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Did American Board of Internal Medicine Overreach?

 |  By jcantlupe@healthleadersmedia.com  
   January 13, 2011

Months ago, the American Board of Internal Medicine proposed sanctioning 139 physicians for passing along and receiving test questions from a test preparation company.

While many physicians feared the sanctions would cost them their jobs, it now appears dozens of the physicians cited won't be held for sanctions the ABIM initially sought.

As the process began, I was wondering if the ABIM officials were over-reaching in their inquiry, and it certainly seems they did. Initially, it reached back more than 20 years to find alleged violators. The board talked tough.

That tough talk is ebbing and now there appears to be reconciliation. In some cases, recommended sanctions have been rescinded, in the words of the ABIM president Christine Cassel, the ABIM president and CEO, acknowledged in a statement to me.

Meanwhile, Drew Wachler, an attorney representing 40 physicians, says the ABIM has allowed his clients to resume their careers, by shifting course, in part. Still, he says, he hopes ABIM will revise its procedures, and that remains to be seen.

The controversy over the testing began when the ABIM cited the 139 physicians in June for improper conduct over the testing. The board took steps to strip board certification of many physicians for periods ranging from one to 5 years. The ABIM also sent what some have dubbed "shame on you" letters to about 2,700 physicians who took the test. These doctors were not accused of wrongdoing, but the ABIM said the doctors should have known what was going on.

Aside from the test takers, the major target of the investigation was Arora Board Review, a New Jersey test-preparation course. The principal of Arora Board Review, being sued by ABIM has surrendered his certificate to perform the tests. Arora Board Review shared information garnered from physicians who took the ABIM test with other would be test takers for years, according to ABIM.

Wachler, one of the many attorneys representing physicians caught up in the ABIM probe, says that in many cases ABIM has shifted from its original position of outright sanctions "in a way that will allow these doctors to continue their careers."

Wachler, based in Royal Oak, MI declined to discuss the specific allegations involving his clients, nor the ABIM's exact determination of their cases. Throughout the legal process, Wachler says that it's been his goal to reach an "alternative resolution" with the ABIM following the initial charges against his clients. Besides preserving each physician's career, he sought to "minimize consequences of licensure, maintenance of staff privilege employment and participation with third party payers."

It appears that ABIM had sought multi-year suspensions in many cases, according to sources. In some instances, ABIM has sought community service from the physicians, although that has not been detailed. Regardless, there is certainly anger among some physicians over the length and breadth of the investigations, the penalties, how physicians were targeted, and for the kind of infractions involved.   One attorney wrote to HealthLeaders Media that he was able to get his client's matter resolved. "It appeared to me that the ABIM people did not review the evidence before (issuing) their letters," the attorney wrote.

The appeals have certainly dragged out, in some cases, for months. Without characterizing the length of the appeals, most of the physicians who received recommended sanctions arising from the investigation "have pursued appeals through ABIM's standard robust, three-stage appeal process," says Cassel, the ABIM president. 

"Some have been resolved and some are ongoing," Cassel said of the cases. "Each appeal involves unique facts and circumstances."

 Some recommended sanctions have been affirmed, she adds. "In a few instances, recommended sanctions have been rescinded." Cassel also did not elaborate. "In any event, individual proceedings are confidential," she says.

"The recommended sanctions and appeals process reflect ABIM's commitment to maintaining the integrity of the board certification process and fulfilling ABIM's obligation to the public" Cassel says.

As for Wachler, he hopes to see some changes within ABIM procedures as the organization weighs potential disciplinary actions, and seems reconciliatory.

"Once we began working with ABIM they have been consistently sensitive to attempts to resolve matters on a case-by-case basis that would balance their view of what happened, but also recognize that many of these doctors are exceptional individuals who have a lot to offer society," he says.

Wachler acknowledges he has not agreed with every aspect of the ABIM position.

Wachler is hoping that ABIM will implement changes to its appeals process and regulatory procedures in the wake of the current investigation. Wachler says he wants to continue "constructive work with ABIM to reach a resolution for each client that will not jeopardize their career."

That hope, however, rests with a conclusion of the appeal process, whenever that may be.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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