National Practitioner Data Bank (NPDB) Regulations

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Federal Register / Vol. 67, No. 78 / Tuesday, April 23, 2002 / Rules and Regulations

under Executive Order 12866 and is not
likely to have a significant adverse effect
on the supply, distribution, or use of
energy. It has not been designated by the
Administrator of the Office of
Information and Regulatory Affairs as a
significant energy action. Therefore, it
does not require a Statement of Energy
Effects under Executive Order 13211.
List of Subjects in 33 CFR Part 165
Harbors, Marine safety, Navigation
(water), Reporting and record keeping
requirements, security measures,
waterways.
For the reasons discussed in the
preamble, the Coast Guard amends 33
CFR part 165 as follows:
PART 165—REGULATED NAVIGATION
AREAS AND LIMITED ACCESS AREAS
1. The authority citation for part 165
continues to read as follows:
Authority: 33 U.S.C. 1231; 50 U.S.C. 191,
33 CFR 1.05–1(g), 6.04–1, 6.04–6, 160.5; 49
CFR 1.46.

2. A new temporary § 165.T09–002 is
added to read as follows:
§ 165.T09–002 Security Zones; Captain of
the Port Chicago Zone, Lake Michigan.

(a) Location. The following areas are
security zones. All coordinates are
based upon North American Datum
1983.
(1) All waters between the Navy Pier
and the Jardine Water Filtration Plant
shoreward of a line starting at the
southeast corner of the Jardine Water
Filtration Plant at 41°53′36″ N,
87°36′17″ W, and ending at the
northeast corner of the Navy Pier at
41°53′33″ N, 87°35′55″ W, and
shoreward of a line starting at the
southeast corner of the Navy Pier at
41°53′29″ N, 87°35′55″ W, thence to the
east end of Dime Pier at 41°53′23″ N,
87°35′58″ W, thence along the south
side of Dime Pier to the west end of
Dime Pier at 41°53′23″ N, 87°36′29″ W
thence southeast to the corner of the
seawall at 41°53′22″ N, 87°36′28″ W;
(2) All waters in the vicinity of the
Dresden Nuclear Power Plant south of a
line starting at the Illinois River shore
at approximate position 41°23′45″ N,
88°16′18″ W, thence east to shore at
approximate position 41°23′39″ N,
88°16′09″ W;
(3) All waters of Lake Michigan
around the Donald C. Cook Nuclear
Power Plant water intakes within a line
starting at the shoreline at 41°58.656′ N,
86°33.972′ W, thence northwest to
41°58.769′ N, 86°34.525′W, thence
southwest to 41°58.589′ N, 86°34.591′
W, thence southeast to the shoreline at
41°58.476′ N, 86°34.038′ W;

