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."