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CA Doctors Miffed at Medical Board's Waiting Room Sign Proposal

Cheryl Clark, for HealthLeaders Media, April 13, 2009

California doctors may soon have to post the state Medical Board's name, Web site, and phone number in their waiting rooms, so their patients know where to complain if they're not happy with care.

Next month, the Medical Board of California will consider requiring any of the state's 125,000 physicians who have waiting areas to "prominently" post a "large, clearly visible sign" 8.5 x 11 inches in 24-point type that says:

Medical doctors are licensed and regulated by the Medical Board of California.

www.mbc.ca.gov

(800) 633-2322

The Medical Board may allow doctors, especially those without waiting rooms, such as radiologists or pathologists, to notify patients in other ways, such as with a brochure or letter that includes similar wording, which could be sent with bills.

California would not be alone with such a posting requirement for doctors. Texas, Kansas, Georgia, and Idaho are among other states that have similar requirements.

"In my experience, many people do not know about the Medical Board of California's existence or enforcement jurisdiction," says attorney Julianne D'Angelo Fellmeth. Fellmeth was appointed by the board as "independent enforcement monitor," a position created by the Legislature, to conduct a two-year examination of the board's oversight process.

When they hear of a physician's alleged misconduct, board investigators first look for court filings. "They routinely come across people who have sued doctors for malpractice but who have not filed a complaint with the Medical Board," says Fellmeth, of the Center for Public Interest Law at the University of San Diego.

A physician's failure to provide proper notice of the board's authority could come with penalties or fines, Fellmeth said.

Medical Board member Mary Lynn Moran, MD, says she is likely to vote for a posting requirement. "If signage is required by cab drivers, it should certainly be expected of physicians to let the public know that they are held to a set of standards and regulated by the state," says the Woodside plastic surgeon. "Consumers have the right to know that if they do not feel that their physician is acting professionally, that the overseeing licensing agency should be informed of their concerns."

The exact language of the board's proposed rule will be issued in several weeks, says board spokeswoman Candis Cohen. Before the rule takes effect, the full board will have to approve it, and then go through a regulatory process of up to six months.

Expectedly, some California doctors are not enthused.

Ted Mazer, MD, a CMA trustee, thinks the regulation "is a stupid waste of time. I think patients already know there's a Medical Board," he said. "Patients will see it, and say 'OK. Whatever.' But I don't think they'll remember that's where they have to go if they have a problem later."

But he also objects because he thinks the posting could encourage patients to report something to the disciplinary agency "that might be far more easily managed with a conversation with the patient."

Mazer, a San Diego ear, nose, and throat specialist, also questioned Fellmeth's motives. "Julie Fellmeth seems to feel that if she doesn't currently have something to slap doctors in the face with, she should find something," he says.

Mazer says he would only support such a requirement if health plans and others who make decisions about patient care as well as attorneys have to post such notices as well, referring patients to the Department of Managed Health Care or the State Bar of California respectively.

James Hay, MD., the CMA's liaison to the Medical Board of California, also thinks the proposed rule is unreasonable.

"The doctor patient relationship from the start should be based on mutual trust," he says. Yet this proposed rule "does not seem to me to be a worthwhile thing to foster that doctor-patient relationship," says Hay, an Encinitas family practitioner. If the Medical Board is supposed to educate the public, but hasn't done it, "that's the medical board's problem," he says. "The Medical Board shouldn't ask the physicians to do it for them." There is enough legal room for such a regulation. A legislatively-mandated report last November by the California Research Bureau noted that a 1998 state law called for the Medical Board to require that doctors notify patients that they practice with oversight from the state. While many other California consumer protection agencies did pass such rules, including those that license architects, auto repair shops, pharmacists, engineers, surveyors, and pest control companies, the Medical Board "has neither adopted nor proposed such regulations," the bureau report said.

That's because of another 10-year-old law, which suggested doctors could satisfy the requirement by wearing a name-tag showing their type of practice and license status. Fellmeth says that view is now discounted. Besides, wearing a nametag still doesn't tell patients that the name of the agency to complain to is the Medical Board.

Fellmeth uses the example of the November 2007 death of rapper Kanye West's mother, Donda, one day after being operated on Los Angeles plastic surgeon Jan Adams.

"If Donda had known about the Medical Board and gone to the board's Web site, she would have seen two medical malpractice judgments of at least $200,000 against Adams. He had been arrested and convicted twice of driving while intoxicated, grounds the medical board was using then in an effort to revoke his license," Fellmeth says. Adams surrendered his license effective April 8.

The CMA currently supports a bill that would require health practitioners to disclose their license type and educational degrees, as well as their board certification. But the CMA bill stops short of requiring any mention that the Medical Board's name, or its phone number be given to patients, Fellmeth says.

"If doctors voluntarily notified patients of the board's existence, we would not need the regulation," Fellmeth says. "But they do not. And it is the law."


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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