a Review Panel that there was substandard care, professional incompetence, or professional misconduct. When a trainee is identified as a provider of substandard care, the attending physician may be reported in supervisory capacity without mention of the trainee. When the trainee's care is described as gross negligence or professional misconduct, the trainee will be considered to be reportable to the NPDB."

I've been given an opportunity to provide a written statement (due no later than 60 days from letter postmark) and that I may contact an attorney at my own expense.

My thinking is that my successful credentialing (fellowship and recent employment ) was due at least in part to the fact that no NPDB entry with my name has been made ? From what I understand, hospitals where I currently have privileges at will check NPDB in 2 years from date of my credentialing and will see the entry? If yes, what will be the effect ? Also, do I now risk losing my malpractice insurance now because of a mistake I made in residency?

I'm also not sure how I should respond in the written statement. I don't know what "gross negligence" or "professional misconduct" exactly means? I obviously don't want to lie or appear defensive but at the same time I don't want my career to be ruined. I also don't want to go down a long, drawn out legal route. Let's just say my supervising attending in the incident has substantial legal resources.

Any suggestions please?

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[QofQuimica]

Any suggestions please?

Get a lawyer who is familiar with this area of the law like they told you to, and follow his/her recommendations. And for sure don't post any details about the case here.

 

[Winged Scapula]

1) you can query the NPDB to see if a report has been filed on you; there is a nominal fee for doing so

2) if you are reported to the NPDB, you are supposed to receive a written report within 60 days.

3) never appear before a Board, or send a response to any credentialing committee when questions about malpractice/negligence are involved without being represented by an attorney. Even if it is just to have an attorney review your written response to the credentialing committee.

4) let this serve as a warning to others that even a "nuisance lawsuit" (which yours appeared not to be) when *settled* will appear on the NPDB which is publicly available and will result in hassles when credentialing and licensings. In the eyes of a layperson, settlement often = guilty.

 

[45408]

Get a lawyer who is familiar with this area of the law like they told you to, and follow his/her recommendations. And for sure don't post any details about the case here.

What she said.

 

[doritos]

Get a lawyer who is familiar with this area of the law like they told you to, and follow his/her recommendations. And for sure don't post any details about the case here.

Ok. I understand I will need legal guidance. When should I inform my employer? After I find a malpractice defense lawyer on my own? I am reluctant to approach my employer without a plan of action. At the same time, maybe my employer will be able to connect me to the right legal resource?

 

[Janedoedoctor]

1. Get yourself a lawyer ASAP. I think it would be unwise to make any kind of statement (written or oral) without having input from a lawyer. This written statement is presumably your only opportunity to defend yourself, so you want to make it as good as possible. No need to report anything to your current employer until you have something to report.

2. What a strange and nasty thing to do for a program. After they have settled the lawsuit, they still feel the need to hunt you down and damage your career... Is this reporting mandatory for a program, or just something they do out of spite/revenge?

3. I recently read an interesting article about litigation. If I remember correctly, it said that the average doctor is sued 2 times during his/her career. Those in high-risk specialties even more. The vast majority of these cases end in a settlement. If getting sued and settling happens so frequently and is out of one's control, it can't be such a huge black mark?

 

[QofQuimica]

Ok. I understand I will need legal guidance. When should I inform my employer? After I find a malpractice defense lawyer on my own? I am reluctant to approach my employer without a plan of action. At the same time, maybe my employer will be able to connect me to the right legal resource?

doritos, this is why you need a malpractice defense lawyer: to answer these questions and guide you through the process. Don't do anything else or talk to anyone, including your employer, until after you meet with your lawyer and get his/her advice.

 

[NotAProgDirector]

1. Get yourself a lawyer ASAP. I think it would be unwise to make any kind of statement (written or oral) without having input from a lawyer. This written statement is presumably your only opportunity to defend yourself, so you want to make it as good as possible. No need to report anything to your current employer until you have something to report.

2. What a strange and nasty thing to do for a program. After they have settled the lawsuit, they still feel the need to hunt you down and damage your career... Is this reporting mandatory for a program, or just something they do out of spite/revenge?

