Fewer Bad Doctors Get Disciplined

Cheryl Clark, for HealthLeaders Media , April 20, 2009

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.

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