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(4) All waters of Lake Michigan
around the Palisades Nuclear Power
Plant within a line starting at the
shoreline in approximate position
42°19′02″ N, 86°19′05″ W, thence
northwest to 42°20′10″ N, 86°20′01″ W,
thence northeast to 42°19′43″ N,
86°19′52″ W, thence to the shoreline at
42°19′26″ N, 86°18′55″ W;
(5) All waters of the Rock River
within a 100-yard radius of the Byron
Nuclear Power Plant; with its center in
approximate position 42°05′01″ N,
89°19′27″ W;
(6) All waters 100 yards in all
directions of the 68th Street Crib, with
its center in approximate position
41°47′10″ N, 87°31′51″ W;
(7) All waters 100 yards in all
directions of the Dever Crib; with its
center in approximate position
41°54′55″ N, 87°33′20″ W;
(8) All waters of Lake Michigan
around the Zion Nuclear Power Plant
within a line starting from the shoreline
in approximate position 42°26′36″ N,
87°48′03″ W, thence southeast to
42°26′20″ N, 87°47′35″ W, thence
northeast to 42°26′53″ N, 87°47′22″ W,
thence to the shoreline at 42°27′06″ N,
87°48′00″ W;
(9) All waters of Lake Michigan
within an arc of a circle with a 100-yard
radius centered on the 79th Street Water
Filtration Plant, approximate position
41°45′30″ N, 87°33′32″ W.
(b) Regulations. (1) In accordance
with § 165.33, entry into this zone is
prohibited unless authorized by the
Coast Guard Captain of the Port
Chicago. Section 165.33 also contains
other general requirements.
(2) The Captain of the Port Chicago
will normally permit those U. S. Coast
Guard certificated passenger vessels that
normally load and unload passengers at
Navy Pier to operate in the zone.
However, should the Captain of the Port
Chicago determine it is appropriate, he
will require even those U. S. Coast
Guard certificated passenger vessels that
normally load and unload passengers at
Navy Pier to request permission before
leaving or entering the security zone.
The Captain of the Port Chicago will
notify these vessels via Broadcast Notice
to Mariners if they must notify the Coast
Guard before transiting the security
zone. This rule will not obstruct the
regular flow of traffic and will allow
vessel traffic to pass around the security
zone.
(3) All persons and vessels shall
comply with the instruction of the
Captain of the Port Chicago or the
designated on-scene U.S. Coast Guard
patrol personnel. On-scene patrol
personnel include commissioned,
warrant, and petty officers of the U.S.

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Coast Guard on board Coast Guard,
Coast Guard Auxiliary, local, state, and
federal law enforcement vessels.
Emergency response vessels are
authorized to move within the zones.
(4) Persons desiring to transit the area
of these security zones may contact the
Captain of the Port at telephone number
(630) 986–2175 or on VHF channel 16
(121.5 MHz) to seek permission to
transit the area. If permission is granted,
all persons and vessels shall comply
with the instructions of the Captain of
the Port or his or her designated
representative.
(c) Authority. In addition to 33 U.S.C.
1231 and 50 U.S.C. 191, the authority
for this section includes 33 U.S.C. 1226.
Dated: March 25, 2002.
R.E. Seebald,
Captain, U.S. Coast Guard, Captain of the
Port, Chicago.
[FR Doc. 02–9939 Filed 4–22–02; 8:45 am]
BILLING CODE 4910–15–U

DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 46
RIN 2900–AJ76

Policy Regarding Participation in
National Practitioner Data Bank
Department of Veterans Affairs.
Final rule.

AGENCY:
ACTION:

SUMMARY: This document amends our
regulations regarding reporting of health
care practitioners to the National
Practitioner Data Bank (NPDB). We are
amending the provisions concerning
malpractice payment reporting by
delegating the underlying decisionmaking to malpractice payment review
panels; by delegating the actual
reporting authority to facility directors
and the Chief Patient Care Services
Officer; by establishing new procedures
for obtaining information from affected
health care practitioners and others; and
by establishing medical reporting
criteria for licensed trainees and
supervisory health care professionals.
We also are amending the regulations
concerning malpractice payment
reporting and clinical privileges actions
reporting by stating that reporting may
not be the subject of negotiated
settlements and that independent
contractors acting on behalf of the
Department of Veterans Affairs (VA) are
subject to the NPDB reporting
provisions. These amendments are
necessary to make the reporting process
more efficient and fair and to ensure
that reporting is accomplished in

