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As President Obama and Congress stand poised to engage this summer in a colossal debate over legislation to provide all Americans with quality affordable health care, citizens of our nation and state must stand on guard against attempts by insurance companies and the health care industry to exploit the health care debate to obtain additional legal protections from accountability for injuries caused by substandard medical care.

Avoiding accountability is nothing new to the health care industry. Although federal law requires hospitals to report physicians who have their admitting privileges revoked or restricted for more than 30 days to the National Practitioner Data Bank (NPDB), a recent report by Public Citizen reveals that hospitals not only are failing to adequately discipline errant doctors but also are "turning a blind eye" to the NPDB reporting requirement.

Prior to the opening of the NPDB, the Department of Health and Human Services estimated that 5,000 hospital clinical privilege reports would be submitted annually; however, the actual number of reports has averaged only 650 per year.

In the 17-plus years the NPDA has been in existence almost half of American hospitals have failed to report even one physician disciplinary action, according to the Public Citizen report. Thousands of hospitals (with collectively hundreds of thousands of doctors with admitting privileges) have never disciplined and reported even a single doctor in the 17 years that the reporting requirement has existed.

In 1996, the Health Resources and Services Administration (the HHS agency that manages the NPDP) held a conference with all the stakeholders (including medical and hospital associations) to examine the issue of the number of reports filed with the NPDB. The conference concluded "the number of reports in the NPDB on adverse actions against clinical privileges is unreasonably low, compared with what would be expected if hospitals pursued disciplinary actions aggressively and reported all such actions."

Public Citizen identified two categories or reasons for this "dangerously low number" of hospital based disciplinary reports: lax hospital peer review and arrangements with disciplined doctors designed to avoid reporting, such as granting a "leave of absence" in lieu of a "suspension" and imposing discipline of less than 31 days.

On the Maryland front, another recent report by Public Citizen disclosed that Maryland ranks near the bottom in the nation (45th) in serious doctor disciplinary actions taken by a state medical licensing board. This embarrassing distinction is nothing new for Maryland, which consistently has been associated with such states as Mississippi and South Carolina for poor doctor discipline.

These studies reflect a reality. Accountability for substandard medical care only exists inside the courtroom, when an injured patient can obtain full compensation from a health care provider if the patient can prove that his or her injuries were the result of medical negligence, and the payment on a judgment must be reported to the NPDP.

If the health care and insurance industries are allowed to use the health care debate as a Trojan horse to limit patients' access to justice in the courtroom, there will be no accountability at all for substandard medical care.

So when the health care reform debate rages this summer, those concerned about protecting patient safety and patients' rights must stand on guard to prevent diversion of health care reform into liability protection. Limiting justice to injured patients is not barter for winning affordable health care for all patients.

Wayne M. Willoughby is public information officer and immediate past president of Maryland Association for Justice (formerly the Maryland Trial Lawyers Association).