The watchdog group Public Citizen has released an analysis of data from the National Practitioner Data Bank (NPDB) showing that state medical boards have failed to discipline 55% U.S. doctors who either lost their clinical privileges completely or had them restricted by the hospitals where they worked.

The study looked at data from the NPDB’s Public Use File from its start in 1990 until 2009. The data showed that of the 10,672 physicians in the data banks who had one or more clinical privilege actions, only 45% had state licensing actions as well, meaning that 55%, or 5,887 of the physicians, had no state licensing actions taken against them. Clinical privileging actions—losing hospital privileges or having them suspended or restricted—occurred for a variety of reasons.

The study pointed out that of the 5,887 physicians who were disciplined by their hospitals but not by the state, 220 were disciplined because they were “an immediate threat to health or safety.” An additional 1,119 physicians were disciplined because of incompetence, negligence, or malpractice. And 605 physicians were disciplined because of substandard care. Other serious deviations of care included sexual misconduct, inability to practice safely, fraud (including insurance fraud, fraud obtaining a license, and fraud against health care programs), and narcotics violations.

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“One of two things is happening, and either is alarming,” Sidney Wolfe, MD, Director of the Public Citizen Health Research Group and overseer of the study, stated in a press release. “Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed.”

To remedy the situation, Public Citizen sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, and notified the 33 medical boards of the states that have the worst records in disciplining the physicians.