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accordance with the statutory
framework.
DATES: Effective May 23, 2002.
FOR FURTHER INFORMATION CONTACT:
Kathryn W. Enchelmayer, Director,
Credentialing and Privileging, Office of
Quality and Performance (10Q), VHA,
Department of Veterans Affairs, 810
Vermont Avenue, NW, Washington, DC
20420; (202)–273–7464 (This is not a
toll-free number).
SUPPLEMENTARY INFORMATION: In a
document published in the Federal
Register on June 5, 2001, at 66 FR
30141, we proposed to amend our
regulations set forth at 38 CFR Part 46
concerning the reporting of physicians,
dentists, and other health care
practitioners to the NPDB. These
regulations concern malpractice
payment reporting and clinical
privileges actions reporting.
Interested persons were given 60 days
to submit comments. The comment
period ended August 6, 2001. We
received comments from two
commenters. One commenter, a
representative of a medical association,
supported the proposed rule without
change. The other commenter, a
representative of a medical school,
suggested that certain changes should be
made. These comments are discussed
below. Based on the rationale set forth
in the proposed rule and this document,
we are adopting the provisions of the
proposed rule as a final rule with
certain changes discussed below.
The medical school representative
objected to the regulations based on the
incorrect assumption that VA would
report a health care practitioner if the
claim constituted a ‘‘nuisance claim’’ or
‘‘if the status of a given practitioner as
a beneficiary [of a malpractice payment]
cannot be demonstrated.’’ No changes
are made based on this comment. The
regulations at § 46.3 provide for
reporting only after a determination by
at least a majority of a review panel that
payment was related to substandard
care, professional incompetence, or
professional misconduct on the part of
the actual health care practitioner to be
reported.
The medical school representative
asserted that the review panel should
consist only of members having the
same area of expertise as the
practitioner in question ‘‘or, in the
alternative, only panel members having
such expertise be allowed to vote.’’ No
changes are made based on these
comments. Based on a review of the
more than 1,100 paid claims that have
been considered by a review panel since
1997, we have concluded that the
overwhelming majority of claims do not

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include issues requiring such
specialized expertise. Further, the
regulations at § 46.3(b) allow for the
review panel to obtain and consider
opinions of experts as needed.
The medical school representative
asserted that VA should provide legal
representation to a health care
practitioner during the preliminary tort
case and during the subsequent process
for determining whether such
individual should be reported to the
NPDB. No changes are made based on
these comments. In matters of dispute,
VA must represent VA’s interest. VA
counsel would create a conflict of
interest if they were also to represent a
health care practitioner regarding the
reporting issues. However, a health care
practitioner may obtain personal
counsel regarding any submissions to
the review panel. Moreover, as stated in
§ 46.3(b), any prior statements provided
by the health care practitioner during
the tort consideration process are not
included in the information provided to
the review panel for consideration.
The medical school representative
asserted that the review panel should be
required to obtain all necessary
information before making a
determination on a case. No changes are
made based on this comment. Under the
provisions of § 46.3(b) the review panel
is required to be provided the
documents pertinent to the care that led
to the claim, including the medical
records of the patient whose care led to
the claim, any report of an
administrative investigation board
appointed to investigate the care, the
opinion of any consultant which the
panel may request in its discretion and,
to the extent practicable, written
statements of the individual(s) involved
in the care which led to the claim. We
believe this is adequate to ensure that a
review panel has all of the necessary
information for making reporting
determinations.
The medical school representative
asserted that the review panel should be
required to articulate in its conclusions
the reasons for reporting a health care
practitioner. We agree and have
amended § 46.3 accordingly.
The medical school representative
asserted that the reporting standards
should be based on the local standard of
care. No changes are made based on this
comment. VA is a nation-wide health
care system that is designed to adhere
to one standard of care at all health care
facilities.
The proposed rule at § 46.3(b)
provides that a health care practitioner
whose actions are under review will
receive a written notice from the VA
facility director indicating that VA is

