Medical board discipline up; lawmakers demand even more

New figures from state medical boards show that disciplinary actions against physicians jumped 20% between 2003 and 2004. Board officials attribute much of the increase to medical boards' beefed-up efforts to crack down on bad doctoring.

But legislators say the figures do not mean that every medical board is doing a good job of regulating and disciplining errant physicians. Doctors and others say there's always room for improvement.

Numbers the Federation of State Medical Boards released last month showed that state boards in 2004 took 5,502 prejudicial actions such as revocations, suspensions and reprimands against physicians. That's up from 4,590 actions in 2003. Substance abuse, unprofessional conduct and prescribing violations were the main reasons for discipline in 2004.

Non-prejudicial actions, which include license reinstatement after probation, climbed to 763 in 2004 from 640 in 2003. These board measures don't adversely impact physician licenses, but the federation said they consume time and resources, leaving small staffs less time to focus on in-depth investigations.

The 2004 numbers continue a rise in doctor discipline. Total board actions rose 36% over the past five years, with 6,265 actions in 2004.

But lawmakers in several states say their boards need to do more to discipline problem physicians, and they are pushing for legislation ranging from more funding and staff for boards to mandated discipline in certain situations.

American Medical Association policy urges state medical societies to recommend to legislatures that all fees and charges collected by state boards be designated for use by the boards. Even with that money, some medical society leaders say boards need more revenue.

"The bottom line is we want to make sure the medical board has the resources it needs to do investigative activities and to effectively do its job," said Robert W. Seligson, the North Carolina Medical Society's executive vice president and chief executive officer.

An upcoming study could validate physician and public concerns. Preliminary findings of a study on state boards in seven states indicated that small staffs and small budgets cause boards to struggle to handle thousands of complaints each year in a timely manner. The study by the University of Iowa and Urban Institute, set for release this summer, is designed to help boards better discipline doctors.

"A lot of times it really comes down to resources. Most medical boards are state agencies who are resource-challenged, and they're always going to have to prioritize," said Dale Austin, the FSMB's senior vice president and chief operating officer.

Behind the numbers

Medical leaders say a growing physician population is one reason for the upsurge in discipline in recent years. The number of medical doctors increased from 684,414 in 1994 to 871,535 in 2003, according to the AMA.

Higher discipline numbers also reflect improvements some medical boards made in how they handle complaints, regulate physicians and conduct business, board officials said.

For example, actions by the Florida Board of Medicine, which regulates MDs, soared to 976 in 2004, up from 410 in 2003, thanks largely to about 400 citations to doctors who did not complete required continuing medical education on time.

The Missouri State Board of Registration for the Healing Arts more than doubled its actions from 2003 to 2004, mainly due to a new state law requiring discipline of doctors who did not file or pay state income taxes, the federation said.

Tom Holloway, the Missouri State Medical Assn.'s government relations director, said it's hard to defend physicians who don't pay taxes and that the intent of the law seemed fair.

"Our board does a very good job of keeping the profession clean. I don't think they're overzealous," he said.

The North Carolina Medical Board said increased funding from the Legislature in 2001 enabled it to hire more legal and investigative staff, translating to a better focus on complaints and an increase in actions. "They want us to have all the resources the medical board needs to do a good job. We're starting to see the benefit of hiring [more staff]," said David Henderson, the North Carolina board's executive director.

Pennsylvania enacted legislation in 2002 requiring doctors to report liability settlements and judgments, leading to increased work for the state medical and osteopathic boards in 2004. The Pennsylvania Board of Medicine boosted the number of board investigators and legal staff, officials said.

Closer scrutiny of boards

Some Pennsylvania legislators say what their state has done may not be enough. Several lawmakers this year called for an investigation into the state medical boards' disciplinary practices.

State Rep. Tony DeLuca in March presented a resolution directing the Legislative Budget and Finance Committee to compare the boards' disciplinary rates before and after Pennsylvania's 2002 legislation. The probe, which has gained the support of other lawmakers, also would compare the boards' disciplinary rates and procedures with other states.

DeLuca said he thought a small percentage of doctors was responsible for large medical liability payouts and that the state's Board of Medicine and the Board of Osteopathic Medicine were doing a poor job of disciplining those physicians.

"They're understaffed," DeLuca said. "I thought it was a good idea to see how we rate ... compared to other states."

Pennsylvania Medical Society spokesman Chuck Moran said the organization had supported stronger medical boards, although it had not taken a position on the current resolution. But he also said that physicians who were involved in liability lawsuits with high payouts hadn't necessarily been negligent in their patient care, as some lawmakers believe.

Legislators also are giving renewed scrutiny to boards in Illinois, North Carolina and Texas, among others.

An Illinois proposal calls for revoking health care professionals' licenses if they have three or more gross negligence violations.

North Carolina is considering measures that include expanding disciplinary options for the board and increasing registration fees for medical licenses, actions that board leaders say would help make the board more effective.

A series in The Washington Post last month piqued the interest of city council members in Washington, D.C. They are planning to meet to discuss the District of Columbia Board of Medicine after the Post articles detailed how some medical boards allowed physicians with drug and alcohol problems to keep practicing, despite relapses, and told how the board did little to discipline doctors.

The Medical Society of the District of Columbia said the district's board does not have enough funding and that the society has advocated for more money for the board.

A few years ago, newspaper reports slammed the Texas State Board of Medical Examiners. Legislators passed a law providing more revenue through licensing fees.

"It basically saved our life," said Donald Patrick, MD, executive director of the Texas board.

Now state legislators are reviewing the Texas board again. The Texas Medical Assn. said it supports a strong, well-funded board that accurately processes license applications and affords due process to both complainants and physicians.

"There's always room for improvement," Dr. Patrick said. "We're working on getting better, and we'll get there."