I

106TH CONGRESS

2D SESSION H. R. 5122

To amend the Health Care Quality Improvement Act of 1986 to provide

for the availability to the public of information reported to the National

Practitioner Data Bank under such Act, to establish additional reporting

requirements, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 7, 2000

Mr. BLILEY introduced the following bill; which was referred to the Committee

on Commerce

A BILL

To amend the Health Care Quality Improvement Act of

1986 to provide for the availability to the public of

information reported to the National Practitioner Data

Bank under such Act, to establish additional reporting

requirements, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Patient Protection Act

5 of 2000’’.
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1 TITLE I—PUBLIC AVAILABILITY

2 OF PHYSICIAN INFORMATION

3 IN NATIONAL PRACTITIONER

4 DATA BANK

5 SEC. 101. PUBLIC AVAILABILITY OF PHYSICIAN INFORMA6 TION.

7 (a) IN GENERAL.—Part B of the Health Care Qual8 ity Improvement Act of 1986 (42 U.S.C. 11131 et seq.)

9 is amended by inserting after section 427 the following

10 section:

11 ‘‘SEC. 428. PUBLIC AVAILABILITY OF PHYSICIAN INFORMA12 TION.

13 ‘‘(a) IN GENERAL.—Not later than January 31,

14 2001, the Secretary, notwithstanding any other provision

15 of this part, shall in accordance with this section promul16 gate regulations under which the public may, through the

17 method described in subsection (c), obtain information re18 ported under this part on physicians.

19 ‘‘(b) LIMITATIONS.—The following information on a

20 physician may not under subsection (a) be made available

21 to the public:

22 ‘‘(1) Information disclosing the identity of any

23 patient involved in the incidents involved.

24 ‘‘(2) The home address of the physician.
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1 ‘‘(3) The social security account number of the

2 physician.

3 ‘‘(4) The date of birth of the physician.

4 ‘‘(5) The number assigned to the physician by

5 the Drug Enforcement Administration.

6 ‘‘(6) The name, title, and telephone number of

7 the official with responsibility for submitting the re8 port on behalf of the entity.

9 ‘‘(c) USE OF INTERNET.—For purposes of subsection

10 (a), the method described in this subsection is to make

11 the information involved available to the public, without

12 charge, through the telecommunications medium known as

13 the World Wide Web of the Internet. The Secretary, act14 ing through the Administrator of the Health Resources

15 and Services Administration, shall provide for the estab16 lishment of a site on such medium, and shall update the

17 information maintained through such medium not less fre18 quently than monthly.

19 ‘‘(d) STATEMENT OF PHYSICIAN.—Regulations under

20 subsection (a) shall require that each disclosure under

21 such subsection include any statement that was submitted

22 under section 426(b) by the physician involved.

23 ‘‘(e) CONTEXT OF DISCLOSED INFORMATION ON

24 MEDICAL MALPRACTICE PAYMENTS.—With respect to in25 formation reported under section 421 on a physician, reg-
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1 ulations under subsection (a) shall require that a disclo2 sure of a report under such section be accompanied by

3 supplemental information in accordance with the fol4 lowing:

5 ‘‘(1) For each State for which such a report is

6 made on the physician:

7 ‘‘(A) The information under section 421

8 shall be presented in context by comparing the

9 physician involved to the experiences of other

10 physicians in the same specialty in the same

11 State.

12 ‘‘(B) In disclosing the amount of the pay13 ment reported under section 421(b)(2):

14 ‘‘(i) The amount shall be presented in

15 context by categorizing the amount in a

16 manner that indicates the level of signifi17 cance of the payment in relation to

18 amounts reported under such section for

19 other physicians in the same specialty in

20 the same State. For such purposes, there

21 shall be a minimum of three graduated

22 categories.

23 ‘‘(ii) The disclosure shall state wheth24 er the amount was made in settlement (or

25 partial settlement) of, or in satisfaction of
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1 a judgment in, a medical malpractice ac2 tion or claim.)

