State agencies that license and discipline doctors in California and Florida are among those with the worst track records in protecting patients from seriously substandard care, according to today's report from Public Citizen, a national consumer advocacy group based in Washington, DC.
The group analyzed data released by the Federation of State Medical Boards on all actions taken against doctors in 2008. It included revocations, surrenders, suspensions, probations and other restrictions ordered by all state medical boards based on the number of actions per 1,000 physicians.
Not only was number of serious actions significantly lower than in previous years, Public Citizen said, but the 2008 rate is 21.5% lower than the peak rate in 2004.
The states with the worst discipline rates were Minnesota, South Carolina, Wisconsin, Mississippi, Connecticut, New Hampshire, Maryland, Florida, California, and Georgia. The advocacy group singled out California and Florida because they have a large number of doctors, and said they should have taken far more disciplinary actions.
The best states were Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado, and Maine.
Public Citizen President Sidney Wolfe, MD, deplored what he called a downward trend in number of serious disciplinary actions. He said state lawmakers must "give serious attention to finding out why their states are failing to discipline doctors and then they need to take action, either legislatively or by applying pressure on medical boards. Otherwise they will continue to allow doctors to endanger the lives and health of their residents because of inadequate discipline."
Wolfe said the report focused on California and Florida for several reasons. In the 20 years in which Public Citizen has issued this report, neither state had ever been in the bottom 10 in number of physician disciplinary actions. Also, he said, Florida has a lot of senior citizens who receive a lot of care and may be vulnerable to poor medical practice.
But he focused specifically on California, whose 2008 ranking fell most precipitously, he said. "California's ranking, which used to be in the middle of the state, has tanked, indicating something has obviously gone wrong in that state," he said. He could not say what that might be.
Attorney Julianne D'Angelo Fellmeth, the board's "independent enforcement monitor," a position created by the legislature, had several explanations for the decrease in California physician disciplinary actions.
"What we have here is a 'perfect storm' of problems that beset (the Medical Board of California's) enforcement program—some of which were within the control of the Board and the attorney general's office, and some of which were not," she said. "Obviously, this is unsatisfactory."
Not only did the board experience a 9% to 12% vacancy rate in its investigative staff, in part because staff members leave for higher paying posts at other agencies, but during 2008, Gov. Schwarzenegger issued an order requiring state agencies to lay off all part-time and temporary employees, she said.
"This meant that the Medical Board of California lost all of its 'medical consultants (part-time physician employees . . . who assist with disciplinary investigations) for about four months," she said.
Candis Cohen, spokeswoman for the Medical Board of California, explained California's decline in disciplinary actions against physicians saying it is due in part to the board's "concerted efforts to improve our ongoing outreach to medical schools, informing students of the rules and educating them about enforcement issues.
She added that the board has also expanded newsletter articles to "continually and proactively educate" the state's doctors about practice behavior that can lead to disciplinary actions against them.
But she agreed with Fellmeth's assessment that Gov. Schwarzenegger's order "prohibited us for several months from using our medical consultants, who assist in many ways with our investigations, and also from hiring court reporters, which required us to continue many hearings."
Additionally, during four months there were no court reporters for administrative hearings, during which judges heard the cases against physicians, and furloughs of state agency employees cost the board 1,600 hours per month in lost investigative time. This too "slowed down" the process.
Wolfe added that of all the relationship between various state physician associations and their respective state medical boards, "none is as bad or is worse than in California. You can't blame the medical association for these bad rankings, but the fact is, the trade associations don't like the idea that any of its members are deemed in need of discipline."
The California Medical Association could not be reached for comment. The AMA declined comment on the report.
Reports from the field indicate that validation surveys by state surveyors on behalf of the CMS are happening with greater frequency in 2009.
Validation surveys are unannounced surveys used to validate an organization's accreditation process. These surveys are conducted on a representative sample basis, or in response to substantial allegations of noncompliance. Unlike in the case of a for-cause survey, hospitals are selected at random for validation surveys. It could be that CMS is requesting more validation surveys to be ready to review the Joint Commission's soon-to-be-submitted applications for continued deeming authority.
Central Maine Medical Center in Lewiston, ME, faced a slightly different challenge than the average hospital—the facility is a 250-bed hospital but is interconnected with 30 outpatient practices as part of the hospital's license.
"CMS goes to all sites," says Patricia Roy, RN, director of professional quality services at Central Maine. "We had to have multiple surveyors out to every physical location we have."
The five-day survey, which took place five weeks after the close of the Joint Commission survey, involved up to 11 surveyors each day.
"The [CMS] visit was a surprise—when they came to the door I thought, 'You've got to be kidding!'" says Roy.
On the upside, however, the entire facility was still very much in survey mode.
"We still had binders we hadn't put away from the Joint Commission visit," says Roy. "As soon as they came in, we went right into response mode. They let us do an opening presentation, and we had it updated and ready."
Again, the surveyors did not arrive together as they would in a Joint Commission survey.
