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Medical Boards Step Up Disciplinary Actions

 |  By cclark@healthleadersmedia.com  
   May 18, 2012

The number of bad doctors who were punished by their state medical boards increased 6.8% between 2010 and 2011, with significant increases in high population states such as Florida, California, Ohio and Texas, according to the latest annual summary from the Federation of State Medical Boards.

The number of disciplinary actions of all types rose from 5,652 to 6,025. These actions include the most severe penalties, in which a physician loses the license to practice or loses certain privileges, to less severe or "non-prejudicial" actions or public reprimands.

But Sidney Wolfe, MD, director of Public Citizen's Health Research Group,  which has long criticized what he sees as lax licensing supervision of the nation's medical professionals, is not impressed.

He sees the latest report as evidence that most state medical boards continue to fail to protect the public from bad doctors, especially in states that have the lowest physician penalty rates:  South Carolina, Minnesota, Massachusetts, Connecticut, Wisconsin, Rhode Island, Nevada, New Jersey, Florida, and the District of Columbia. Wolfe's group incorporated the new FSMB data into its own much more negative report Thursday.

In fact, Wolfe says, 70% of the disciplinary actions "are merely reprimands and slaps on the wrist and in our view not serious. There was (usually) no revocation or (license) surrender. And when you look to see what the doctors actually did, it turns out it was pretty serious."

In an introduction to the FSMB report, however, the federation's president and CEO Humayun Chaudhry, DO, cautioned against using the new state-by-state disciplinary actions to compare states.

"Because states operate with different financial resources, levels of autonomy, legal constraints and staffing levels, the FSMB discourages using data from this report to compare or rank states," he wrote.

The reasons for the increase are unclear, says Lisa Robin, the federation's chief advocacy officer. However she offered some possibilities.

Better training
In the last two or three years, many states have adopted a new certification program to better train and accredit their investigators to prepare better cases that help the boards and their attorneys make solid cases.

Reciprocity among states
A reciprocity agreement now enables states to promptly discipline a doctor within 24 hours after the doctor has been disciplined in another state. "There's been an improved ability to communicate (between states) and take reciprocal action," Robin says.

Streamlined reporting
Several government agency reports in recent years have criticized a system by which hospitals reported doctors they disciplined to the National Practitioner Data Bank, as they're required to do, but did not, in turn, report those same doctors to their respective state medical boards. Robin says that process has been streamlined "with technical enhancements" between the bank and various state physician licensing agencies.

Patient outreach
Several states have stepped up their outreach directly to patients. For example, California, where the number of disciplined physicians increased between 2010 and 2011 by 19%, from 545 to 648, enforced a new signage rule in 2010 that requires every physician who sees patients to post a visible sign telling patients where they can complain if they didn't like their care.

High-profile cases
Dan Wood, spokesman for the California board, said some high-profile national cases, like the one involving physician Conrad Murray, implicated in the overdose death of entertainer Michael Jackson, "have made people more aware of what the board does."  Additionally, Wood says, "we've managed to reduce the amount of time it takes to process a disciplinary action to just under a year," when prior reports estimated investigation and processing times at two years or longer.

Other reasons may relate to closer relationships between drug enforcement agencies and pharmacies that track the number of times certain doctors prescribe potentially dangerous painkillers such as Oxycontin.

Enforcement activities rose across the spectrum of disciplinary actions, the federation report said.

For example, loss of license or privilege to practice went from 1,815 in 2010 to 1,905 in 2011; restriction of a license or licensed privilege actions rose from 1,296 in 2010 to 1,323 in 2011; other prejudicial actions rose from 1,687 in 2010 to 1,768 in 2011; non-prejudicial actions, such as penalties or reprimands, rose from 854 to 1,038.

Wolfe pointed to the wide variation in the percentage of doctors in each state who undergo any kind of discipline as evidence that prosecutions against bad physician practice is uneven throughout the country.

"There's really no difference in the quality of doctors from state to state," he says. "What's different is the quality of the state medical boards." Even if, for example, a state like California did discipline more doctors in 2011, it still is 35th in the nation in percentage of disciplinary actions.

"Doctors are getting away with things in California that they wouldn't get away with other states" such as Louisiana, Alaska, or Ohio, where the percentage of doctors disciplined is the highest, he says.

Additionally, according to Public Citizen's report, the rate of serious actions per 1,000 doctors nationally is even lower than it was in 2009 and "continues to be significantly lower than the peak for the past 10 years."

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