CLEAR News - Fall
2000
Report on Doctors' Discipline Issued
On August 8, 2000 the Public Citizens Health Research Group released a state-by-state ranking of state medical boards' disciplinary actions. The report 20,125 Questionable Doctors,(2000 Edition), lists doctors that have been formally disciplined during the past decade. Over ninety percent of these sanctions were for serious offenses, including substandard care, criminal conviction, substance abuse, sex-related offenses, mis-prescribing of drugs, providing false information to boards, loss of hospital privileges or insurance fraud.
The report ranked Alaska first, after it issued serious sanctions against 12 of its 1,160 licensed physicians last year. Delaware meanwhile, which disciplined 2 of its 2,029 physicians, ranked last. Top ranking states by the number of sanctions issued, included North Dakota, Wyoming, Idaho, Oklahoma, Kentucky and Ohio. Those near the bottom were Nebraska, Tennessee, Minnesota, Hawaii and Connecticut. The national average is 3.5 serious actions per 1,000 doctors.
However, according to the report, the majority of those doctors who were disciplined for the most serious offenses were not required to stop practicing, even temporarily. "For instance, 3,215 doctors were disciplined for substandard care, incompetence or negligence, but only about a third had to stop practicing, even temporarily. Similarly, only about two-fifths of the 2,963 doctors with criminal convictions had to stop practicing, even temporarily, while only a third of 1,715 doctors disciplined for substance abuse were required to stop practicing, even temporarily." Dr. Sidney M. Wolfe, director of Public Citizen's Health Research Group, which conducted the research, stated that "In the majority of cases, the seriousness of these offenses was not matched by the severity of the sanctions ordered by medical boards."
The report is the only publicly available listing of sanctioned physicians. The federal database, the National Practitioner Data Bank, is not accessible by the public. Dr. Wolfe maintains that "(I)t is time for Congress to respond to the needs of citizens and open the National Practitioner Data Bank to the public. There are no excuses for allowing this data to be viewed by HMOs and insurance companies but not by the people who must put their lives in the hands of these practitioners." The Federation of State Medical Boards lists a summary of state board actions but does not provide the names of physicians. (see www.fsmb.org/) The data used by Public Citizen is taken from state and federal agencies and contains the doctor's name, degree, license number, date of birth, location, the disciplinary state or agency, the date of the disciplinary action, the nature of the discipline and available information about the case.
Critics of the report maintain that a ranking of punitive actions does not fairly represent actions taken by medical boards and according to the FSMB annual summary of board actions the data "doesn't account for differences from one board's jurisdiction to another and is considered inappropriate to use as a ranking device." Furthermore, Dr. James R. Winn, executive vice president of the Federation of State Medical Boards maintains that boards have stepped up efforts to guide physicians at the front end. "We're seeing some positive impact from boards improving standards for licensure, conducting better assessments up front to intercept doctors who are borderline in the first place, and articulating to licensees from the beginning what conduct is appropriate." And, "The general sense from the boards is that more now believe they need to be more proactive. They're outlining what they expect, Rather than saying ' Doctor, you should've known better.'"
The report concluded that the nation's system for protecting the public from medical incompetence is far from adequate, and that medical boards are too forgiving of doctors who have erred.
Public Citizen recommends that states promptly make public all their disciplinary actions, strengthen their medical practice statutes, restructure their medical boards to sever any links with state medical societies, and better staff and fund their medical boards. Also states should establish programs to weed out bad doctors and encourage complaints.
For examples of state efforts to provide the public with information on disciplinary actions please visit the following Web sites: Maryland http://207.86.25.147/ and Massachusetts www.massmedboard.org/.
To order the Public Citizen report and for further information go to: www.questionabledoctors.org