Reversing a policy that has kept medical errors secret for more than two decades, federal officials say they intend to soon allow Medicare beneficiaries to obtain data about doctors who botched their care.
Tens of thousands of Medicare patients file complaints each year about the quality of care they receive from doctors and hospitals. In many cases, patients get no useful information because doctors can block the release of assessments of their performance.
Under a new policy, doctors will no longer be able to veto disclosure of the findings of investigations, officials said.
Federal law has for many years allowed for review of care received by Medicare patients, and the law says a peer review organization must inform the patient of the “final disposition of the complaint” in each case.
The federal rules used to carry out the law say the peer review organization may disclose information about a doctor only “with the consent of that practitioner.” The federal manual for peer review organizations includes similar language about disclosure.
Under the new plan, investigators will have to tell patients whether their care met “professionally recognized standards of health care” and inform them of any action against the doctor or the hospital.
Patients could use such information in lawsuits and other actions against doctors and hospitals that provided substandard care.
The new policy came in response to a lawsuit against the government by the son of a Medicare patient who was admitted to a hospital in Jacksonville, Fla., on Dec. 8, 1998, after an asthma attack and after experiencing high blood pressure. The patient, Mary S. Levine, died of a stroke six days later, while still a patient at the hospital.
The plaintiff, Alan S. Levine, had concerns about his mother’s care. He filed a complaint, which was investigated by a group of medical quality experts known as a peer review organization.
Levine and his lawyer, Amanda Frost of the Public Citizen Litigation Group, a non-profit law firm, filed the lawsuit, in which they argued that the old Medicare policy violated federal law.
“Getting the results of the investigation won’t bring back my mother,” Levine said in an interview. “But it will help me understand her death and come to terms with it.”
Levine said he was “curious to know whether the hospital or the doctors did anything that contributed to her death. A nurse told my sister that our mother had received a very high dose of asthma medication.”
The Florida peer review group had initially denied Levine’s request for information.
“Federal laws and regulations prohibit us from releasing information about your mother’s care without the consent of her physician,” Dr. Ferdinand Richards III, medical director of the Florida peer review group, wrote to Levine in August 1999. “Her physician refused to give consent. Therefore, we are unable to provide any specific information about the results of our review.”
Officials of the Department of Health and Human Services said they recently told the Florida review organization to disclose its findings to Levine, and the officials said they would change Medicare policy so patients in similar circumstances could get such information.
A senior official of the department said, “The revision of our policy is definitely an outgrowth of this particular case. We want to fix the problem and make sure no one has the same problem in the future.”
The peer review organizations are powerful watchdogs. They can deny payment for services and can order corrective action, including remedial education for doctors. In extreme cases, they can recommend fining doctors or excluding them from Medicare and Medicaid, the federal programs for people who are elderly, disabled or poor.
Levine said he had recently received a report about the investigation from the peer review organization, Florida Medical Quality Assurance Inc., which has a contract with the government to investigate complaints about Medicare service in Florida.
Richards wrote to Levine that the federal government had instructed him to reveal the findings.
The services provided to Levine’s mother “did not meet professionally recognized standards of quality,” Richards wrote. “Specifically, she received medications to which there was a documented possible allergy.”