3 ‘‘(2) A statement providing that a payment

4 made pursuant to a medical malpractice action or

5 claim may occur for a variety of reasons which do

6 not necessarily reflect negatively on the professional

7 competence or conduct of the physician.

8 ‘‘(3) A statement providing that a payment

9 made pursuant to a medical malpractice action or

10 claim should not be construed as creating a pre11 sumption that medical malpractice has occurred.

12 ‘‘(4) A statement providing that some physi13 cians work primarily with high risk patients, and

14 such physicians may have numbers of medical mal15 practice actions or claims that are higher than aver16 age for their specialties because they specialize in

17 cases or patients who are at very high risk for med18 ical problems.

19 ‘‘(5) A statement providing that—

20 ‘‘(A) malpractice histories tend to vary by

21 specialty, and some specialties are more likely

22 than others to be the subject of litigation, and

23 ‘‘(B) the disclosure and accompanying in24 formation compare physicians only to the mem25 bers of their specialty, not to all physicians, in
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1 order to make an individual physician’s history

2 more meaningful.

3 ‘‘(6) A statement providing that—

4 ‘‘(A) malpractice histories tend to vary by

5 State, and due to variations in State laws, phy6 sicians in some States are more likely than

7 those in other States to be the subject of litiga8 tion, and

9 ‘‘(B) the disclosure and accompanying in10 formation compare physicians only to other

11 physicians within a given State, not to all physi12 cians, in order to make an individual physi13 cian’s history more meaningful.

14 ‘‘(f) CONTEXT OF DISCLOSED INFORMATION RE15 GARDING CRIMINAL ACTS.—With respect to information

16 that under section 422(c) or 424A is reported on a physi17 cian, regulations under subsection (a) shall require that

18 a disclosure of a report under such a section be accom19 panied by a statement providing that the disclosure may

20 fail to provide all crime-related information on the physi21 cian because the availability of such information depends

22 in part on State laws and in part on self-reporting by phy23 sicians.’’.

24 (b) DISCLOSURE.—Section 427(b)(1) of the Health

25 Care Quality Improvement Act of 1986 (42 U.S.C.
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1 11137(b)(1)) is amended by striking ‘‘Information re2 ported’’ and inserting ‘‘Except for the disclosure of infor3 mation authorized by this title, information reported’’.

4 (c) FEES.—Section 427(b) of the Health Care Qual5 ity Improvement Act of 1986 (42 U.S.C. 11137(b)) is

6 amended by striking paragraph (4).

7 TITLE II—REPORTING REQUIRE8 MENTS REGARDING NA9 TIONAL PRACTITIONER DATA

10 BANK

11 SEC. 201. REQUIRING REPORTS ON MEDICAL MAL12 PRACTICE PAYMENTS.

13 Section 421(b) of the Health Care Quality Improve14 ment Act of 1986 (42 U.S.C. 11131(b)) is amended—

15 (1) by redesignating paragraph (5) as para16 graph (6);

17 (2) in paragraph (4), by striking ‘‘and’’ after

18 the comma at the end; and

19 (3) by inserting after paragraph (4) the fol20 lowing paragraph:

21 ‘‘(5) in the case of a physician—

22 ‘‘(A) the medical field of the physician, in23 cluding the medical specialty,

24 ‘‘(B) the date on which the physician was

25 first licensed in the medical field and specialty,
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1 and the number of years the physician has been

2 practicing in such field and specialty, and

3 ‘‘(C) the professional license number of the

4 physician, and the name of the State in which

5 the license is held, and’’.