"They sort of staggered in on the first day rather than arriving en masse," says Roy. "The lead surveyor showed up first, then a few more, then we had the rest arrive a few hours later."
This allowed for even more prep time to get escorts ready for surveyors and prepare staff. The pharmacist surveyor arrived on day four, while the engineer surveyor arrived on day two.
"The amount of resources and people needed as opposed to a Joint Commission survey just to play host is quite a bit more," says Roy. "Managers and directors always want to be back in their departments to help them get ready, but we really had to have eight or nine people playing host."
With so many outpatient facilities, transportation was a unique problem as well.
"Just to have enough people to drive them around was tough," says Roy. "We had two fire marshals for all of the days as well who also had to go to every physical site. It was an awful lot of traveling."
To help keep things streamlined and organized, Central Maine developed in preparation for its most recent survey a command center concept.
"This worked very well for us, so we did the same for the CMS survey," says Roy.
Staff were dedicated to the command center, passing out information to survey hosts, and were the repository for information coming in from staff regarding what surveyors were looking for and which files they wanted.
"It helped us coordinate who was with who, where they were going, printing out the right schedules," says Roy. "We had a managers briefing every night after the surveyors left with notes about what they were seeing, what their concerns were, so that the managers and staff could be prepared and calm."
Roy found the focuses varied between surveys.
"Compared to the Joint Commission survey, the CMS team focused tremendously on performance improvement and quality," says Roy. "Hours and hours and hours spent discussing minutes, when did [a certain decision go] to the board, details around one chapter of the regulations."
For the Joint Commission survey, these things were discussed but not highlighted in such a key way.
"I spent three days with two surveyors talking about quality," she says. "What are you working to improve upon, what are your safety items?"
The survey team pulled out the regulations and went through it line by line.
"The Joint Commission are much more trying to get the gestalt of the standard," says Roy. "In the CMS survey, it's much more black and white—they pull out a chapter of the CMS regulations and check off yes or no."
In the end the survey was very positive, with no recommendations from the survey team.
A survey by the International Foundation of Employee Benefit Plans finds that the recession is forcing employers to increase cost-sharing and reduce benefits.
Tom Stys, MD, with Sanford Clinic Heart Partners, will serve as state representative for the newly-formed Transcatheter Cardiovascular Therapeutics State Chapter of South Dakota. TCT is an educational resource for the interventional cardiology and endovascular medicine community.
Janice Smith joins Woodland Healthcare as vice president and CFO. She will serve as the key financial strategist for both Woodland Memorial Hospital and the Woodland Clinic Medical Group. Prior to joining Woodland Healthcare, Janice was a chief administrative officer at UC Davis Health System, where she also helped develop its primary care network, was a manager in managed care operations, and served as budget director.
Morton Plant Mease Health Care has named Chris Winters the new CFO. In his new position, he will assist senior management with strategic financial planning and budgeting, according to a release. With 17 years of healthcare experience, Winters was previously CFO of the western region of Cleveland Clinic Health System.
The Memorial Hospital CFO Barry Bergman submitted his resignation April 9 and will be leaving his post May 1. Samantha Johnston, TMH service excellence officer and spokesperson, said Bergman left to pursue a career opportunity in Anchorage, AK. Bergman was the hospital's CFO since April 2007. His departure is the second administrative resignation at the hospital in about a month. CCO Bob Lindberg, who joined the hospital in September 2006, resigned in early March and left TMH on April 3. Lindberg also resigned for personal reasons, Johnston said. Kathy Fagan, inpatient services director, has taken his place as interim CCO. The hospital has not yet named an interim CFO. Quorum Health Resources will be tasked with finding Bergman's replacement.
Sally Jeffcoat has been named president and CEO of Saint Alphonsus, a 387-bed regional medical center. Most recently, Jeffcoat served as the executive vice president/COO of Healthcare Operations for Ascension Health in St. Louis. Prior to that, from 2003 to 2007 Jeffcoat was the president and CEO of Carondelet Health Network in Tucson, AZ. He will begin as CEO at Saint Alphonsus on June 1.
HHS has named Henry Claypool director of the HHS Office on Disability. Claypool has 25 years of experience developing and implementing disability policy at the federal, state, and local levels, and he has personal experience with the nation's healthcare system from the perspective of an individual with a disability. Claypool now serves as the policy director at Independence Care System, a managed long-term care provider in New York City. Claypool has advised the federal government on disability policy for several years.
President Obama has named Virginia Technology Secretary Aneesh P. Chopra to be the nation's first chief technology officer. The president announced the choice over the weekend in his weekly radio and Internet address, adding Chopra to a small group of advisers whose aim it is to enhance and modernize the delivery of government services. The president also named Jeffrey Zients, a chief executive and former management consultant, to be his chief performance officer. The position was initially offered to Nancy Killefer, who withdrew after questions were raised about her payment of taxes. Chopra, appointed by Virginia Gov. Timothy M. Kaine in 2006, had been under consideration for months for a job in the Obama administration, including technology chief at the Department of Health and Human Services.
