When Must a Hospital Report Medical Staff Conduct to the NPDB and the Utah DOPL? Understanding Adverse Action and Unprofessional Conduct
Reporting Requirements under Federal and Utah Laws
By Kristy Kimball-Finlayson in conjunction with Laura Anne Taylor
The federal Health Care Quality Improvement Act of 1986 (HCQIA) requires hospitals to report certain disciplinary actions taken against physicians to the National Practitioner Databank (NPDB) and the state licensing entity. The Act states that if a hospital:
(a) takes a professional review action that adversely affects the clinical privileges of a physician for a period of longer than 30 days;
(b) accepts the surrender of clinical privileges by a physician–
(i) while the physician is under an investigation by the entity relating to possible incompetence or improper professional conduct, or
(ii) in return for not conducting such an investigation or proceeding . . .
the hospital “shall report” information about the physician and the physician’s conduct directly to the NPDB, with a copy provided to the appropriate state licensing agency. 42 U.S.C. § 11133(a)(1); 45 C.F.R. § 60.5. Information to be reported includes the physician’s name and a description of the acts, omissions, or other reasons for the disciplinary action, along with any other information that might be relevant. In Utah, as the state entity with the exclusive responsibility for the licensing of physicians, the Utah Department of Occupational and Professional Licensing (DOPL) fills the role of the “Board of Medical Examiners” contemplated by the statute. Thus, hospitals are required to report adverse actions affecting the clinical privileges of physicians directly to the NPDB as well as provide a copy of the report to DOPL.
The Utah Medical Practice Act does not contain a separate DOPL reporting requirement for actions against practitioners covered under its provisions. See Utah Code Ann. §§ 58-67-101 et seq. (2013). However, the Utah Nurse Practice Act, does contain a reporting requirement if a hospital takes disciplinary action against a nurse. Hospitals are required to report to DOPL within 30 days any disciplinary actions against employees licensed under the Nurse Practice Act related to the employee’s professional acts or omissions, competence, or alcohol or drug abuse. Utah Code Ann. § 58-31b-702(1).
Finally, the Utah Health Care Providers Immunity from Liability Act (Liability Act) requires hospitals to report a broader scope of medical staff conduct to DOPL. The Liability Act requires any health care facility that “employs, grants privileges to, or otherwise permits a licensed health care provider to engage in licensed practice within the health care facility” to report to DOPL certain licensee actions within 30 days. Utah Code Ann. § 58-13-5(3). This statute defines “licensed health care provider” as any health care provider licensed by DOPL that practices within the health care facility, extending beyond physicians and nurses to include licensed social workers, lab techs, physical therapists, and on-site pharmacists, among others. Utah Code Ann. § 58-13-5(1); § 78B-3-403(12). Reportable events include terminations for cause, disciplinary actions, and findings of unprofessional or unlawful conduct including violations of professional obligations or alcohol or drug abuse. Note that this reporting requirement is much broader than the requirements under either the HCQIA or the Nurse Practice Act; in additional to reporting official disciplinary actions, the Liability Act requires reporting to DOPL of any “findings,” even those that do not result an official action, related to any licensed health care provider’s conduct.
In conclusion, hospitals are under an affirmative obligation under federal law to report certain events affecting a physician’s clinical privileges to the NPDB as well as to the state entity with responsibility for physician licensing—in Utah, DOPL—within 30 days. In addition, hospitals are under an affirmative obligation under Utah law to report terminations, disciplinary actions, and findings of any DOPL licensees’ unprofessional or unlawful conduct to DOPL within 30 days.
Written by Kristy Kimball of Holland & Hart LLP, formerly of Kimball Legal, in conjunction with Laura Anne Taylor, SJ Quinney College of Law.
(This article originally appeared in Kimball Legal’s October Newsletter. To learn more about Kristy Kimball, please visit her website page at https://www.hollandhart.com/kmkimball.)