Pediatricians and the Law
by Steven A. Bondi, J.D., M.D., FAAP
Many of us still can hear our teachers warning that
our behavior would “go on our permanent record.”
Although most of these threats were hollow, as physicians, we now face legitimate concerns about our
Medical providers are linked to a great amount of
information that is used for a variety of purposes,
including malpractice insurance underwriting, licensing, privileging, credentialing and hiring. Comprehension of how and where a physician’s history
is memorialized is important to understanding its
impact on your career.
National Practitioner Data Bank (NPDB)
The NPDB was established by the Health Care
Quality Improvement Act of 1986. It serves as a
permanent database for actions against U.S. health
“Provider” refers to an “individual who is licensed
or otherwise authorized by a State to provide health
care services.” This definition relies on the law of
the provider’s state and typically includes physicians,
residents, dentists, nurse practitioners, physician assistants, nurses and many other professionals.
Most associate the NPDB with malpractice
claims. Hospitals and malpractice insurance companies are required to submit information regarding
payments made on behalf of a provider. A provider
need not report payments made on his or her behalf
out of personal funds, but a payment made from
a physician’s practice must be reported. Reporting
is mandatory for both court judgments and settlements. Even small amounts must be reported. A
payment made solely for the benefit of a hospital
or clinic is not reported, even if it was made due a
physician’s actions. Special considerations exist for
certain federal employees because they are covered
by the Federal Tort Claims Act and may not be sued
as an individual.
Malpractice judgments and settlements are not
the only events reportable to the NPDB. Involun-
tary terminations and limitations on privileges im-
posed by a hospital are reportable to the NPDB if
the limitation is greater than 30 days. These adverse
actions are reported whether based on professional
incompetence or disruptive behavior. A provider
who resigns or agrees to a limitation of privileges
while under investigation also will be reported.
Similarly, state licensing boards and professional
societies are required to report their actions against
providers. In addition, participation exclusions from
federal programs such as Medicare and negative ac-
tions by the Drug Enforcement Agency are reported.
Voluntary limitations, such as retiring or relin-
quishing hospital privileges while maintaining an
outpatient practice, do not require NPDB reporting.
The NPDB is not an open source of data. Neither
malpractice insurers nor the public may obtain a
report. Hospitals are required to query the database
as part of their credentialing process. Professional
societies, licensing boards, health plans, law enforcement agencies and certain other entities are allowed
to obtain NPDB reports.
Plaintiffs in a malpractice suit can query the database only if they can show that the credentialing
hospital did not appropriately review a provider’s
Subjects of an NPDB report are notified and can
obtain an official copy of the entry. There is a dis-pute-resolution process, and the provider may attach
a statement of explanation.
The NPDB reporting requirements do not pertain
to individual physicians or independent practices. In
general, they apply only to practices that are large
enough to have formal peer review and credentialing
(e.g., accountable care organizations).
The NPDB has a comprehensive guidebook available at https://www.npdb.hrsa.gov/resources/NPD
Claim histories are used mainly for credentialing
and insurance underwriting. These processes rely on
provider self-reporting through application materials and documentation provided by practice locations. Questions regarding claims are much broader
than the NPDB reports.
Organizations requesting a claim history usually seek information on all claims irrespective of
outcome, including dropped or dismissed cases.
Although an individual’s responses will depend on
the specific questions, these questionnaires give the
applicant an opportunity to explain the details of
the claim. Those reviewing claim histories and explanations are well aware that physicians often are the
subject of claims even in cases where no malpractice
has been committed.
While the NPDB and claim histories are the most
formal sources of provider information, there are
numerous other repositories. State medical boards
receive complaints, conduct investigations, enact
sanctions and maintain records regarding providers. Laws and regulations surrounding complaints,
including the public availability of such reports, are
state-specific. Links to state medical boards can be
found at http://fsmb.org/policy/contacts.
Graduate medical education records of any sanction also are frequently requested. Internal hospital
departments, such as human resources, the medical
staff office and risk management may keep files on
individual providers. Similarly, health insurance
companies also track data about individual providers. Non claim-related institutional files are held
internally and usually are not released beyond the
Certain information not directly related to one’s
clinical practice also can impact a physician’s practice and employment. These could include records
of higher education discipline, criminal arrest or
conviction, civil legal actions, credit reports and
bankruptcy, and treatment for substance abuse or
While that detention you served for running in
the hall during junior high may no longer be haunting you, it is important to be aware of the data that
follow you through your career as a medical provider.
Knowing what information is available allows you
to address it and may give you some peace of mind.
Dr. Bondi is a member of the AAP
Committee on Medical Liability and
What goes on your ‘permanent record’ and how it can impact your career
Risk management programs at the AAP National Con-
ference & Exhibition in Chicago include:
• “Pediatricians and the Law: Answers to Medicolegal
Questions (A1144)” from 4-5: 30 p.m. Sept. 16
• “Keeping Inpatient Pediatricians in the Hospital and
Out of Trouble: Navigating the Legal Landscape
(H1087)” from 1-4: 15 p.m. Sept. 16
• “Provider Protect Yourself! Limiting Your Risk in the
Face of Nonadherence or Refusal (F2010)” from
7:30-8: 15 a.m. Sept. 17