The AdvoKayte Podcast: Holding Healthcare Accountable!

Summary (46m 43s).
Episode 6 - Understanding the NPDB with Dr. Oshel

What happens when the database of bad practitioners that was designed to inform and protect our health care system is routinely undermined by the very institutions it was designed to protect? Dr. Robert Oshel was the Associate Director for Research and Disputes for the National Practitioner Data Bank (NPDB) until his retirement in 2008. He tells us about the Data Bank, why it was founded, how it is used, and why it ultimately fails to protect patients from the malpractice of bad practitioners. 

The NPBD should provide a foundation for every healthcare providing institution and organization to safely stand on in regards to patient safety. Instead, it’s more like a wooden floor with tiny cracks that bad actors slip through. Dr. Oshel is here to fill us in on where those cracks are, what happens when bad actors slip through them, and why the very people the NPDB is supposed to protect are often the first to undermine it. 

The National Practitioner Data Bank exists to collect information about bad doctors and other medical practitioners. Established by Congress in 1986, the NPDB is a repository of reports on medical malpractice payments and other actions related to health care practitioners, providers, and suppliers. It is supposed to be a tool used in the hiring process to prevent practitioners from moving from one state to another without disclosing previous issues surrounding lawsuits, malpractice complaints, or other damaging events. If updated and used properly, the NPDB could be a powerful list of high-risk hires, people you wouldn’t want working for your organization or even thinking about touching your patients. Unfortunately, the way the system works actually incentivises hospitals and health care groups to try to circumvent reporting when problems happen within their organization. It gets twice as frustrating when you realize how narrow the problem actually is. 

Dr. Oshel explains that only 1.8% of all physicians were responsible for half of all the money paid out for malpractice. Of that 1.8%, only 6% of them ever had any action taken against their clinical privileges in a hospital and only 11% of them ever had any action (even a reprimand) taken against their licensure. The profession can do a lot better in terms of policing itself.

“The incentives basically are to protect a physician who's a problem physician unless he is so bad that he's causing problems for the hospital's image basically or they think there's going to be a legal liability in terms of malpractice if they don't do something about somebody with a really proven bad record. But the incentives are not to take action and not to report and it's just very unfortunate.” Dr. Robert Oshel, AdvoKAYte, December 17, 2025

NPDB files are held confidential within a closed system of regulators, healthcare providers and employers, legal professionals, and other parties with interest in such critical patient safety information. The group that doesn’t have access to these files are patients themselves. 

Nevertheless, underreporting and finding ways to circumvent reporting rules appears to be the norm. Dr. Oshel outlines some of the ways hospitals and other health care institutions work to get around rules designed to protect both them and you the patient. He also goes over the penalties for not reporting, some of which are slight and some of which are extraordinary but none of which appear to actually compel proper reporting practices. 

Kay and Dr. Oshel talk about how the system could be changed to force health care institutions to properly report bad practitioners rather than allow them to quietly move on to another malpractice. When the system works, it works remarkably well to weed out bad practitioners. Dr. Oshel tells us how the National Practitioners Data Bank has made hospitals aware of critical information about previous cases or complaints against physicians that even state licensing boards are unaware of. If there was legislated consistency in reporting, the NPDB could be an even greater deterrent to the small number of very bad actors in our healthcare systems and help ensure a greater degree of patient safety.