How Does Your State Rank?
Public Citizen, the consumer advocacy group, is looking at the numbers and finds that California and Florida are not living up to the task of disciplining doctors who are practicing substandard medicine.
Public Citizen previously reported that about five percent of doctors are responsible for half of the medical malpractice in the U.S. that can result in permanent injury or death. To weed out the bad doctors and create better outcomes for patients, state medical boards are established to periodically review complaints and investigate bad outcomes. This report casts a doubt whether that is happening.
Minnesota, Maryland, South Carolina and Wisconsin are among the worst with the lowest rates of disciplinary action against acts of malpractice.
Taking data from state medical boards, serious discipline is defined as suspension or revocation of a medical license, surrendering a medical license and probation or restrictions of a license. The rankings were averaged over three years and were calculated per 1,000 doctors.
Overall, the rate of discipline was down in 2008 compared to the peak year of 2004. Then 3.72 doctors per 1,000 were disciplined. In 2008, the rate dropped to 2.92.
Translated into actual doctors, 770 avoided disciplinary action that would have been addressed compared to the 2004 standard. In a 2006 report, Public Citizen found that even when a doctor is convicted of drug related offenses or insurance fraud, they often did not receive severe discipline by their state’s board.
The Best / The Worst
States with the lowest serious disciplinary action rates for 2006-2008, were, starting with the lowest: Minnesota (0.95 actions per 1000 physicians); South Carolina (1.23); Wisconsin (1.64);Mississippi (1.87); Connecticut (1.97); New Hampshire (2.10); Maryland (2.20); Florida (2.35); California (2.37); and Georgia (2.40), according to Public Citizen.
The states with the most doctor discipline were: Alaska (6.54 serious actions per 1,000 physicians); Kentucky (5.87); Ohio (5.33); Arizona (5.12); Oklahoma (5.02); North Dakota (4.99); Louisiana (4.74); Iowa (4.56); Colorado (4.54); and Maine (4.44).
"The overall national downward trend of serious disciplinary actions against physicians is troubling because it indicates many states are not living up to their obligations to protect patients from bad doctors," said Sidney Wolfe, M.D., Public Citizen’s acting president and director of its Health Research Group said in a statement.
"State lawmakers must give serious attention to finding out why their states are failing to discipline doctors and then they need to take action - either legislatively or by applying pressure on medical boards. Otherwise, they will continue to allow doctors to endanger the lives and health of their residents because of inadequate discipline."
What Goes Into Doctor Discipline
States that provide adequate funding from licensing fees that support board activities tended to do a better job disciplining physicians. And boards that had adequate staffing and initiated proactive investigations rather than reactive action tended to do better. Excellent leadership is also important to have a fully functioning medical board that takes actions when needed.
The legal community is often blamed for spikes in medical malpractice insurance. In response, the legal community and patient advocates suggest that five percent of bad doctors, responsible for the most medical malpractice, should be disciplined vigorously.
Public Citizen suggests a standard involving “the preponderance of the evidence” might make the board more proactive rather than “beyond a reasonable doubt” or “clear and convincing evidence.” #