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19679

considering whether to report the
practitioner to the National Practitioner
Data Bank because of a specified
malpractice payment made, and
providing the practitioner the
opportunity, within 30 days of receipt,
to submit a written statement
concerning the care that led to the
claim. Based on our further review of
this matter, we believe it is necessary to
lengthen the time period allowed for the
health care practitioner to respond from
30 days to 60 days to ensure that the
practitioner has sufficient time to
prepare a response.
Paperwork Reduction Act
This document contains provisions
constituting collections of information
under the Paperwork Reduction Act (44
U.S.C. 3501–3520) approved by the
Office of Management and Budget under
control number 2900–0621.
Executive Order 12866
This document has been reviewed by
the Office of Management and Budget
under Executive Order 12866.
Regulatory Flexibility Act
The Secretary hereby certifies that the
adoption of this proposed rule would
not have a significant economic impact
on a substantial number of small entities
as they are defined in the Regulatory
Flexibility Act, 5 U.S.C. 601–612. This
rulemaking proceeding affects only
individuals. Accordingly, pursuant to 5
U.S.C. 605(b), this proposed rule is
exempt from the initial and final
regulatory flexibility analyses
requirements of sections 603 and 604.
The Catalog of Federal Domestic
Assistance numbers for the programs affected
by this document are 64.005, 64.007, 64.008,
64,009, 64.010, 64.011, 64.012, 64.013,
64.014, 64.015, 64.016, 64.018, 64.019,
64.022, 64.024, and 64.025.

List of Subjects in 38 CFR Part 46
Health professions.
Approved: February 19, 2002.
Anthony J. Principi,
Secretary of Veterans Affairs.

For the reasons set forth in the
preamble, 38 CFR part 46 is revised to
read as follows:
PART 46—POLICY REGARDING
PARTICIPATION IN NATIONAL
PRACTITIONER DATA BANK
Subpart A—General Provisions
Sec.
46.1 Definitions.
46.2 Purpose.
Subpart B—National Practitioner Data Bank
Reporting
46.3 Malpractice payment reporting.

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46.4

Federal Register / Vol. 67, No. 78 / Tuesday, April 23, 2002 / Rules and Regulations

Clinical privileges actions reporting.

privileges of a physician or dentist taken
Subpart C—National Practitioner Data Bank as a result of a professional review
activity based on the competence or
Inquiries
professional conduct of an individual
46.5 National Practitioner Data Bank
physician or dentist in cases in which
inquiries.
such conduct affects or could affect
Subpart D—Miscellaneous
adversely the health or welfare of a
46.6 Medical quality assurance records
patient, or patients. An action is not
confidentiality.
considered to be based on the
46.7 Prohibitions concerning negotiations.
competence or professional conduct of a
46.8 Independent contractors.
physician or dentist, if the action is
Authority: 38 U.S.C. 501; 42 U.S.C. 11101– primarily based on:
11152.
(1) A physician’s or dentist’s
association with, administrative
Subpart A—General Provisions
supervision of, delegation of authority
to, support for, or training of, a member
§ 46.1 Definitions.
(a) Act means The Health Care Quality or members of a particular class of
health care practitioner or professional,
Improvement Act of 1986, as amended
or
(42 U.S.C. 11101–11152).
(2) Any other matter that does not
(b) Claim of medical malpractice
relate to the competence or professional
means a written claim or demand for
conduct of a physician or dentist in his/
payment based on an act or omission of
her practice at a Department of Veterans
a physician, dentist, or other health care
Affairs health care facility.
practitioner in furnishing (or failing to
(k) Professional review activity means
furnish) health care services, and
an activity with respect to an individual
includes the filing of a complaint or
physician or dentist to establish a
administrative tort claim under the
recommendation regarding:
Federal Tort Claims Act, 28 U.S.C.
(1) Whether the physician or dentist
1346(b), 2671–2680.
may have clinical privileges with
(c) Clinical privileges means
respect to the medical staff of the
privileges granted by a health care entity facility;
to individuals to furnish health care.
(2) The scope or conditions of such
(d) Dentist means a doctor of dental
privileges or appointment; or
surgery or dental medicine legally
(3) Change or modification of such
authorized to practice dental surgery or
privileges.
dentistry by a State (or any individual
(l) State means the fifty States, the
who holds himself or herself out to be
District of Columbia, Puerto Rico, the
so authorized).
Virgin Islands, Guam, American Samoa,
(e) Director means the duly appointed the Northern Mariana Islands, and any
director of a Department of Veterans
other territories or possessions of the
Affairs health care facility or any
United States.
individual with authorization to act for
(m) State Licensing Board means,
that person in the director’s absence.
with respect to a physician, dentist, or
(f) Gross negligence is materially
other health care practitioner in a State,
worse than substandard care, and
the agency of the State, which is
consists of an entire absence of care, or
primarily responsible for the licensing
an absence of even slight care or
of the physician, dentist, or practitioner
diligence; it implies a thoughtless
to furnish health care services.
disregard of consequences or
(n) Willful professional misconduct
indifference to the rights of others.
means worse than mere substandard
(g) Health care facility means a
care, and contemplates the intentional
hospital, domiciliary, outpatient clinic,
doing of something with knowledge that
or any other entity that provides health
it is likely to result in serious injuries
care services.
or in reckless disregard of its probable
(h) Other health care practitioner
consequences.
means an individual other than a
§ 46.2 Purpose.
physician or dentist who is licensed or
The National Practitioner Data Bank,
otherwise authorized by a State to
authorized by the Act and administered
provide health care services.
by the Department of Health and Human
(i) Physician means a doctor of
Services, was established for the
medicine or osteopathy authorized to
purpose of collecting and releasing
practice medicine or surgery by a State
(or any individual who holds himself or certain information concerning
physicians, dentists, and other health
herself out to be so authorized).
(j) Professional review action means a care practitioners. The Act mandates
recommendation by a professional
that the Department of Health and
review panel (with at least a majority
Human Services seek to enter into a
vote) to affect adversely the clinical
Memorandum of Understanding with

