An agency within the U.S. Department of Health and Human Services that maintains a discipline and medical-malpractice database reopened it for public access yesterday, two months after the agency had first taken the database offline.

The National Practitioner Data Bank contains information used by hospitals, insurers, and licensing boards to track doctors' records, check prospective hires, and make other decisions. A publicly available version of the database -- which removed confidential identifiers such as doctors' names and addresses -- had long been used by reporters and others interested in patient safety. In the years it was online, journalists could reference the database and, with additional reporting, could at times identify doctors with uniquely long histories of being sued or disciplined for medical malpractice.

Then, two months ago, the government cut off public access -- a decision that was sharply criticized by a number of journalismorganizations and consumer groups. 

What was behind that decision? Apparently, one Kansas doctor with a trail of malpractice suits.

A public records request by Sen. Charles Grassley and the New York Times turned up documents about the decision that shows that the agency closed the database days after the doctor, Robert Tenny, complained to the government. Thanks to the database, he told the Health Resources and Services Administration, or HRSA, he was about to get unwanted attention in his local paper.  

We culled through the documents and pulled out some interesting snippets that give a glimpse into the backstory behind why the public database was temporarily shut down and why -- even now -- the restored database has some new restrictions.  

A brief timeline:

Aug. 16 - A local newspaper reporter requested a comment from Dr. Tenny, a neurosurgeon, through Tenny's attorney. The reporter, Alan Bavley of the Kansas City Star, was working on a story about doctors who went undisciplined despite histories of malpractice allegations. He had used the public database coupled with publicly available court records to do his reporting.

Aug. 24 - The doctor sent a fax to Cynthia Grubbs at HRSA. Tenny asked for help, alarmed that the reporter had identified him and was poised to report on his malpractice settlements. The fax looked like this:

Aug. 26 - The HRSA wrote to the reporter, warning that he could face at least $11,000 in fines for each violation of confidentiality. The doctor was copied on the letter.

Sept. 1 - The agency cut off public access to the database.

Sept. 4 - An article ran on the front page of the Kansas City Star, telling the story of a woman who died in 2007 after undergoing a brain surgery with Dr. Tenny. It noted that Tenny had been sued at least 16 times for medical malpractice but had never been disciplined by the state’s licensing boards. (Update: Worth noting that according to the report, Dr. Tenny settled at least six of the 16 lawsuits; the others were either dismissed or the outcomes either weren't clear. "In at least one case, the verdict was in Tenny's favor," the Star reported.) 

On the same day, the doctor wrote to HRSA again, this time with a copy of the article, and expressed a desire that this “will change the way public data is presented.”

Sept. 5, 7, 11, 14, 15, and 20 - Dr. Tenny wrote five more letters to HRSA, complaining that the newspaper was making “a concerted effort” to end his career and that the article “significantly questioned the security of your data.” He also speculated that the reporter had gotten improper access to information from the full data bank either from a local medical center or from a disgruntled former Data Bank employee.

Sept. 22 - The Kansas City Star wrote a story about how groups were urging that the database be reopened. Dr. Tenny wrote to HRSA again: “Stay strong and keep up the good work!” (The American Medical Association, around this time, also wrote a letter supporting the agency's decision to remove the file.)

Sept. 26 - HRSA responded to Dr. Tenny's six letters, telling him that the publicly accessible database had been removed, and that the agency had contacted hospitals to remind them of confidentiality requirements and sanctions for breaches of confidentiality.

Nov. 9 - HRSA restored public access to the database, but as many reports have noted, it comes with a major caveat. According to the website, users of the new database are no longer allowed to combine information gleaned from the public database with any other publicly available information in a way that would identify doctors. In other words, the government is now trying to tell the public -- including the press -- what it’s allowed to do with publicly available information. (The agency told the Kansas City Star that it has a duty "to make certain that information about individual practitioners remains confidential.")

Sen. Grassley and others have pledged to keep fighting the agency’s interpretation of the law, questioning whether the database is ultimately meant to protect the public or to protect physicians.

“The interpretation of the law ought to be for public benefit,” Grassley said. “A single physician complained that a reporter identified him through shoe leather reporting, not the public data file. One complaint shouldn’t dictate public access to federally collected data for 300 million people.”

We've called Dr. Tenny's office for comment but have not received a response.