6 SEC. 202. REPORTING OF SANCTIONS TAKEN BY BOARDS

7 OF MEDICAL EXAMINERS.

8 (a) IN GENERAL.—Section 422(a) of the Health Care

9 Quality Improvement Act of 1986 (42 U.S.C. 11132(a))

10 is amended—

11 (1) in paragraph (1)(A), by striking ‘‘which re12 vokes or suspends’’ and inserting ‘‘which denies, re13 vokes, or suspends’’; and

14 (2) in paragraph (2)—

15 (A) in subparagraph (B), by striking ‘‘(if

16 known)’’ and all that follows and inserting ‘‘for

17 the action described in paragraph (1)(A) that

18 was taken with respect to the physician or, if

19 known, for the surrender of the license,’’;

20 (B) by redesignating subparagraph (C) as

21 subparagraph (F);

22 (C) by inserting after subparagraph (B)

23 the following subparagraphs:

24 ‘‘(C) the medical field of the physician, in25 cluding the medical specialty,
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1 ‘‘(D) the date on which the physician was

2 first licensed in the medical field and specialty,

3 and the number of years the physician has been

4 practicing in such field and specialty, and

5 ‘‘(E) the professional license number of the

6 physician, and the name of the State in which

7 the license is held, and’’.

8 (b) CRIMINAL ACTS OF PHYSICIANS.—Section 422 of

9 the Health Care Quality Improvement Act of 1986 (42

10 U.S.C. 11132) is amended by adding at the end the fol11 lowing subsection:

12 ‘‘(c) CRIMINAL ACTS OF PHYSICIANS.—

13 ‘‘(1) IN GENERAL.—Each Board of Medical Ex14 aminers shall report, in accordance with section 424,

15 the information described in paragraph (2), to the

16 extent that the information is collected by such

17 Board.

18 ‘‘(2) INFORMATION TO BE REPORTED.—With

19 respect to the Board of Medical Examiners of a

20 State, the information to be reported under para21 graph (1) is as follows:

22 ‘‘(A) A description of felony convictions of

23 physicians in courts of the State or other

24 States.
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1 ‘‘(B) A description of such misdemeanor

2 convictions of physicians in such courts as in

3 the Secretary’s discretion may reflect on quality

4 health matters.

5 ‘‘(C) A description of any criminal charges

6 in such courts to which the physician pled nolo

7 contendere.’’.

8 (c) CONTEXTUAL INFORMATION REGARDING DIS9 CLOSURES OF PHYSICIAN INFORMATION.—Section 422 of

10 the Health Care Quality Improvement Act of 1986, as

11 amended by subsection (b) of this section, is amended by

12 adding at the end the following subsection:

13 ‘‘(d) CONTEXTUAL INFORMATION REGARDING DIS14 CLOSURES OF PHYSICIAN INFORMATION.—Each Board of

15 Medical Examiners shall, in accordance with section 424,

16 report to the Secretary such information as the Secretary

17 may request from the Board for purposes of assisting the

18 Secretary in making disclosures in accordance with section

19 428(e), to the extent that such information is collected by

20 such Board.’’.

21 (d) CONFORMING AMENDMENT.—Subsections (a)

22 and (b) of section 424 of the Health Care Quality Im23 provement Act of 1986 (42 U.S.C. 11134) are each

24 amended by striking ‘‘section 422(a)’’ and inserting ‘‘sec25 tion 422’’.
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1 SEC. 203. REPORTING OF CERTAIN PROFESSIONAL REVIEW

2 ACTIONS TAKEN BY HEALTH CARE ENTITIES.

3 (a) IN GENERAL.—Section 423(a)(3) of the Health

4 Care Quality Improvement Act of 1986 (42 U.S.C.

5 11133(a)(3)) is amended—

6 (1) in subparagraph (B), by striking ‘‘and’’

7 after ‘‘surrender,’’;

8 (2) by redesignating subparagraph (C) as sub9 paragraph (D); and

10 (3) by inserting after subparagraph (B) the fol11 lowing subparagraph:

12 ‘‘(C) in the case of a physician—

13 ‘‘(i) the medical field of the physician,

14 including the medical specialty,

15 ‘‘(ii) the date on which the physician

16 was first licensed in the medical field and

17 specialty, and the number of years the

18 physician has been practicing in such field

19 and specialty, and

20 ‘‘(iii) the professional license number

21 of the physician, and the name of the State

22 in which the license is held, and’’.