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the Department of Veterans Affairs (VA)
for the purpose of having VA participate
in the National Practitioner Data Bank.
Such a Memorandum of Understanding
has been established. Pursuant to the
Memorandum of Understanding, VA
will obtain information from the Data
Bank concerning physicians, dentists,
and other health care practitioners who
provide or seek to provide health care
services at VA facilities and also report
information regarding malpractice
payments and adverse clinical
privileges actions to the Data Bank. This
part essentially restates or interprets
provisions of that Memorandum of
Understanding and constitutes the
policy of VA for participation in the
National Practitioner Data Bank.
Subpart B—National Practitioner Data
Bank Reporting
§ 46.3

Malpractice payment reporting.

(a) VA will file a report with the
National Practitioner Data Bank, in
accordance with regulations at 45 CFR
part 60, subpart B, as applicable,
regarding any payment for the benefit of
a physician, dentist, or other licensed
health care practitioner which was
made as the result of a settlement or
judgment of a claim of medical
malpractice. The report will identify the
physician, dentist, or other licensed
health care practitioner for whose
benefit the payment is made. It is
intended that the report be filed within
30 days of the date payment is made.
This may not be possible in all cases;
e.g., sometimes notification of payment
is delayed, and sometimes the
malpractice payment review process
cannot be completed within the
timeframe. The report will provide the
following information:
(1) With respect to the physician,
dentist, or other licensed health care
practitioner for whose benefit the
payment is made—
(i) Name;
(ii) Work address;
(iii) Home address, if known;
(iv) Social Security number, if known,
and if obtained in accordance with
section 7 of the Privacy Act of 1974;
(v) Date of birth;
(vi) Name of each professional school
attended and year of graduation;
(vii) For each professional license: the
license number, the field of licensure,
and the State in which the license is
held;
(viii) Drug Enforcement
Administration registration number, if
applicable and known;
(ix) Name of each health care entity
with which affiliated, if known.
(2) With respect to the reporting VA
entity—

