Innovations and Evasions in the Information Age by Anne Paxton, Editor Professional Licensing Report

Bureaucracy fills partly practical needs, and partly irrational needs. For example, we all know that licensing exists to protect the public, but in its function as career gatekeeper it also helps us ration, or limit, elite job opportunities as well as identify and sort candidates for the less elite jobs. As the Internet makes information more widely accessible, lately it's been making it much more obvious that licensing is an information gatekeeper too. Even in a technological age, licensing plays the role of making some information magic, other information taboo.

The names of physicians who make mistakes, even life-threatening ones, continue to be sheltered, despite the annual release of the Health Research Group's compiled disciplinary actions, now up to more than 16,000 "questionable doctors." One of the most interesting stories so far this year was the news from North Carolina that "wrong-side" surgeries are on the rise. In about 15 cases since 1995, surgeons in the state have operated on the wrong side, the wrong level, or the wrong extremity of the body.

The medical board discovered this through mandatory reporting of malpractice cases, but consumers won¹t find out who the surgeons are, and the board has made no mention of disciplinary action against these physicians. Instead, a protocol has been recommended, under which patients are to be advised when surgery is planned to take an indelible marker and mark their skin the night before on the side of the surgical site. The nurse is supposed to note whether the patient has marked the skin and request that the patient do so.

Respiratory therapists in California got a more sophisticated "indelible marker" when their new licenses arrived in the last couple of years. Because the Respiratory Care Board encountered so many cases of counterfeit licenses, it opted to use a plastic, credit care size credential in dark colors: green for an unrestricted license and red for a probationary license. "The RCB specifically chose dark colors for the credit card license to thwart possible attempts to alter the license," the board said. "A clear photocopy of either an unrestricted or probationary license is virtually impossible. It also prompts the employer to call the RCB for verification, ensuring factual and actual practice status."

In the very near future, hiring a respiratory therapist might be like renting a car-but with the car presenting its credentials instead of the driver. The board plans to go on-line with hospitals in the state, using a magnetic strip on the license that would allow for electronic verifications, similar to the technology used by merchants to verify credit card purchases. The information would include the licensee's name, license number, address, expiration date, and any enforcement action that is public information.

Technology has made release of test scores more convenient. Starting last November, takers of the New York state bar exam could check their results on the Internet for the first time. The twice-yearly exam's results were formerly mailed to candidates, then published about a week to ten days later in the New York Law Journal. The State Board of Law Examiners decided to post the names of those who passed on the Internet ( to make them available to the largest number of people in the quickest possible time.

Meanwhile, the nation's first license renewals over the Internet are being made in Maryland, where a technology grant gave the Department of Labor, Licensing and Regulation the boost it needed to turn real estate licenses over to cyberspace, followed by the design professions. By 2000, there will be 20 professions renewing online.

But there are a lot of things that the Internet isn't changing. Traditionally, professionals who advertise have tested the limits of boards' tolerance about information disclosure, and the Internet is just giving a new twist to the tradition. In at least one case, junk e-mail, the latest type of advertising considered unprofessional by many state licensing boards, has led to loss of a license. An Internet ad by lawyer Laurence Canter advertising his Phoenix immigration law practice generated hundreds of complaints and led the Tennessee Supreme Court to impose a one-year suspension in June 1997.

According to the court, Canter posted the unsolicited ad on more than 5,000 chat groups and thousands of e-mail addresses. The practice, known as "spamming," often meets with irate "flaming" from recipients-and in this case from the legal profession. The ad failed to meet state standards, in that it carried no disclaimer and lacked the appropriate wording, said state disciplinary authorities, who found that Canter's book, How to Make a Fortune on the Information Superhighway, also provided plenty of evidence against him.

There were other reasons why Canter is being disciplined; his penalty is running concurrently with his disbarment for other infractions, including neglecting client cases, converting client funds, and writing paychecks that bounced. But the disciplinary investigation over the Internet ad turned up the stealing, and the Internet ad had brought the board more complaints than it had received on anything else in memory.

German dentist Michael Vorbeck experienced the same effect when he tried to post his prices for dental procedures on the World Wide Web: the medical board in the state of Trier put a hasty stop to the practice. In December, a court upheld that the board can keep him from listing prices, since price competition by doctors is banned. So is recording the names of visitors to your web site, the court told him.

As these cases suggest, the innovations of technology don't necessarily make information freer- they may just provide high-tech ways to make information unfree. But they also suggest that Marshal McLuhan was right; it's possible to become a technological nation, and remain at the same time a tribal nation.

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