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55% of Censured Docs Face No Licensing Action by State Medical Boards

 |  By cclark@healthleadersmedia.com  
   March 17, 2011

More than half of U.S. physicians whose negligence, malpractice, sexual abuse, fraud, or other behaviors result in censure by hospital peer review escape any state medical board licensing action, according to national health watchdog group, Public Citizen.

"One of two things is happening, and either is alarming," said Public Citizen director, Sidney Wolfe, MD, in a statement. "Either state medical boards are receiving this disturbing information from hospitals but not acting on it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed."

Wolfe's group combed the National Practitioner Data Base (NPDB) for the names of doctors whose hospitals had revoked or restricted their physician staff privileges and found 10,672 doctors between 1990 and 2009. Hospitals are required by law to report such sanctions to the NPDB when disciplinary action to revoke or limit staff privileges extends for more than 30 days, and to the state professional licensing agency.

Of these, 55% – 5,887 doctors – had no licensing action taken against them by their state medical boards.

The group sent its report along with a letter to Secretary of Health and Human Services Kathleen Sebelius urging her to have the Office of Inspector General investigate state medical boards, "something it has not done since 1993," Wolfe wrote.

"State medical board licensure action against a physician, if warranted, provides a greater assurance than a hospital privilege action alone that the 105 million patients whose medical care is partly funded by HHS...would be better protected from questionable physicians," Wolfe's letter to Sebelius said.

Because the NPDB public use file identifies physicians through the use of code numbers rather than names, the identities of these physicians have not been made public.

Of the 5,887 whose staff privileges were curtailed, 220 were identified as causing an immediate threat to health or safety, 605 were disciplined for substandard care, and 1,119 because of incompetence, negligence, or malpractice. Other categories of substandard behavior included sexual misconduct, inability to practice safely, fraud including insurance fraud or fraud obtaining a license and fraud against healthcare programs and narcotics violations.

Of the 5,887 doctors who escaped licensure action, 3,6707 had either a permanent penalty from their hospital or a penalty of a year or more, but no state medical board action.

The report says that some states had far worse track records of not taking action against doctors whose peer reviews had resulted in a report to the NPDB.

In Illinois, for example, "a doctor had clinical privileges permanently revoked in 1999 and accumulated 10 medical malpractice reports between 1992 and 2006 totaling $7 million for, among other things, improperly managing cases, failing to diagnose and failing to identify fetal distress. One patient suffered a major permanent injury while another became a quadriplegic due to a brain injury. Yet Illinois did not discipline the doctor," the group said.

And "in Florida, a doctor had hospital privileges permanently revoked in 2002 for incompetence and racked up 10 medical malpractice reports totaling $1 million between 1992 and 2009 for, among other things, an unnecessary procedure, leaving a foreign body in a patient, and misdiagnosis. Two patients died. Yet the state of Florida took now disciplinary action against the doctor."

In Florida, 63% of the 571 physicians with one or more adverse clinical privilege actions, or 361, had no action taken against them by the Florida licensing agency.

In Delaware, Hawaii, Indiana, New Mexico, Nevada, Pennsylvania, South Dakota and Tennessee, more than 70% of physicians with one or more clinical privileges escaped any state license action. Of large states, in California, 54% of physicians had no licensure actions, Texas, 60%; Ohio 57%, New York 50% and in Illinois, 66%.

Of the 5,887 doctors whose hospitals reported their clinical privilege limitations to the NPDB, 350 had three such reports, 231 had more than three, and of those, 23 had seven or more, without any state action.

Public Citizen's report explains that federal officials apparently believe they don't have the authority to investigate state medical boards. However "during the 1980s and 1990s, the OIG acknowledged the importance of effective medical board oversight; during this time period they conducted 16 evaluations of state health professional licensing boards including nine specifically addressing inadequate medical boards performance.

"Because of highly questionable legal constraints imposed by OIG lawyers, the last OIG review of state medical boards was 18 years ago."

Wolfe's report said that the group's analysis "raises serious questions about whether state medical boards are responding adequately to hospital peer review determinations of substandard care or conduct, and, secondarily, whether state boards are getting copies of hospital reports to the NPDB. Given the value of hospital disciplinary reports, such reports must be received and properly utilized by medical boards to assure patient safety."

Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards, says Public Citizen's report serves "as a reminder of the collaboration required by many parties to better protect the public."
 
That said, however, many state Medical Boards "will tell you that there is significant under-reporting of sanctions taken by hospitals, and this is not a surprise to us."
 
Additionally, he says, there may be some legitimate reasons why a gap exists between disciplinary actions listed by the NPDB and actions taken by a state medical board against those doctors.
 
"States do the best job they can to license and discipline doctors as appropriate, but not all hospital actions result in or require a licensure action," he says.  
 
Another reason may be that the medical board received the hospital's report and is in the process of investigating. "Each report has to be carefully considered by the board," Chaudhry says. "Hospitals are required to take and share action, but they may not share the investigation and work that led to it," which means that those state boards have to do that work themselves.
 
Or, it may be that the state board did take action, but that action may remain confidential, dependent on until the successful completion of a drug or alcohol diversion, or it may be a much lower level of discipline. "How do you know if you don't have the name of the physician?" he says.
 
A new project started last year means the NPDB and the Health Resources and Services Administration are working with state medical boards to cross check data they have on physicians, "and where there is something missing or doesn't make sense, they (the state boards) are going to act on it," Chaudhry said.

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