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(i) Name and address of the reporting
entity;
(ii) Name, title and telephone number
of the responsible official submitting the
report on behalf of the Federal
government; and
(iii) Relationship of the entity to the
physician, dentist, or other health care
practitioner being reported.
(3) With respect to the judgment or
settlement resulting in the payment—
(i) Where an action or claim has been
filed with an adjudicative body,
identification of the adjudicative body
and the case number;
(ii) Date or dates on which the act(s)
or omission(s), which gave rise to the
action or claim occurred;
(iii) Date of judgment or settlement;
(iv) Amount paid, date of payment,
and whether payment is for a judgment
or a settlement;
(v) Description and amount of
judgment or settlement and any
conditions attached thereto, including
terms of payment;
(vi) A description of the acts or
omissions and injuries or illnesses upon
which the action or claim was based;
and
(vii) Classification of the acts or
omissions in accordance with a
reporting code adopted by the Secretary
of Health and Human Services.
(b) Payment will be considered to
have been made for the benefit of a
physician, dentist, or other licensed
health care practitioner only if (at least
a majority of) a malpractice payment
review panel concludes that payment
was related to substandard care,
professional incompetence, or
professional misconduct on the part of
the physician, dentist, or other licensed
health care practitioner. For purposes of
this part, a panel shall have a minimum
of three individuals appointed by the
Director, Medical-Legal Affairs
(including at least one member of the
profession/occupation of the
practitioner(s) whose actions are under
review). The conclusions of the panel
shall, at a minimum, be based on review
of documents pertinent to the care that
led to the claim. These documents
include the medical records of the
patient whose care led to the claim, any
report of an administrative investigation
board appointed to investigate the care,
and the opinion of any consultant
which the panel may request in its
discretion. These documents do not
include those generated primarily for
consideration or litigation of the claim
of malpractice. In addition, to the extent
practicable, the documents shall include
written statements of the individual(s)
involved in the care which led to the
claim. The practitioner(s) whose actions

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are under review will receive a written
notice, hand-delivered or sent to the
practitioner’s last known address (return
receipt requested), from the VA facility
director at the time the VA facility
director receives the Notice of Payment.
That notice from the VA facility director
will indicate that VA is considering
whether to report the practitioner to the
National Practitioner Data Bank because
of a specified malpractice payment
made, and provide the practitioner the
opportunity, within 60 days of receipt,
to submit a written statement
concerning the care that led to the
claim. Inability to notify or nonresponse from the identified
practitioner(s) will not preclude
completion of the review and reporting
process. The panel, at its discretion,
may request additional information
from the practitioner or the VA facility
where the incident occurred. The
review panel’s notification to the VA
facility Director shall include the acts or
omissions considered, the reporting
conclusion, and the rationale for the
conclusion.
(c) Attending staff (including contract
employees, such as scarce medical
specialists providing care pursuant to a
contract under 38 U.S.C. 7409) are
responsible for actions of licensed
trainees assigned under their
supervision. Notwithstanding the
provisions of paragraph (b) of this
section, actions of a licensed trainee
(intern or resident) acting within the
scope of his or her training program that
otherwise would warrant reporting for
substandard care, professional
incompetence, or professional
misconduct under the provisions of
paragraph (b) of this section, will be
reported only if the panel, by at least a
majority, concludes that such actions
constitute gross negligence or willful
professional misconduct. For purposes
of paragraph (b) of this section, payment
will be considered to be made for the
benefit of a physician, dentist, or other
health care practitioner, in their
supervisory capacity, if the panel
concludes, by at least a majority, that
the physician, dentist or other health
care practitioner was acting in a
supervisory capacity; that the payment
was related to substandard care,
professional incompetence, or
professional misconduct of the trainee
and not the supervisor; and that the
trainee did not commit gross negligence
or willful professional misconduct.
Such report will note that the physician,
dentist, or other health care practitioner
is being reported in a supervisory
capacity.

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19681

Note to paragraph (c): Licensed trainees
acting outside the scope of their training
program (e.g. acting as admitting officer of
the day) will be reported under the
provisions of paragraph (b) of this section.

