When the San Francisco Department of Health decided in 1998 to cut two staff positions at county-owned Laguna Honda Hospital, Dr. John Ulrich, Jr., stood up at a staff meeting and calling the layoffs “an injustice to patients.” The following week, he and other physicians sent a letter of protest to the health department.
Less than two weeks later, hospital officials notified Dr. Ulrich he was being investigated for incompetence, “spanning the full range of hospital care” from incomplete diagnoses to inappropriate diagnostic orders to overall poor management of his patients' hospitalizations.
Eventually, a California Medical Board review of Dr. Ulrich's performance would determine that the doctor had provided acceptable care, but at the time, Dr. Ulrich - believing he was being targeted for speaking out - quit in protest. He posted a resignation letter, near a nurses' station, that criticized the hospital's budget priorities.
By resigning while under investigation, though, Dr. Ulrich learned the following week that he would be reported to the National Practitioner Data Bank, a listing of doctors who have faced disciplinary sanctions, lost hospital privileges, or lost malpractice judgments.
Dr. Ulrich immediately tried to take back his resignation. When the hospital refused, he sued.
The databank that strikes such fear in physicians was established as part of the Health Care Quality Improvement Act of 1986, though it was not in operation until 1990.
It was prompted by evidence that incompetent or unprofessional doctors, once they had been detected, were simply moving to other states and resuming their practices.
The listings are not public, but every state medical board and hospital checks for databank information on any doctor who applies for a license to practice in their states or for staff privileges at their hospitals.
Since 1991, the Rockville, Md., databank has collected reports on more than 125,000 physicians, most of them for malpractice payments. Reports on doctors who lost their clinical privileges or their licenses represent less than 20 percent of the total, with 1,000 such reports filed each year.
About 1,500 reports overall have been filed for “unprofessional conduct,” which could include whistleblower physicians if they're deemed “disruptive,” but also includes doctors who have raped patients or committed fraud.
Once a physician is listed in the databank, only the reporting hospital can withdraw the report. A doctor can appeal to the Health and Human Services secretary if he believes the report is inaccurate or on technical grounds, but less than 5 percent of those appeals succeed.
A databank report “can essentially make you unemployable, and it can be the difference between getting insurance and not getting insurance,” said Dr. Edward Dench, Jr., recent president of the Pennsylvania Medical Society.
“With malpractice being what it is, insurers are clearly cherry picking, and if there's anything that makes you look unusual, they're not going to take you,” Dr. Dench said.
After Dr. Ulrich sued, the presidents of two California medical associations told the court that “it will be virtually impossible” for Dr. Ulrich to find work at any U.S. hospital with that report in the databank.
Dr. Ulrich, 54, lost in U.S. District Court - once the resignation was accepted, the hospital did not have to rescind it, the court said. But on appeal, the U.S. 9th Circuit Court ruled he could pursue his argument that he had been retaliated against for exercising his free-speech rights.
Dr. Ulrich, reached by phone, declined to talk about what happened, saying he still hopes to reach some resolution with the hospital. A hospital spokesman also declined comment, citing the pending legal action.
The Pittsburgh Post-Gazette is the sister paper of The Blade. Steve Twedt is a Post-Gazette staff writer.