Public Citizen recently posted a report that revealed an extremely disturbing failure by licensing boards and/or hospitals to take appropriate disciplinary action against physicians, who have had their hospital privileges revoked, suspended or restricted.
At the heart of this revelation is the fact that when a physician does have action taken against his/her hospital privileges, the hospital is required to report such negative, adverse action to the jurisdiction’s medical licensing board. Nevertheless, as Public Citizen reports, during the time period being analyzed by Public Citizen (1990 to 2009), almost 6,000 such physicians have escaped any disciplinary action by state medical boards.
Of 10,672 physicians listed in the NPDB (National Practitioner Data Bank) for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards. That means 55 percent of them – 5,887 doctors – escaped any licensing action by the state. The study examined the NPDB’s Public Use File from its inception in 1990 to 2009.
For anyone familiar with how hospitals operate, it usually takes some egregious conduct for a hospital to take action against one of its privileged physicians. Threats of lawsuits by the physician against the institution are many times the first defense taken by a physician causing many hospitals to back-down from taking any disciplinary action. Often, those called upon to review the conduct of their fellow physicians are hesitant to discipline their peers too harshly for a multitude of reasons – not the least of which is the concept of “there but for the grace of God go I.”
That being said, how is it that when such an extraordinary step such as revocation, suspension or curtailment of hospital privileges does take place, these physicians escape being disciplined by their state medical boards?
Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and overseer of the study, offers these thoughts:
One of two things is happening, and either is alarming. Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed.
While I personally don’t purport to know the “reporting requirements” for all medical licensing boards throughout the United States, let me share with you the reporting requirements and legislative mandate of two jurisdictions with which I am familiar.
In Maryland, one need only look at the Maryland Board of Physicians (this state’s regulatory body) “responsible for licensing and disciplining physicians, physician assistants, respiratory care practitioners, licensed radiation therapists, radiographers, nuclear medicine technologists, radiologist assistants, and polysomnographic technologists” Hospital Reporting Requirements FAQ to get the answer as to whether or not such hospital actions are a “reportable event.”
By law, hospitals must report to the Board – within 10 days of action – any action taken that immediately affects the privileges of a practitioner or any other health professional regulated by the Board, based on any of the grounds listed in Sections 14-404 (Physicians), 14-5A-17 (Respiratory Care), 14-5B-14 (Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants), 15-314 (Physician Assistants), and 14-5C-17 (Polysomnographic Technologists) of the Medical Practice Act. These matters generally relate to questions of competence, performance, unprofessional practices and unethical practices.
In the District of Columbia, once you work your way through the maze of online links, you eventually find that it is the Board of Medicine, “a division within the DC Department of Health, Health Regulation and Licensing Administration (HRLA), that “has the responsibility to regulate the practice of medicine in the District of Columbia.
What is interesting is that on its website, the D.C. Board of Medicine takes pride in the fact that in 2010, Public Citizen, the very source of criticism of the various licensing agencies in the most recent 2011 report being discussed here, listed D.C. as No. 16 in the nation in “living up to their obligations to protect patients from doctors who are practicing substandard medicine.” A review of the 2010 report by Public Citizen reveals that D.C. had previously been ranked No. 42 in terms of “meeting its obligations” to “protect patients from doctors…practicing substandard medicine.”
So exactly where is the proverbial ball being dropped? Is it the hospital that is failing to report its adverse action to the medical board? Is it the medical board, having been told of the adverse action, that sweeps the sins of the offending physician under the rug? Whichever it is – and it’s most likely a combination of the two to some extent but more likely the latter – those who suffer in the final analysis are patients, who unknowingly come under the care of these questionable physicians.
We are not talking here about a physician, who is otherwise a competent, skilled practitioner in his or her area of specialty, but who has a “bad day” and renders substandard care to a patient. Unfortunately, that happens with some degree of regularity across the nation every day. For a hospital to go to the point of bringing one of its own up on disciplinary charges and taking adverse action against that physician is a major step – one reflecting by necessity such a level of incompetency, a pattern of unsafe, bad care, outrageous conduct and the like that it must call into question the overall competency, integrity and character of that physician. Then, if that is the case – which it clearly must be – why are such physicians allowed to simply pull-up stakes and move on elsewhere to practice their trade? How is this in the interest of patient safety, which is precisely one of the main reasons for the very existence of medical licensing boards?
Public Citizen didn’t just report the findings of its analysis; it did something about it.
Public Citizen today sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, urging the agency’s Office of Inspector General to reinstitute investigations of state medical boards, something it has not done since 1993. Public Citizen also is notifying the 33 medical boards that have had the worst records in disciplining these doctors.
We commend Public Citizen for its investigation and report. While it is no doubt important that this problem comes to light, it is even more important that it be corrected – and soon. Will Secretary Sebelius take action? Will the licensing boards clean-up their act now that their misdeeds have been brought to the public’s attention? If hospitals are, in fact, not reporting their adverse actions, will there be repercussions for this failure? When will medical boards do what they are constituted to do – protect the safety and well-being of patients – not when they feel like it, but when they are mandated to do it?