23 (b) APPLICABILITY OF REQUIREMENTS TO FEDERAL

24 ENTITIES.—

25 (1) IN GENERAL.—Section 423 of the Health

26 Care Quality Improvement Act of 1986 (42 U.S.C.
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1 11133) is amended by adding at the end the fol2 lowing subsection:

3 ‘‘(e) APPLICABILITY TO FEDERAL FACILITIES AND

4 PHYSICIANS.—

5 ‘‘(1) IN GENERAL.—Subsection (a) applies to

6 Federal health facilities (including hospitals) and ac7 tions by such facilities regarding the competence or

8 professional conduct of Federal physicians to the

9 same extent and in the same manner as such sub10 section applies to health care entities and profes11 sional review actions.

12 ‘‘(2) RELEVANT BOARD OF MEDICAL EXAM13 INERS.—For purposes of paragraph (1), the Board

14 of Medical Examiners to which a Federal health fa15 cility is to report is the Board of Medical Examiners

16 of the State within which the facility is located.’’.

17 (2) CONFORMING AMENDMENT.—Section 432

18 of the Health Care Quality Improvement Act of

19 1986 (42 U.S.C. 11152) is amended—

20 (A) by striking subsection (b); and

21 (B) by redesignating subsection (c) as sub22 section (b).
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1 SEC. 204. PHYSICIAN SELF-REPORTING REGARDING FEL2 ONY CONVICTIONS.

3 Part B of the Health Care Quality Improvement Act

4 of 1986 (42 U.S.C. 11131 et seq.) is amended by inserting

5 after section 424 the following section:

6 ‘‘SEC. 424A. PHYSICIAN SELF-REPORTING REGARDING FEL7 ONY CONVICTIONS.

8 ‘‘(a) IN GENERAL.—Each physician shall report, in

9 accordance with subsection (b), each felony conviction of

10 the physician.

11 ‘‘(b) FORM OF REPORTING.—The information re12 quired to be reported under subsection (a) shall—

13 ‘‘(1) be reported regularly (but not less often

14 than monthly) and in such form and manner as the

15 Secretary prescribes, and

16 ‘‘(2) be reported to the Secretary, or, in the

17 Secretary’s discretion, to the agency described in

18 section 424(b).

19 ‘‘(c) SANCTIONS FOR FAILURE TO REPORT.—Any

20 physician who fails to report information on a felony con21 viction required to be reported under this section shall be

22 subject to a civil money penalty of not more than $10,000

23 for each such failure to report. Such penalty shall be im24 posed and collected in the same manner as civil money

25 penalties under subsection (a) of section 1128A of the So-
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1 cial Security Act are imposed and collected under that sec2 tion.’’.

3 SEC. 205. NOTICE TO PRACTITIONERS; CORRECTION OF IN4 FORMATION.

5 Section 426 of the Health Care Quality Improvement

6 Act of 1986 (42 U.S.C. 11136) is amended—

7 (1) by inserting ‘‘(a) IN GENERAL.—’’ before

8 ‘‘With respect to’’;

9 (2) in subsection (a) (as so designated), in

10 paragraph (1), by striking ‘‘, upon request,’’; and

11 (3) by adding at the end the following sub12 section:

13 ‘‘(b) STATEMENT OF PRACTITIONER.—

14 ‘‘(1) IN GENERAL.—With respect to informa15 tion reported under this part, if the physician or

16 other licensed health care practitioner involved sub17 mits to the Secretary a statement regarding the in18 formation so reported, the statement shall be made

19 a part of the report involved, subject to paragraph

20 (2). Such a statement may be made at any time, and

21 may be revised.

