QUESTION:    One of our older surgeons had several very bad cases right in a row. Medical Staff and Hospital leadership were very concerned and, after a lot of discussion, we decided we could not let the surgeon practice until we had completed a focused review. We asked the surgeon to “agree to refrain from exercising her clinical privileges” while we completed the focused review, but she refused. We then imposed a precautionary suspension. A week later, the surgeon resigned. We had not commenced an investigation so we weren’t sure if we had to report the resignation to the National Practitioner Data Bank (“NPDB”).

 ANSWER:     You are correct in thinking about whether an investigation was started with respect to your reporting obligation to the NPDB. The Health Care Quality Improvement Act (“HCQIA”) imposes an obligation on hospitals to report professional review actions that adversely affect the clinical privileges of a physician for a period of longer than 30 days. The HCQIA also requires a hospital to file a report if it accepts the surrender of clinical privileges “while the physician is being investigated…relating to possible incompetence or improper professional conduct or…in return for not conducting such an investigation.” So, clearly, if the physician had resigned during an investigating or in return for not conducting an investigation, the resignation would have been reportable to the NPDB.

In your situation, even though there was no investigation, the physician’s clinical privileges had been precautionarily suspended. The NPDB Guidebook specifically addresses the reportability of resignations that occur during a suspension. According to E-20 of the Guidebook: “If the physician, dentist, or other health care practitioner surrenders his or her clinical privileges during a summary suspension, that action must be reported to the NPDB.” Therefore, even though the surgeon did not resign during or in lieu of an investigation, the surgeon’s resignation while under a precautionary suspension must be reported to the NPDB. It is also important for you to check state law. You may have a separate obligation to report the resignation under state law.