Reporting Requirements under New Jersey Law

Submitted by New Jersey Professional License Defense lawyer, Jeffrey Hark

As with federal law, the law of New Jersey requires practitioners and other health care entities to make certain disclosures to government agencies regarding medical malpractice settlements. Under the substantive state law of New Jersey, there are several provisions which impact the reporting of settlements to the State Board of Medical Examiners or other state entity. Under N.J.S.A. 17:30D-17, any insurer or insurance association which is authorized to issue medical malpractice insurance in New Jersey is required to notify the Medical Practitioner Review Panel of any medical malpractice claim settlement, judgment, or arbitration award. In addition, under the requirements of N.J.S.A. 45:9-19.9, insurers or practitioners must notify the review board of not only medical malpractice claim settlements and adjudications, but also any terminations or denial of or surcharge on the medical malpractice liability insurance coverage of a practitioner. That section also allows the panel to receive referrals from the State Board including complaints alleging professional misconduct, incompetence, negligence or impairment from other health care providers or consumers. N.J.S.A. 45-9-19.9(b). These complaints, however, are not mandatory.

The New Jersey state law also places a burden of informing the state medical board on practitioners themselves. Practitioners are required to update the board as necessary to ensure that their consumer protection profile contains all of the required information. N.J.S.A. 45:9-22.22. While much of that information is biographical, the profile also requires that the practitioner inform the board of a number of pieces of information regarding legal action. First, practitioners must inform the board of any criminal convictions of a sufficient degree (for crimes of the first, second, third or fourth degree) within the most recent ten years. N.J.S.A. 45:9-22.23(a)(6). Second, information must be provided including a description of any final board disciplinary actions within the most recent 10 years, including actions being appealed, though these will be identified as such. Id. at (a)(7). Likewise, the statute requires that the board receive a description of any final disciplinary actions in that same 10 year period from any out of state licensing boards. Id. at (a)(8). The board must also receive a description of any revocation or involuntary restriction of the privileges at a health care facility for reasons related to a practitioner’s competence, misconduct, or impairment. Id. at (a)(9). Such reportable incidents include non-renewal of staff membership, or the restriction of privileges taken in lieu of or in settlement of disciplinary cases within the past 10 years. The State Board defined such restrictions of privileges actions as “a privileges action must be related to the physician’s professional competence or conduct in a way that adversely affects or could adversely affect the patient’s health or welfare.” See http://www.state.nj.us/lps/ca/bme/reportob/obligations.htm. Such actions must be reported to the board and submitted to the National Practitioner’s Data Bank if the action lasts more than 30 days. Id.

Perhaps the most important reporting requirement in the statute is the requirement that all medical malpractice judgments, arbitration awards, and all settlements within the most recent five years be reported to the board. N.J.S.A. 45:9-22.23(a)(10). The law states that the practitioner must report all settlements of medical malpractice claims in which a payment is made to the complaining party within the most recent five years. Id. The reporting of claims and settlements, though, is handled in a specific manner. Pending claims will not be included in the profile nor disclosed to the public, malpractice claims being appealed shall be identified as such, the payment of claims shall be placed into context based on the number of judgments against the practitioner, and any settlements in the profile will be disclaimed. Id. Specifically, all settlement information placed into the record shall contain language to the effect that “Settlement of a claim and, in particular, the dollar amount of the settlement may occur for a variety of reasons, which do not necessarily reflect negatively on the professional competence or conduct of the physician (or podiatrist or optometrist). A payment in settlement of a medical malpractice action or claim should not be construed as creating a presumption that medical malpractice has occurred.” Id. at (a)(10)(d). One should note, however, that New Jersey law doesn’t have a single cogent definition of “medical malpractice,” so it is not entirely clear which activities, beyond the obvious, would trigger the reporting requirements. As with the federal laws and regulations, the state of New Jersey ultimately requires the reporting of any medical malpractice claim settlement payment and any adverse action taken against the privileges of the practitioner to the State, and ultimately, to the NPDB.