(d) The Director of the facility at
which the claim arose has the primary
responsibility for submitting the report
to the National Practitioner Data Bank
and for providing a copy to the
practitioner, to the State Licensing
Board in each State where the
practitioner holds a license, and to the
State Licensing Board in which the
facility is located. However, the Chief
Patient Care Services Officer is also
authorized to submit the report to the
National Practitioner Data Bank and
provide copies to the practitioner and
State Licensing Boards in cases where
the Chief Patient Care Services Officer
deems it appropriate to do so. The
Director of the facility also shall provide
to the practitioner a copy of the review
panel’s notification to the Director.
(The Office of Management and Budget
has approved the information collection
requirements in this section under
control number 2900–0621.)
§ 46.4

Clinical privileges actions reporting.

(a) VA will file an adverse action
report with the National Practitioner
Data Bank in accordance with
regulations at 45 CFR part 60, subpart B,
as applicable, regarding any of the
following actions:
(1) An action of a Director after
consideration of a professional review
action that, for a period longer than 30
days, adversely affects (by reducing,
restricting, suspending, revoking, or
failing to renew) the clinical privileges
of a physician or dentist relating to
possible incompetence or improper
professional conduct.
(2) Acceptance of the surrender of
clinical privileges, including the
surrender of clinical privileges inherent
in resignation or retirement, or any
restriction of such privileges by a
physician or dentist either while under
investigation by the health care entity
relating to possible incompetence or
improper professional conduct, or in
return for not conducting such an
investigation or proceeding whether or
not the individual remains in VA
service.
(b) The report specified in paragraph
(a) of this section will provide the
following information—
(1) With respect to the physician or
dentist:
(i) Name;
(ii) Work address;
(iii) Home address, if known;

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Federal Register / Vol. 67, No. 78 / Tuesday, April 23, 2002 / Rules and Regulations

(iv) Social Security number, if known
(and if obtained in accordance with
section 7 of the Privacy Act of 1974);
(v) Date of birth;
(vi) Name of each professional school
attended and year of graduation;
(vii) For each professional license: the
license number, the field of licensure,
and the name of the State in which the
license is held;
(viii) Drug Enforcement
Administration registration number, if
applicable and known;
(ix) A description of the acts or
omissions or other reasons for privilege
loss, or, if known, for surrender; and
(x) Action taken, date action was
made final, length of action and
effective date of the action.
(2) With respect to the VA facility—
(i) Name and address of the reporting
facility; and
(ii) Name, title, and telephone number
of the responsible official submitting the
report.
(c) A copy of the report referred to in
paragraph (a) of this section will also be
filed with the State Licensing Board in
the State(s) in which the practitioner is
licensed and in which the facility is
located. It is intended that the report be
filed within 15 days of the date the
action is made final, that is, subsequent
to any internal (to the facility) appeal.
(d) As soon as practicable after it is
determined that a report shall be filed
with the National Practitioner Data Bank
and State Licensing Boards under
paragraphs (a)(2) and (c) of this section,
VA shall provide written notice to the
practitioner that a report will be filed
with the National Practitioner Data Bank
with a copy to the State Licensing Board
in each State in which the practitioner
is licensed and in the State in which the
facility is located.
Subpart C—National Practitioner Data
Bank Inquiries
§ 46.5 National Practitioner Data Bank
inquiries.

VA will request information from the
National Practitioner Data Bank, in
accordance with the regulations
published at 45 CFR part 60, subpart C,
as applicable, concerning a physician,
dentist, or other licensed health care
practitioner as follows:
(a) At the time a physician, dentist, or
other health care practitioner applies for
a position at VA Central Office, any of
its regional offices, or on the medical
staff, or for clinical privileges at a VA
hospital or other health care entity
operated under the auspice of VA;
(b) No less often than every 2 years
concerning any physician, dentist, or
other health care practitioner who is on

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the medical staff or who has clinical
privileges at a VA hospital or other
health care entity operated under the
auspice of VA; and
(c) At other times pursuant to VA
policy and needs and consistent with
the Act and Department of Health and
Human Services Regulations (45 CFR
part 60).
Subpart D—Miscellaneous
§ 46.6 Medical quality assurance records
confidentiality.

