NEWS RELEASE
Government Must Tell Medicare Patients Results of Investigations
Into Complaints That Doctors Erred, Appeals Court Says
HHS Policy of Withholding Information Violates Law, Court Concurs with Public Citizen
WASHINGTON, D.C. - A federal appeals court has ruled that the government cannot keep secret the results of
its investigations into Medicare patients' complaints about the quality of their medical care. Under
the policy at issue in the case, the government would keep secret the results of investigations, even when it found that the doctor in
question made a medical error, if the doctor refused to consent to disclosure.
The U.S. Court of Appeals for the District of Columbia held that this policy violated the Peer Review Improvement
Act, affirming a July 2001 ruling by a district court.
Public Citizen filed suit in 2000 against the U.S. Department of Health and Human Services (HHS). The complaint
stemmed from the agency's refusal to disclose investigation results to Kentucky resident David
Shipp, who filed a complaint related to his wife's care in 1998 and 1999 at Baptist East Hospital in Louisville. HHS's Peer Review
Organization (PRO) launched an investigation into three doctors, but refused to tell Shipp the results of the
investigations into two of the doctors because the physicians did not consent to the disclosure.
Lawyers for HHS argued that maintaining this confidentiality was consistent with the law and necessary for the
PRO to perform its duties. However, that litigation position was at odds with a report from
HHS' Office of Inspector General, which concluded that the policy of keeping investigation results secret "hinder[s] the
PROs' ability to be responsive to beneficiaries who complain" and urged that the results of all
investigations be disclosed. Public Citizen contended that the policy violated the Peer Review Improvement Act of 1982, as amended in 1986,
which states that PROs "shall inform the individual (or representative) of the organization's final disposition of the
complaint."
In today's ruling, the three judge panel agreed with Public Citizen that the form letter HHS had sent to
complainants, notifying them only that their complaint had been received but not disclosing the results of the
investigations into the quality of medical care provided under Medicare, did not meet the requirements of the law.
A copy of the ruling is online at http://pacer.cadc.uscourts.gov/docs/common/opinions/200306/01-5294a.pdf .
"The decision is a victory for Medicare patients who are the victims of substandard medical care," said Amanda
Frost, an attorney with Public Citizen Litigation Group. "People who have personally been
harmed, or whose family members have been harmed, deserve to know what came of their complaint."