Liana Gedz thinks that if she had seen Dr. Allan Zarkin’s private records, then the obstetrician now known as “Dr. Zorro” would never have had a chance to carve his initials in her abdomen after delivering her baby.
Now she is fighting to make those records available to all patients by opening the National Practitioners Data Bank, which was established by Congress 10 years ago and contains information on doctors who have been the object of malpractice lawsuits, medical license revocations or disciplinary action by medical societies.
The proposal appears headed for Congress, but it’s being bitterly opposed by doctor groups, who say making the information public could cause more harm than good.
For Gedz, though, the matter is clear: Keeping the National Practitioners Data Bank closed perpetuates “a white wall of silence where hospitals protect doctors and doctors protect their peers.”
Interest in Congress
By law, only hospital administrators, managed-care companies and licensing boards can get information from the data bank.
The law was created to keep state medical boards informed of doctors’ records in other states — in case a bad doctor skipped town and applied for a medical license elsewhere.
Rep. Thomas J. Bliley Jr., R-Va., said he can’t understand why the public should be denied access to those records.
“It would seem unfair to restrict this information from consumers, the very people the law was intended to protect,” he wrote in a letter to Health and Human Services Secretary Donna Shalala in November.
“It is unconscionable that consumers have more comparative information about the used car they purchase or the snack foods they eat than the doctors in whose care they entrust their health and well-being,” Bliley said.
Bliley said he plans to bring the issue to the congressional Commerce Committee.
“At this time, it is safe to say that hearings will be held on the matter,” said Pete Sheffield, the Commerce Committee spokesman. “We want consumers to be able to make decisions about their health care, and this seems to be an important element in making those decisions.”
But being sued for malpractice isn’t necessarily a sign of incompetence, countered Dr. Yank D. Coble Jr., secretary-treasurer of the American Medical Association’s (AMA) Board of Trustees.
“I looked up all the chairs of surgery in Florida and New York,” he said. “All of them had suits against them. It’s more surprising if you have a surgeon or an obstetrician who doesn’t have a liability suit. These suits don’t correlate with competence. They correlate more with bad outcomes.
“We’re talking about a system that doesn’t identify physicians who have not acted properly and often identifies those who did a good job and had an unfortunate outcome,” said Coble.
The database also would unfairly flag doctors who perform high-risk procedures or specialize in areas such as obstetrics that produce more lawsuits, said Rep. Greg Ganske, R-Iowa. Ganske is also a doctor in Des Moines, Iowa. The result eventually could be fewer doctors going into such specialties or performing risky but necessary surgeries, he said.
Rep. John Dingell, D-Mich., and several other lawmakers suggested that the potential hearing might be Bliley’s way of exacting revenge on the AMA for opposing Republican patient-protection legislation. The Republican House leadership and the insurance industry opposed the measure, which would have given patients the right to sue health maintenance organizations if needed treatment had been withheld.
Not so, said Commerce Committee spokesman Sheffield– it’s a straightforward matter of keeping the public informed.
“The AMA seems to feel that the public can’t understand this information,” Sheffield said. “To get down to the bare essentials of the matter, the public deserves this information. They should know if their doctors are bad doctors; if they have a history of malpractice or criminal behavior.”
Available on the Web
Some information about doctors’ mistakes is available to the general public. For the past decade, the consumer advocacy group Public Citizen, founded by Ralph Nader, has published successive editions of Questionable Doctors, a volume listing doctors disciplined by state or federal boards.
The last edition listed 16,638 doctors, and the next will have more names, said Booth Gunter, communication director of Public Citizen. “It just keeps going up,” he said.
Information in the book comes from state medical boards’ reports, Gunter said. While that information traditionally has been hard for an average patient to obtain — often requiring a letter to the state board — it now is increasingly available on the Internet. Forty states and the District of Columbia now report disciplinary action on Web sites. Public Citizen is issuing a study of those Web sites.
“We rate them in terms of functionality — whether they are user-friendly,” Gunter said.
But those disciplinary reports omit a lot of information that is in the National Practitioner Data Bank, such as malpractice suits and hospital reports of doctors’ misconduct, Gunter said.
“The argument against [opening the data bank] is that consumers will not be able to make sound decisions,” he said. “We think that the public can be trusted to interpret the information and make the right decisions.”
Pleaded not guilty
Gedz thinks if she had seen Zarkin’s file, she would not have allowed him to deliver her baby at Beth Israel Medical Center.
A year before the incident, nurses and doctors at the hospital reported incidents in which Zarkin, 61, screamed at staff members and newborns’ fathers and pulled the arms of newborn babies, New York Health Commissioner Antonia Novello said.
Zarkin has since pleaded not guilty to two counts of first-degree assault and is scheduled for a March 14 hearing. His license to practice medicine was revoked by the state Department of Health, and he faces up to 25 years in prison if he is convicted, with a mandatory minimum sentence of five years.
Barry Fallick, Zarkin’s lawyer, admits that his client cut the letters “A” and “Z” into Gedz — who is a dentist — but said his client is not responsible because he suffers from a brain disease that impairs judgment.
“Dr. Zarkin is very sorry for what happened to Dr. Gedz,” Fallick said. “He never meant to hurt her. He has an organic brain disorder.” The lawyer added that Zarkin now is being treated for the problem.
‘How often have you been sued?’
Hugh Greeley is the chairman of the Greeley Education Company, which markets hundreds of education programs on physicians’ credentialing and also maintains a related Web site. He sees opening the database as a way of putting available information at consumers’ fingertips.
“The stand that the public will not be able to interpret the information is just pandering to a small group of individuals who don’t want it to be widely available,” Greeley said.
“[The information] is often available if people have the skill to find it, but it is not easy to find. Someone needs skilled access to the Internet and the patience of Job to track it down.”
And malpractice information does matter, Greeley said.
“If a physician has had one claim in a 10-year practice, it means nothing,” he said. “But if seven settlements have been paid by that physician in 10 years, that information is so significant that the public should have it.
“A patient should not have to ask a physician, ‘How often have you been sued?’”