After Massachusetts, the Deluge

by ANNE PAXTON

Editor, Professional Licensing Report

It seemed that Massachusetts was striking off on its own last year when it decided to put physician discipline and malpractice information on the Internet. But the reaction in other states suggests that the floodgates are opening:

• The Florida Agency for Health Care Administration announced in December that it will issue a quarterly list of physicians with long malpractice or disciplinary records. A Tampa Tribune investigation last year showed the state had never restricted the practices of most of the 19 physicians with the worst malpractice histories. A spokesman for the agency said, "All we can do is lay this stuff out there and hope the more exposure consumers have to this information, the better decisions they make."
  
• Pharmacists and optometrists are to be the first professionals whose licensing and disciplinary histories go on-line in Illinois this year. Anyone with a computer and Internet access will be able to verify a professional's license or inquire about disciplinary action. The rest of the 45 professions licensed by the Department of Professional Regulation will follow later.
  
• In North Carolina, a listing of 32,000 professionals including physicians, nurse practitioners and physician assistants has been on-line since December and is updated twice a month. If the state has taken no disciplinary action against a professional, the listing will say, "no current action." If disciplinary action has been taken, the listing will say to contact the appropriate board for more information.
  
• Because of protests from the state's largest medical society, the Maryland medical board had to backtrack in February, after it announced that it would start computerized physician profiles as early as March. Now the profiles will wait until at least early summer. But the board, which receives 10,000 requests a year for information about physicians' backgrounds, wants to reduce the work of fielding consumer inquiries. It began a $750,000 project two years ago to computerize its records for the hospitals that rely on them. It is advocating a computer bulletin board, which would not make the profiles available on the Internet. It would also require inquiries to specify an individual doctor's name, so that consumers could not browse for doctors in a certain specialty or part of the state. Under the scheme, malpractice lawsuits filed against doctors would be included regardless of the outcome of the case. The board says it has been told by the state attorney general that it doesn't have a choice: malpractice claims are required to be available to the public.

Journalists love these initiatives. Their credo is that open information is healthy and the public has the right to know, especially where government agencies are involved. But even more than accountability is at stake with professional discipline, a system that has, by accident or design, shown an amazing number of anomalies. Three examples that recently came to light:

• A Chicago Sun-Times investigation in November revealed that 271 security guards licensed by Illinois have kept their registration cards since December 1994, despite lying on their applications or failing to notify the state about past crimes like burglary, drug dealing, battery, theft, and domestic violence. In 48 cases the guards disclosed their convictions and were allowed to work. The reason: a giant loophole in the statute. The application used for registering security guards asks whether the applicant has a criminal conviction, then the state does a fingerprint check. The process can take months—and the security guard is allowed to work during that time. If undisclosed convictions are revealed, the security guard is sometimes put on probation and allowed to continue working. The Department of Professional Regulation says it is frustrated with the system but is just following the letter of the law.
  
• It would seem that if anyone has a right to comment on a professional's petition for reinstatement, then patients or clients should head the list. But the Florida state supreme court held October 18 that Jimmy Hatcher, a former client of Leo Greenfield, did not have standing to file an objection to Greenfield's petition for reinstatement. The issue is procedural, according to the Florida Board of Bar Examiners, which guides the readmission decisions; it does not consider unsolicited public input. But there is a peculiar discrepancy in the law. While suspended attorneys who seek reinstatement go before the state bar in full public proceedings, disbarred attorneys or those who resign have their petitions heard under tight confidentiality. The board says it will be re-examining its confidentiality policy this year.
  
• Some physicians have believed that surrendering a license, even under pressure from the board, helps them salvage a reputation that would be ruined by a revocation. State laws differ on whether this kind of surrender constitutes disciplinary action. In Idaho, the surrender of LeVar Withers' license occurred after 117 women accused him of sexually abusing them, but the board's public statement gave no background. It said, "Dr. Withers has permanently surrendered his license to practice medicine and surgery effective July 31, 1995. Dr. Withers will not practice in this state or any state in the future." An activist in Idaho Falls faxed a press release to newspapers to fill in the missing information. But the case highlights an important difference in what data banks collect. According to the board's executive director, the National Practitioner Data Bank considers Withers' license surrender a reportable disciplinary action, but the Federation of State Medical Boards' discipline data bank does not; it includes only public disciplinary actions. Since many boards do not query the federal databank and rely on the federation's when checking out a license, the anomaly is significant.
  

Is the release of malpractice and disciplinary information really a response to "public demand?" Or is it a symptom of a shift of power in health care, in which managed-care companies—not professionals—are calling nearly all the shots? Whatever its origins, the airing of disciplinary data is sure to expose more policies and procedures that, like these examples, just don't make sense.