3. I recently read an interesting article about litigation. If I remember correctly, it said that the average doctor is sued 2 times during his/her career. Those in high-risk specialties even more. The vast majority of these cases end in a settlement. If getting sued and settling happens so frequently and is out of one's control, it can't be such a huge black mark?

Reporting the NPDB is manditory. The letter/wording the OP received is relatively boilerplate. The good news (sort of) is that an independent board reviews the case to try and determine where fault really lies -- so your program can't throw you under the bus, at least not without some difficulty.

As a trainee, you are supposed to be supervised by faculty. Hence, you're (theoretically) only liable if you're grossly negligent -- i.e. you so something so ridiculous that no one at your stage of training would consider doing; or if there is professional misconduct -- i.e. you lie, cheat, steal, violate rules, etc. So, if it's just a case gone bad and you did what you were supposed to do / were told to do, you, again theoretically, should not be found at fault.

But, just as you get to describe the incident, so does everyone else. And if they all say that everything was fine until you decided to take the clamp and stick it into the heart to see it "pop like squished twinkie", well, it might not go so well for you. So, as others have said, you absolutely need a lawyer.

What's somewhat interesting here, that I haven't thought of in the past, is that the cost of the lawyer is being passed onto you. You would think that your medmal insurance (from your residency) would cover this. It might -- and you might want to contact them to find out. Certainly no harm in asking. But it might not, as they may say that the "case is over once settled" and the costs of defending against the NPDB are not their problem.

You could also enquire whether your current medmal will cover it. It might -- as they might see any past judgement against you making you a higher risk of losing the in future (or of a higher payout in the end), and hence in their best interest to defend.

I doubt that telling your current employer about it will matter. I assume that you told them about the issue when you got your job in the first place, so this won't be news to them. Again, they have some interest in defending you, or might be able to refer you to a lawyer that they have worked with.

Even if, in the end, you lose and get listed in the NPDB, it's not the end of your career. Many physicians are listed. Your event will be many years in the past, and when you were in training. You would want to keep your same job for a good number of years, to prove that there are no more issues and to push this further in the past. It will be a pain going forward -- you'll need to report it for licensing, credentialling, etc, but you will likely be fine.

This assumes, of course, that you didn't do something absolutely horrible. If you had "inappropriate relations" with a sedated patient, you have really big problems no matter what you do.

 

[deleted109597]

From the wording, he isn't asking about medmal. The hospital already paid the claim, they sent him a letter stating he may be listed on NPDB. I'm not sure lawyering up is warranted at this point, because what are they going to do except take your money? Do you think the hospital will take his statement and decide that he wasn't responsible for the act?
If the NPDB sends him a letter that has has been reported, then perhaps legal advice may be necessary.

However, being on NPDB isn't a deathknell, or would wouldn't have any neurosurgeons or OB/GYNs practicing in this country.

 

[doritos]

thanks very much everyone for the feedback. I got in touch with a lawyer. We'll see how it goes.

aProgDirector - i'd certainly like to think my adverse outcome was not due to gross negligence . Definitely no "inappropriate relations" 😉 Interesting suggestions about recuperating the costs. will look into your suggestions. And I greatly appreciate your "in the end.." reassurances.

 

[doritos]

From the wording, he isn't asking about medmal. The hospital already paid the claim, they sent him a letter stating he may be listed on NPDB. I'm not sure lawyering up is warranted at this point, because what are they going to do except take your money? Do you think the hospital will take his statement and decide that he wasn't responsible for the act?
If the NPDB sends him a letter that has has been reported, then perhaps legal advice may be necessary.

However, being on NPDB isn't a deathknell, or would wouldn't have any neurosurgeons or OB/GYNs practicing in this country.

Dr.McNinja, thank you for your input. At this point, I do feel more comfortable having my lawyer review my written statement just to make sure I don't say anything inappropriate.

