Doctor disciplinary actions down for 3rd year
■ Some state medical boards are being accused of acting too slowly. But other boards note that the rankings don't take into account rehabilitation initiatives.
The number of disciplinary actions against doctors by state medical boards has fallen for three straight years.
Nationwide, total disciplinary actions are down 15% from a 2004 high, according to an April report by the Federation of State Medical Boards. Prejudicial actions, which include serious discipline such as license revocations and suspensions, have dropped 17% from 2004 to 2007.
The news comes on the heels of intense scrutiny of boards in Kansas and Nevada and legislation proposed or enacted in more than a dozen states aimed at strengthening medical boards' powers.
The Kansas State Board of Healing Arts, for example, came under fire in a five-part Topeka Capital-Journal series. The board was criticized for not suspending the license of Stephen Schneider, DO, until a 34-count federal indictment in December 2007 charged the family physician with unlawful distribution of controlled substances, health care fraud and money laundering. He maintains his innocence. Trial is set for February 2009.
Dr. Schneider prescribed narcotics that led to four patients' deaths by overdose, according to the indictment. The board had been investigating him since May 2006.
Two top board staffers resigned due to the controversy. The Kansas Senate last month unanimously passed a bill aimed at giving the board power to act on a single complaint, whereas now it must document a pattern of misconduct. The bill is before the House, and Democratic Gov. Kathleen Sebelius has promised to sign it.
The Kansas board ranked poorly -- 41st -- in an analysis of medical board data by the consumer advocacy group Public Citizen. The national rate of serious disciplinary actions per 1,000 licensed physicians fell 22% during the last three years, the group said.
"This is a huge decrease when you take into account that the number of doctors is increasing," said Sidney Wolfe, MD, director of Public Citizen's Health Research Group. Dr. Wolfe said the rate of discipline is a good measure of a medical board's effectiveness and closely tracks staffing and funding levels as well as strength of a board's leadership.
But others disagreed. The focus on disciplinary actions is "misleading," said David Watt, MD, PhD, FSMB senior vice president of professional services.
"There's no evidence to suggest that there's any correlation between the number of disciplinary actions taken and the protection of the public," Dr. Watt pointed out. "It could very well be that the best medical boards succeed in preventing serious problems and would have low numbers of disciplinary actions, and the citizens of those states would be better protected."
Medical board executives point to education and rehabilitation initiatives to explain why disciplinary actions are down, but Dr. Wolfe said those programs are common and not enough to explain the variation in discipline.
Variation among the states
South Carolina's board finished last in the Public Citizen ranking of the 50 states and District of Columbia. The board took nine serious disciplinary actions in 2007, while the No. 2-ranked Kentucky Board of Medical Examiners tallied 83 such actions last year. The states' physician work forces are similar in size, with Kentucky boasting 9,446 practicing doctors, 171 more than South Carolina.
The South Carolina Board of Medical Examiners did not respond to AMNews inquiries, but South Carolina Medical Assn. President Gerald E. Harmon, MD, defended the state's record. He said, for example, that incoming physicians are required to have a face-to-face interview with a board member before licensure, which helps weed out problem physicians.
Doctors in trouble "know we mean business," Dr. Harmon said, touting the board's 90%-plus rate of rehabilitating physicians with alcohol or drug problems through the state's impaired physician program. The Public Citizen approach to ranking medical boards "is like saying the safest state to live is the one with the most prisoners," he said.
Other medical board executives agreed.
"We don't get any credit for correcting our physicians and helping them to improve their ability to care for patients," said Drennan A. Clark, executive director of the Nevada State Board of Medical Examiners, which ranked 46th on Public Citizen's list. "We only get credit if we hang, draw and quarter a doctor."
Yet Nevada's board has been criticized for moving too slowly after a clinic's alleged unsafe syringe use infected eight patients with hepatitis C and exposed another 40,000 patients to bloodborne infections such as hepatitis C and HIV.
In late April, eight weeks after receiving a formal complaint from the Southern Nevada Health District, the Nevada board filed court papers to temporarily suspend the licenses of two physician clinic co-owners connected to the outbreak. The physicians each performed procedures on three patients who became infected because nurse anesthetists reused syringes, contaminating single-use vials of anesthesia, the health district said.
Days before the licensure move, Clark told AMNews that the medical records needed to help make the case were in police custody, and that because one physician voluntarily agreed to stop practicing, he did not pose the immediate danger to the public required to suspend his license temporarily. But board officials moved to suspend the two doctors' licenses under intense pressure from state lawmakers.
Indiana, New Mexico and Washington have enacted legislation this year beefing up board authority. Nine other states are considering legislation to increase funding, allow emergency suspensions or deny licenses for any criminal past.
AMA policy calls for all fees and charges collected by medical boards to fund board activities and says that legislatures should appropriate more funding when necessary. The Federation of State Medical Boards has similar policy.
Kansas state Sen. Jim Barnett, MD, said his state's board was handicapped by a loss of more than $1 million in fees the Legislature diverted to the general fund in the last few years. He voted for the bill to give his state board more power, but said the issue has been politicized.
"I don't think the Legislature should micromanage the Board of Healing Arts," he said.