FAQ: Act 13 Physician Self-Reporting Rules
Effective since May 19, 2002, the physician self-reporting provision of Act 13—the Medical Care Availability and Reduction of Error (Mcare) Act—requires physicians to notify their licensing board when they are sued for malpractice. Below are answers to frequently asked questions about physicians' responsibilities under Act 13.
- How did the physician reporting provisions come to be included in the law?
- What tort and insurance reforms were created by Act 13?
- What patient safety elements were included in the law in exchange for these reforms?
- What are the physician reporting requirements under Act 13, and should physicians be alarmed by these or by the State Board’s investigation process?
- How does the State Board determine which cases warrant an investigation?
1. How did the physician reporting provisions come to be included in the law?
When the negotiating sessions that led to Act 13 were convened by Senate Majority Leader David Brightbill, the interested parties were told that the legislation would address three major areas:
- Tort reform
- Insurance
- Patient safety
Even our strongest supporters in the legislature made it clear that we would have to accept significant patient safety changes in return for reforms in tort and insurance law.
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2. What tort and insurance reforms were created by Act 13?
|
Tort reforms |
Insurance reforms |
| • |
Expert witness requirements |
| • |
Periodic payment of future medical bills |
| • |
Reduction to present worth for future wage loss |
| • |
Collateral source rule |
| • |
Venue reform |
| • |
Statute of repose |
| • |
Remittitur | |
| Act 13 provided critically needed insurance relief in the form of: |
| • |
A reduction in the mandatory insurance requirement from $1.2 million to $1 million, and |
| • |
A grant of approximately $400 million from Auto CAT Fund revenues to help pay down the Mcare fund’s unfunded liability. | |
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3. What patient safety elements were included in the law in exchange for these reforms?
Legislators and other critics charged that Pennsylvania’s licensing boards were among the worst in the nation in disciplining physicians who practice poor medicine. In exchange for tort and insurance reforms, these changes—imposed over the objections of the State Society—had broad bipartisan support in the General Assembly and were the price physicians were required to pay for the reforms achieved in other areas.
Patient safety elements included:
- Creation of the Patient Safety Authority
- New physician reporting requirements
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4. What are the physician reporting requirements under Act 13, and should physicians be alarmed by these or by the State Board’s investigation process?
Physicians are required to report the following to their licensure board within 60 days of the occurrence:
- Notice of a civil malpractice lawsuit.
- Notice of a disciplinary action against the physician by the licensing authority of another state.
- Any controlled substance conviction.
- Any arrest for a criminal offense such as homicide, assault, sexual offenses, and controlled substance violations.
Under Act 13, failure to report such complaints to the State Board of Medicine will result in a fine of $1,000.
To comply:
- Make a copy of the complaint
- Print and complete the Act 13 physician self-reporting form at the bottom of the page
- Mail both to the State Board
The boards have established a process for determining which cases are serious enough to warrant the initiation of an investigation (see next question for details). It's clear from these criteria that, while technically possible, it's highly unlikely that a physician would ever be disciplined for committing a single act of simple negligence. Rather, the guidelines are designed to identify the small number of physicians who commit serious errors or engage in repeated acts of negligence.
It's also important to note that Act 13 did not, in any way, reduce the due process rights of physicians who have been cited by their licensing board.
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5. How does the State Board determine which cases warrant an investigation?
According to the Act 13 guidelines, the State Board of Medicine’s legal office will investigate the following types of Mcare reports (note that these guidelines may vary slightly from those adopted by the Osteopathic Medicine Board):
- Any sexual misconduct case.
- Any physician with two or more claims in a biennium for non-surgical specialties and four or more claims per two-year cycle for physicians in surgical specialties; any claims showing multiple instances of the same error or complication by the same licensee.
- Any claim related to wrong site surgery, wrong procedure performed, or procedure performed on wrong patient.
- Any claim which could be characterized under current guidelines as “gross negligence.”
- The definition of “gross negligence” is presently set forth in the Medical Board’s regulations at 49 Pa. Code § 16.61(a)(6): “Practicing medicine fraudulently, or with reckless indifference to the interests of a patient on a particular occasion, or with negligence on repeated occasions.”
- Leaving a patient unattended, constituting patient abandonment;
- Leaving a procedure unattended.
- Any claim related to improper prescribing of medication, including:
- Failing to adhere to accepted standards in the prescribing or administering drugs for specific conditions, including pain management; (e.g. Violating the Medical Board’s current regulations at 49 Pa. Code § 16.92:“Prescribing, administering, and dispensing controlled substances.” This provision sets up the standards under which all controlled substances should be prescribed, including proper patient history and examination, proper record keeping, and follow up evaluations of the patient.)
- Gross errors in dosing of a medication [i.e., 5-10X normal dose or 1/10 of normal dose] (includes anesthesia & over prescribing);
- Giving a medication when a patient’s records clearly documents an allergy to such medication.
- Practicing while physically or mentally impaired from substance abuse or while otherwise suffering from a documented impairment for which practitioner should be but is not receiving treatment or should be but is not taking regular medication, or because of which practitioner has been advised not to practice.
- Treatments or procedures beyond the scope of the practitioner’s ability, knowledge, technical skills, experience.
- Intentional harm or intentional abuse.
- Any case that results in the unexpected death of a patient. Death is unexpected when it is not one of the anticipated outcomes of the medical service being provided.
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If you have further questions, please contact Catherine Wilson in the Society’s Division of Health Policy and Regulatory Affairs at (800) 228-7823, ext. 1465.
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Last Updated: 10/8/2008