Are state medical boards underdisciplining doctors?

Most states aren’t living up to their obligations to protect consumers from doctors who are practicing medicine in a substandard manner.

That’s the assessment of Public Citizen’s Health Research Group after analyzing data released by the Federation of State Medical Boards on all disciplinary actions taken against doctors in 2008.

Action needs to be taken, legislatively and through pressure on the medical boards themselves, to increase the amount of discipline and, thus, the amount of consumer protection. The group offers this conclusion in its article “Public Citizen’s Health Research Group Ranking of the Rate of State Medial Boards’ Serious Disciplinary Actions, 2006-2008.”

The five states with the largest decreased in rank of the rate of serious disciplinary actions from 2001-2003 to 2006-2008 are:

• Alabama

• California

• Georgia

• Mississippi

• New Hampshire

The five states with the largest increases in rank of the rate of serious disciplinary actions from 2001-2003 to 2006-2008 are:

• D.C.

• Hawaii

• Illinois

• Maine

• North Carolina

State medical boards are likely to be able to do a better job of disciplining doctors, according to the group, if the following conditions are met:

• Adequate funding.

• Adequate staffing.

• Proactive investigations rather than only reacting to complaints.

• The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions, malpractice payouts, and the criminal justice system.

• Excellent leadership.

• Independence from state medical societies.

• Independence from other parts of the state government so that the board has the ability to develop its own budgets and regulations.

• A reasonable legal standard for disciplining doctors.

Without adequate legislative oversight, many medical boards will continue to perform poorly, the group stated in the article.

Copyright 2009, Rita R. Robison, Consumer Specialist

Comments

[William Price]

FORMAL HEARING, ARIZONA MEDICAL BOARD MEETING, OCTOBER 9, 2008. www.azmd.gov minutes (October 8 & 9, 2008, pages 19 & 20)

5.MD-07-0798ASHAWN D. BLICK, M.D.27246Issue an Advisory Letter for inadequate medical records and inadequate informed consent for performing a new procedure. There is insufficient evidence to support discipline. Obtain 15-20 hours non-disciplinary CME in medical ethics within six months. The CME is in addition to the hours required for license renewal.Complainant WP spoke during the call to the public. Dr. Blick was present with legal counsel, Mr. Daniel Jantsch. Drs. Krishna and Petelin stated they know Mr. Jantsch, but it would not affect their ability to adjudicate this case. Bhupendra Bhatheja, M.D., Medical Consultant, stated that Dr. Blick misled a patient by failing to disclose that he would not be the surgeon of record and that this was his first live human case. Mr. Jantsch stated that the MC was never provided the Boards interview of the other surgeon involved in this case. Dr. Blick stated that he feels he provided the patient adequate informed consent. Dr. Petelin commented that it was erroneous and deceptive to document himself as the supervising physician of a procedure that he had no experience performing. Dr. Blick stated that he did not intend to mislead the patient and that he was never knowingly deceitful. Dr. Martin found that Dr. Blick was deceitful in having the other physician take credit for the procedure. Dr. Bhatheja pointed out that the other physician testified that he and Dr. Blick received credit for performing the procedure.MOTION: Dr. Petelin moved to enter into executive session.SECONDED: Dr. LeeVote: 10-yay, 0-nay, 0-abstain, 0-recuse, 2-absent.MOTION PASSED.The Board went into Executive Session for legal advice at 3:05 p.m.The Board returned to Open Session at 3:08 p.m.No deliberations or discussions were made during Executive Session.MOTION: Dr. Petelin moved for a finding of unprofessional conduct in violation of A.R.S. 32-1401(27)(e) - Failing or refusing to maintain adequate records on a patient; and A.R.S. 32-1401(27)(t) - Knowingly making any false or fraudulent statement, written or oral, in connection with the practice of medicine or if applying for privileges or renewing an application for privileges at a health care institution.SECONDED: Dr. MartinFinal Minutes for the October 8-9, 2008 Board MeetingPage 20 of 21Dr. Petelin stated that there is a preponderance of evidence to support that Dr. Blick was intentionally misleading and deceitful.VOTE: 5-yay, 4-nay, 1-abstain, 0-recuse, 2-absent.MOTION PASSED.Dr. Petelin stated that the patient should have been informed of the surgeons level of experience, providing the patient with the opportunity to choose whether he preferred to undergo the procedure with a more experienced physician.MOTION: Dr. Petelin moved for a draft Findings of Fact, Conclusions of Law and Order for a Letter of Reprimand for failing to inform the patient about his lack of experience, for failure to inform a patient that he was not going to be the surgeon of record for the robotic prostatectomy, and for inadequate medical records.SECONDED: Ms. IbezDrs. Krishna, Mackstaller and Schneider spoke against the motion as they believed this matter does not rise to the level of discipline.ROLL CALL VOTE: Roll call vote was taken and the following Board members voted in favor of the motion: Ms. Ibez and Dr. Petelin. The following Board members voted against the motion: Ms. Griffen, Dr. Krishna, Dr. Mackstaller, Dr. Martin, Dr. Pardo and Dr. Schneider. The following Board members were abstained: Dr. Lee and Ms. Proulx. The following Board members were absent: Drs. Goldfarb and Lefkowitz.VOTE: 2-yay, 6-nay, 2-abstain, 0-recuse, 2-absent.MOTION FAILED.MOTION: Dr. Krishna moved to issue an Advisory Letter for inadequate medical records. There is insufficient evidence to support discipline.SECONDED: Dr. SchneiderDr. Petelin spoke against the motion and reiterated that the patient was not adequately informed of the surgeons experience.ROLL CALL VOTE: Roll call vote was taken and the following Board Members voted in favor of the motion: Ms. Griffen, Dr. Krishna, Dr. Mackstaller, Dr. Pardo and Dr. Schneider. The following Board members voted against the motion: Ms. Ibez, Dr. Lee, Dr. Martin, Dr. Petelin and Ms. Proulx. The following Board members were absent: Drs. Goldfarb and Lefkowitz.VOTE: 5-yay, 5-nay, 0-abstain, 0-recuse, 2-absent.MOTION FAILED.MOTION: Dr. Schneider moved to issue an Advisory Letter for inadequate medical records and inadequate informed consent for performing a new procedure. There is insufficient evidence to support discipline. Obtain 15-20 hours non-disciplinary CME in medical ethics within six months. The CME is in addition to the hours required for license renewal.SECONDED: Dr. LeeROLL CALL VOTE: Roll call vote was taken and the following Board members voted in favor of the motion: Ms. Griffen, Ms. Ibez, Dr. Krishna, Dr. Lee, Dr. Mackstaller, Dr. Martin, Dr. Pardo, Ms. Proulx and Dr. Schneider. The following Board members voted against the motion: Dr. Petelin. The following Board members were absent: Drs. Goldfarb and Lefkowitz.VOTE: 9-yay, 1-nay, 0-abstain, 0-recuse, 2-absent.MOTION PASSED.NO.CASE NO.PHYSICIANLIC

[Rita]

Hi William,

This is quite a case note. It's hard to follow, but it looks as though the doctor didn't receive any disciplinary action from the medical board.

See the report "Hospitals Drop the Ball on Physician Oversight" by Public Citizen, a consumer advocacy organization for more information on the difficulties that are occurring with disciplining doctors.

Rita