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Most Medical Boards 'Terrible' at Discipline

 |  By jcantlupe@healthleadersmedia.com  
   March 29, 2012

By the time the Medical Board of California filed a petition to revoke the license of Michael Jackson's doctor this month—three years after the pop icon died—public complaints were common. Chief among them: What took so long? 

It was shortly after Jackson's death that critics started pounding the medical board for failing to quickly revoke physician Conrad Murray's license, or at least seek an interim suspension, after the doctor was charged with illicitly administering anesthesia to the performer, who had wanted to overcome insomnia.

The Jackson case was certainly high-profile, but it is only one of many across the country in which medical boards have failed to act expeditiously, or even at all, against bad doctors.

Earlier this month, a New England investigative reporting group published a story about the Massachusetts Board of Medicine, describing a "veil of secrecy" afforded to some doctors "due to physician-friendly provisions in state law, the board's policy of purging certain records, sometimes in violation of state law, and outdated technology."

Senators call for investigation
In fact, several U.S. Senators last month asked the inspector general of Health and Human Services to investigate the quality of state medical boards in the wake of critical media reports.

Some hospitals are handing medical boards information about bad docs, yet the state boards aren't acting on the knowledge. These do-nothing bodies are betraying patients as well as the hospitals that ferret out wrongdoing on wayward physicians, only to have their findings ignored.

That's the feeling you get after talking to Sidney M. Wolfe, MD, director of Public Citizen's Health Research Group, a consumer health advocacy and lobbying group based in Washington D.C.

"A small number of medical boards are doing a good job. Most are doing a terrible job," Wolfe tells HealthLeaders Media. "Medical boards have been asleep at the wheel too often. Most states are doing a terrible job protecting patients (against) a small number of doctors who are doing damage. One doctor may see 500 or 1,000 patients, but if that doctor shouldn't be practicing, a lot of patients may be injured or killed by that doctor."

Hospitals are filing internal actions banning doctors from their facilities, yet state medical boards, which have the ultimate authority in their jurisdictions, don't act, and these physicians are then free to practice across town.

State-hopping docs
Another issue is state-hopping. Some doctors are disciplined in one state, but they manage to slip unnoticed into another one, even though a national data bank is supposed to alert state officials about sanctioned doctors, Wolfe says.

The situation underscores continued problems with medical boards and their lack of oversight and control, says Wolfe, a veteran voice for better oversight of physicians. He is calling for medical boards to overhaul their structures and improve their leadership to get the job done.

The Federation of State Medical Boards, which represents 70 medical and osteopathic boards in the U.S. and territories, has been working to prevent "doctors hopscotching around the country," says Dan Wood, spokesman for the Medical Board of California. "Doctors do get in trouble and move from one place to another."

Through the federation, state boards "communicate with each other and we're very good at doing that.  Some places, like Wyoming or Montana or North Dakota, can move faster on cases, because they don't have the caseload like California. We have been impacted by shortage of people and budget restraints."

Even under the best of circumstances, medical boards have a difficult task. Medical boards often rely on information from the healthcare system, including physician "peers" and "that is the most challenging source of information," says Russ Aims, the chief of staff for the Massachusetts Medical Board.

Some colleagues may simply not want to squeal about a colleague's behavior, he says. "We can't assign [an investigator] over every physician's shoulder." However, Aims says, the board implements education programs and touts the importance of "patient safety and that's what it's all about."

Whether it's because of budget issues or politics, many states aren't moving quickly on doctor discipline cases.  An analysis of the National Practitioner Data Bank Public Use File for 1990-2009 found  that a total of 10,672 physicians have hospital sanctions, known as clinical privilege actions, against them for improper conduct. As many as 5,887 of these doctors—or 55%—have no pending state licensing actions, however, according to the Public Citizen report.

The hospital clinical privilege actions are peer review orders that Public Citizen says are one of the most important pieces of information used for medical board oversight. But, state board actions against a physician's license provide better assurance that a practitioner would be monitored or limited in work, the organization states.

A Public Citizen analysis says this "raises serious questions about whether state medical boards are responding adequately to hospital disciplinary reports and whether, as required by federal law, state medical boards are receiving such reports."

As a result, many of the doctors disciplined by their hospitals continue to practice unfettered, Wolfe says. "A large number have been thrown off the staff of hospitals and never disciplined," Wolfe adds.

"Part of the reason is that the executive branches of state governments are taking money dedicated to state doctors' licensing fees that are supposed to fund the medical boards and they are using it to try to balance the budgets for the rest of the state's [needs]. That's been going on in a number of states. It means the states are not taking a serious responsibility to discipline doctors who really need to be disciplined."

Wolfe says that Public Citizen has sent letters to state medical boards, urging them to investigate physicians who were disciplined by hospitals for various reasons, but not by the boards themselves.

Of the 5,887 physicians who were disciplined by hospitals between 1990 and 2009:

  • 1,119 were cited for incompetence, negligence or malpractice.
  • 605 had carried out substandard care.
  • 220 were disciplined because they were an "immediate threat to health or safety."

In addition, many of the doctors had a history of medical malpractice payments. A physician in New Mexico had 26 malpractice cases, while a physician in Indiana had 20. Fourteen states had a physician with at least one clinical privilege report, no state licensure action, and at least 10 medical malpractice payments.

The data "demonstrate a remarkable variability in the rates of serious disciplinary actions taken by the state boards. Only one of the nation's 15 most populous states, Ohio, is represented among those 10 states with highest disciplinary rates," according to Public Citizen.

The California state medical board was sharply criticized for failing to act promptly following Michael Jackson's death on June 25, 2009. A judge eventually suspended Murray's license to practice medicine and ordered the state to notify other states where he was licensed about the suspension. Other states where Murray had a medical license, among them Nevada, Hawaii, and Texas, were slow to discipline him too, according to a USC Annenberg School of Communication and Journalism report.

Murray was charged, tried, and convicted of involuntary manslaughter and sentenced to four years in prison before California filed a petition to remove his license.

California officials have defended their actions, saying they were always in touch with prosecutors, and the safety of the public was never at stake.

"We were able to move along at the pace we needed to," says medical board spokesman Wood, referring to the proposed discipline of Murray.

The pace of the states' medical board work involving physician discipline hasn't been good for years. According to Public Citizen "most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner."  Without legislative oversight, it says, "many medical boards will continue to perform poorly."

The situation is not without hope, however. State boards can turn their behaviors around, says Wolfe. Most need adequate funding and staffing. They should also have independence from state medical societies, and what they need most of all, says Wolfe, is "excellent leadership" and a board willing to do the right thing.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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