Discipline, Bureaucracy & Integrity

Recently, the Federal Government started a database called the Healthcare Integrity and Protection Data Bank.  This grouping of information is being amassed to assist the healthcare industry in highlighting nurses and other health care providers who, through honest errors or negligence have been written up in various hospitals and medical facilities.  The goal is to prevent providers from moving from facility to facility to avoid having to account for their malfeasance.  Created in 1996, the HIPDB website lists their goal, “to combat fraud and abuse in health insurance and health care delivery.”   The initiative is noble and necessary in the health delivery industry.  It protects good nurses from having to deal with negligence from others, and it protects the confidence with which the public views nurses’ ability to provide care in the hospital setting.
The devil, however, is in the details.  Currently, the bureaucracy that pervades the federal government agencies that are not subject to the direct oversight in laws that Congress passes has made it virtually impossible for facilities to access the information or for individual providers to dispute potentially career threatening claims.  Access according to the law is to be granted to the provider through Section 1128E of the Social Security Act, which states in part, “the Secretary [of HHS] will…provide for…disclosure of the information, upon request, to the health care provider, supplier, or licensed practitioner.”  Unfortunately, the red tape surrounding the agency prevents said provider from accessing the information in most cases.  This data is of critical importance to the working nurse.  If you have been disciplined, most labor laws mandate that you have a right to defend yourself.  Even common criminals have the right to a trial by their peers.
What’s worse is that human resource departments of hospitals and nursing homes across the country are finding similarly difficult processes in obtaining information about potential hires.  A recent story uncovered by National Public Radio shed some light into this issue.  In the piece, Dr. Sidney Wolfe of the Public Citizen's Health Research Group talks about the problems surrounding the red tape.  Dr. Wolfe “notes that there are more than 102,000 nurses, nurse aides, pharmacists and pharmacy assistants who've been disciplined and included in the registry, but that hospitals and nursing homes can't check the data bank.”
There are three critical areas of importance in regard to this data.  First and foremost, hospital HR managers must have access to this information so that patient care does not suffer.  Without it, it would be easy for negligent providers to move from hospital to hospital without worrying about their past mistakes following them.  This is a detriment to the hospital and to the patient.
Second, the nursing profession needs to be able to identify “problem” professionals and either assist them through training and education, or our work toward removing their credentials. This is critical for the long term success of the industry itself.
Finally, nurses must be able to appeal these decisions.  The way a disciplinary write up could eventually affect a person’s career is at stake.  Overall, the HIPDB is a noble and necessary idea, but without the removal of bureaucracy, it's useless.