Under the Health Care Quality Improvement Act of 1986, hospitals, state medical practice boards and other entities have duties to report certain actions and suspensions of physicians, dentists and certain other practitioners to the specially created National Practitioner Data Bank. Hospitals are required by the Act to inquire of the Data Bank every two years concerning doctors and dentists on their medical staffs who are seeking the renewal of their hospital privileges. A physician or dentist who is reported to the Data Bank may well find his career at an end because of the reluctance of hospitals to grant privileges to a professional with documented "quality" or "competence" problems.
Not infrequently providers are "coerced" into resigning from the medical staff or independently seek to avoid a Data Bank report by resigning from the Medical Staff. Unfortunately, resignation during a pending hospital investigation or to avoid a hospital investigation also triggers a reportable event. Under the rules regarding disputes concerning reported events, 45 CFR 60.14, a physician or dentist may submit a notice to the Secretary of HHS of the existence of a dispute with the report within 60 days of the mailing of the original notice of the report by the Secretary. In the case of Simpkins v. Donna E. Shallala, 999 F. Supp. 106 (D. D.C. 1998), the District of Columbia U.S. District Court ruled that the Secretary had a duty to investigate the facts of the dispute to determine that the facts of the dispute to determine whether the reporting obligation was properly triggered. The Secretary could not get buy simply by indicating that a dispute existed as to the facts. The Court in Simpkins found that Dr. Simpkins did in fact resign from the medical staff, but that he did not resign "while under investigation" concerning the quality of his care. The court held that a negative review by Dr. Simpkins supervisor did not constitute the type of formal "entity" investigation required to implicate the reporting requirement.
"Thus the text of the relevant statute and regulation signify that formal action by the hospital, as an organization , triggers [42 U.S.C.A. ]Section 11133(1)(A)'s reporting provisions, not individual action."
The court cited NPDB's own Guidebook for the proposition that the reporting hospital must provide contemporaneous evidence to the NPDB of an ongoing investigation at the time of the surrender of privileges.