 

[MD97]

Hi,
I am in the same boat.
I was a resident on call for VA hospital. Anesthesia doctor had given epidural steroid injection in VA pain clinic to this patient who next c/o inability to walk. Patient was admitted by the intern, then I saw the patient. Neurosurgey and Neurology had already been consulted by ER MD. ER MD, intern, myself and my attending had examined the patient, then next day neurology came and neurologist thought that the patient is faking it and apparently saw him moving his legs. He advised to consult Psychiatry for any secondary gain. Team attending thought there was no need to consult Psych but any how the intern consulted and Psych wrote that there was no malingering.
Pt had already been started on IV Decadran, he improved and was discharged. I was on the team for 2 days then my duty changed and another PGY2 came, pt was discharged by new team as I was off the team.
I recieved a similar letter saying that I have been identified as the participant in the episode of care of the patient which had led to the payment of medical malpractice claim and that I *may* be reported to the NPDB . and that "Reporting to the NPDB is based on the conclusions of a Review Panel that there was substandard care, professional incompetence, or professional misconduct. When a trainee is identified as a provider of substandard care, the attending physician may be reported in supervisory capacity without mention of the trainee. When the trainee's care is described as gross negligence or professional misconduct, the trainee will be considered to be reportable to the NPDB."

I've been given an opportunity to provide a written statement (due no later than 60 days from letter postmark) and that I may contact an attorney at my own expense.

I came to know that amongst atleast all the trainees only I had been identified as the participant in the care of the patient and I also suspect that attending may also have not been identified.

I heard that the VA hospital does not report its doctors and I am the only one who was not epmloyed by them but by my residency program. Now I donot work there and i had completed the residency 5 years ago.

Patient's court complaint clearly mentions the name of the Anesthesiologist who had given the injection.

Please help me how can I defend myself

Should I expect any fair deal from the review panel. Thanks.

 

[Winged Scapula]

Hi,
I am in the same boat.
I was a resident on call for VA hospital. Anesthesia doctor had given epidural steroid injection in VA pain clinic to this patient who next c/o inability to walk. Patient was admitted by the intern, then I saw the patient. Neurosurgey and Neurology had already been consulted by ER MD. ER MD, intern, myself and my attending had examined the patient, then next day neurology came and neurologist thought that the patient is faking it and apparently saw him moving his legs. He advised to consult Psychiatry for any secondary gain. Team attending thought there was no need to consult Psych but any how the intern consulted and Psych wrote that there was no malingering.
Pt had already been started on IV Decadran, he improved and was discharged. I was on the team for 2 days then my duty changed and another PGY2 came, pt was discharged by new team as I was off the team.
I recieved a similar letter saying that I have been identified as the participant in the episode of care of the patient which had led to the payment of medical malpractice claim and that I *may* be reported to the NPDB . and that "Reporting to the NPDB is based on the conclusions of a Review Panel that there was substandard care, professional incompetence, or professional misconduct. When a trainee is identified as a provider of substandard care, the attending physician may be reported in supervisory capacity without mention of the trainee. When the trainee's care is described as gross negligence or professional misconduct, the trainee will be considered to be reportable to the NPDB."

I've been given an opportunity to provide a written statement (due no later than 60 days from letter postmark) and that I may contact an attorney at my own expense.

I came to know that amongst atleast all the trainees only I had been identified as the participant in the care of the patient and I also suspect that attending may also have not been identified.

I heard that the VA hospital does not report its doctors and I am the only one who was not epmloyed by them but by my residency program. Now I donot work there and i had completed the residency 5 years ago.

Patient's court complaint clearly mentions the name of the Anesthesiologist who had given the injection.

Please help me how can I defend myself

Should I expect any fair deal from the review panel. Thanks.

Please take the advice given above to the OP; get an attorney to help you with this.

 

[MD97]

I have. He said that he will help me in writing the response but do not file any litigation at this time. Any body in the same situation in the past, please suggest names of attorneys. Thanks
I feel that it was not fair to name me even though I have not given any epidural injection, moreoever none of the other inernal medicine doctors/trainees who took care of the patient were named or asked to write any response. Please hep. I have limited time.

 

[smq123]

Just as SDN is not for medical advice, it is also not for legal advice. It sounds like you need to schedule an appointment with another attorney ASAP, there is not much more anyone on SDN can tell you.

Closing.