Note that medical quality assurance
records that are confidential and
privileged under the provisions of 38
U.S.C. 5705 may not be used as
evidence for reporting individuals to the
National Practitioner Data Bank.
§ 46.7 Prohibitions concerning
negotiations.

Reporting under this part (including
the submission of copies) may not be
the subject of negotiation in any
settlement agreement, employee action,
legal proceedings, or any other
negotiated settlement.
§ 46.8

Independent contractors.

Independent contractors acting on
behalf of the Department of Veterans
Affairs are subject to the National
Practitioner Data Bank reporting
provisions of this part. In the following
circumstances, VA will provide the
contractor with notice that a report of a
clinical privileges action will be filed
with the National Practitioner Data Bank
with a copy with the State Licensing
Board in the State(s) in which the
contractor is licensed and in which the
facility is located: where VA terminates
a contract for possible incompetence or
improper professional conduct, thereby
automatically revoking the contractor’s
clinical privileges, or where the
contractor terminates the contract,
thereby surrendering clinical privileges,
either while under investigation relating
to possible incompetence or improper
professional conduct or in return for not
conducting such an investigation or
proceeding.
(Authority: 38 U.S.C. 5705)
[FR Doc. 02–9875 Filed 4–22–02; 8:45 am]
BILLING CODE 8320–01–P

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ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 52
[CA 247–0322a; FRL–7158–4]

Revisions to the California State
Implementation Plan, Monterey Bay
Unified Air Pollution Control District
AGENCY: Environmental Protection
Agency (EPA).
ACTION: Direct final rule.
SUMMARY: EPA is taking direct final
action to approve a revision to the
Monterey Bay Unified Air Pollution
Control District (MBUAPCD) portion of
the California State Implementation
Plan (SIP). This revision concerns the
emission of volatile organic compounds
(VOC) from the transfer of gasoline into
stationary storage containers and from
gasoline bulk plants and terminals. We
are approving local rules that regulates
this emission source under the Clean
Air Act as amended in 1990 (CAA or the
Act).
DATES: This rule is effective on June 24,
2002, without further notice, unless
EPA receives adverse comments by May
23, 2002. If we receive such comments,
we will publish a timely withdrawal in
the Federal Register to notify the public
that this rule will not take effect.
ADDRESSES: Mail comments to Andy
Steckel, Rulemaking Office Chief (AIR–
4), U.S. Environmental Protection
Agency, Region IX, 75 Hawthorne
Street, San Francisco, CA 94105.
You can inspect copies of the
submitted rule revisions and EPA’s
technical support document (TSD) at
our Region IX office during normal
business hours. You may also see copies
of the submitted rule revisions and TSD
at the following locations:
Environmental Protection Agency, Air
Docket (6102), Ariel Rios Building,
1200 Pennsylvania Avenue, NW,
Washington DC 20460.
California Air Resources Board,
Stationary Source Division, Rule
Evaluation Section, 1001 ‘‘I’’ Street,
Sacramento, CA 95814.
Monterey Bay Unified Air Pollution
Control District, 24580 Silver Cloud
Court, Monterey, CA 93940.
FOR FURTHER INFORMATION CONTACT: Al
Petersen, Rulemaking Office (AIR–4),
U.S. Environmental Protection Agency,
Region IX; (415) 947–4118.
SUPPLEMENTARY INFORMATION:
Throughout this document, ‘‘we,’’ ‘‘us’’
and ‘‘our’’ refer to EPA.

Table of Contents
I. The State’s Submittal

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