22 ‘‘(2) LENGTH OF STATEMENT.—Paragraph (1)

23 applies to a statement by a physician or other li24 censed health care practitioner only if the statement
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1 does not exceed 4,000 characters, including spaces

2 and punctuation.

3 ‘‘(3) NOTICE.—In carrying out subsection

4 (a)(1), the Secretary shall inform the practitioner in5 volved that a statement under paragraph (1) may be

6 submitted, and that the statement is subject to the

7 limitation described in paragraph (2).’’.

8 TITLE III—DUTY TO OBTAIN

9 INFORMATION

10 SEC. 301. DUTY OF HOSPITALS TO OBTAIN INFORMATION.

11 Section 425 of the Health Care Quality Improvement

12 Act of 1986 (42 U.S.C. 11135) is amended by adding at

13 the end the following subsection:

14 ‘‘(d) APPLICABILITY TO FEDERAL HOSPITALS.—

15 This section applies to Federal hospitals to the same ex16 tent and in the same manner as such subsection applies

17 to other hospitals.’’.

18 SEC. 302. DUTY OF BOARDS OF MEDICAL EXAMINERS TO

19 OBTAIN INFORMATION.

20 Part B of the Health Care Quality Improvement Act

21 of 1986 (42 U.S.C. 11131 et seq.) is amended by inserting

22 after section 425 the following section:
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1 ‘‘SEC. 425A. DUTY OF BOARDS OF MEDICAL EXAMINERS TO

2 OBTAIN INFORMATION.

3 ‘‘(a) IN GENERAL.—Effective six months after the

4 date of the enactment of the Patient Protection Act of

5 2000, it is the duty of each Board of Medical Examiners

6 to request from the Secretary (or the agency designated

7 under section 424(b)) information reported under this

8 part concerning a physician—

9 ‘‘(1) at the time the physician submits the ini10 tial application for a physician’s license in the State

11 involved, and

12 ‘‘(2) at each time the physician submits an ap13 plication to continue in effect the license.

14 A Board of Medical Examiners may request information

15 reported under this part concerning a physician at other

16 times.

17 ‘‘(b) FAILURE TO OBTAIN INFORMATION.—With re18 spect to an action for mandamus or other cause of action

19 against a Board of Medical Examiners, a Board which

20 does not request information respecting a physician as re21 quired under subsection (a) is presumed to have knowl22 edge of any information reported under this part to the

23 Secretary with respect to the physician.

24 ‘‘(c) RELIANCE ON INFORMATION PROVIDED.—With

25 respect to a cause of action against a Board of Medical

26 Examiners, each Board of Medical Examiners may rely
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1 upon information provided to the Board under this title,

2 unless the Board has knowledge that the information pro3 vided was false.’’.

4 TITLE IV—GENERAL

5 PROVISIONS

6 SEC. 401. REQUEST OF BOARD OF MEDICAL EXAMINERS RE7 GARDING PHYSICIAN INFORMATION IN NA8 TIONAL PRACTITIONER DATA BANK.

9 Section 427(a) of the Health Care Quality Improve10 ment Act of 1986 (42 U.S.C. 11137(a)) is amended by

11 adding at the end the following: ‘‘The Secretary (or the

12 agency designated under section 424(b)) shall, upon re13 quest, provide the Board of Medical Examiners of a State

14 a summary of information reported under this part on

15 physicians who are licensed in that State. For each physi16 cian included in such a summary, the summary shall at

17 a minimum provide the name, address, total number of

18 reports of such information, and the number of reports

19 for each report type.’’.

20 SEC. 402. REGULATIONS; EFFECTIVE DATE.

21 The Secretary of Health and Human Services shall

22 promulgate a final rule to implement the amendments

23 made by this Act not later than January 31, 2001. Such
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1 amendments take effect 30 days after the date on which

2 such final rule is promulgated.

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