More doctors disciplined as states bolster medical boards

It used to take 1½ years to resolve a complaint filed against a Florida physician. Now it takes less than 100 days.

Fueling the Florida Board of Medicine's quicker case turnaround is a refined complaint process, 50 new employees and outside consultants handling complaints. Thanks largely to the changes since 1998, the board, which regulates MDs only, increased disciplinary actions by 30% from 2002 to 2003.

"It was a combination of processes, legislation and all those things that came together," said board executive director Larry McPherson Jr. "It finally all clicked in one year. Ultimately, this all pays off in patient safety."

Florida's increase contributed to a national boost in disciplinary actions, which rose 10% from 2002 to 2003 -- the largest one-year jump in a decade.

Are there more bad doctors, or are changes instituted by medical boards working?

Physician leaders point to the changes.

They say a key reason why disciplinary numbers have increased is that state medical boards have improved how they process complaints, regulate doctors and conduct business. That translates into a rise in license suspensions, revocations and other restrictions against doctors. Reforms in Texas as well as Florida have helped those state boards clear backlogged cases and run more efficiently.

"What it means is the [Florida] board is doing a better job of regulating medical practice. It doesn't mean that Florida has many more bad doctors," said Lisette Mariner, Florida Medical Assn. spokeswoman.

In 2003, state medical boards took 4,590 punitive actions against doctors, up from 4,169 in 2002, according to an annual summary of board actions released this month by the Federation of State Medical Boards. The states with the largest percentage increases were Kentucky, Texas and Florida.

Nationwide, the main reasons for physician discipline continue to be substance abuse, unprofessional conduct and prescribing violations, board officials said.

Each state's disciplinary numbers may fluctuate yearly, depending on the timing of case closures. But board officials say the overall trend is an upward climb in disciplinary actions.

"It has been inching up," said Dale Austin, federation senior vice president and chief operating officer.

Greater awareness of patient safety is a contributing factor. The public has become more attuned to the issue because of increased media coverage and reports detailing deaths related to medical errors. That awareness has led to increased scrutiny of medical boards, which then boost scrutiny of physicians.

"As public awareness of errors has become more pronounced, it may have led to more complaints being generated," Austin said.

A growing physician population is another contributing factor. The number of medical doctors rose from 684,414 in 1994 to 853,187 in 2002, the most recent year for which data are available, according to the AMA.

"More doctors mean more complaints, and more complaints mean more actions, so it follows suit," said C. William Schmidt, executive director of the Kentucky Board of Medical Licensure.

Changes lead to board improvements

Those familiar with the disciplinary process said board revisions are the key to rising disciplinary numbers in many states.

Harsh criticism by the media, public and legislators about five years ago prompted changes to the Arizona Medical Board. Laws were revised to improve enforcement, and investigation times decreased through the use of more investigators and consultants. This year the board added an online complaint filing system that allows patients to enter complaint information via computer. About 10% of all complaints are received through the online process.

In 1999, the Arizona board handed out 64 punitive actions. In 2003, it took 140 actions against doctors.

The South Carolina Board of Medical Examiners increased disciplinary actions in 2003 by reorganizing its litigation team to conduct more frequent hearings, federation officials said. That allowed swifter action on problem physicians.

The Kentucky Board of Medical Licensure hired a new attorney, giving the board two full-time attorneys to handle cases. Meanwhile, the public seems more aware of the board.

Many boards say they need more funding from their states to do a better job. But in Iowa, the board made do when no extra funds were in sight.

About a year ago, the Iowa Board of Medical Examiners re-evaluated which complaints it investigates. The board decided to focus efforts on practicing physicians first and push back investigations of out-of-state doctors whose licenses were inactive.

"We had to prioritize what was a risk to the public and what wasn't," said Ann Mowery, executive director.

Changes to medical boards often are prompted by media reports that draw closer scrutiny from the public and legislators.

Colorado lawmakers are considering changes in how the Colorado Board of Medical Examiners regulates doctors, following a series in The Denver Post, which said the board goes easy on doctors who provide poor care.

Susan Miller, board program director, said the board may make changes without legislation, but she disputed the newspaper's claim that the board is doing a poor job.

"I don't know of any press in the country that says boards are too hard [on physicians]," she said.

In Texas, newspaper articles and problems with that state's board led to change. In 2002, a governor's grant helped the Texas State Board of Medical Examiners hire five more attorneys, reducing a backlog of cases. Then, a law passed last year called for more board funding and speedier handling of complaints, especially those dealing with alleged sexual misconduct. To speed investigations, 20 new enforcement employees were hired.

"With that support from our legislature, we've had more thorough investigations and been able to get a few more bad guys off the street," said Larry Price, DO, board vice president."The guys who are out there who know they're doing wrong may be trying to hide a little bit more now."