Alerts foil state-jumping by disciplined doctors

A more mobile society, telemedicine and the Internet have heightened the need to monitor physicians across state lines.

By Damon Adams — Posted May 21, 2007

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For having sex with a patient and inappropriately prescribing her drugs, an Alabama family physician had his license revoked in 2005 by the state's medical board. Soon after, Ohio, where the doctor also was licensed, was alerted to the discipline.

Ohio's board investigated and came to the same conclusion last year -- the doctor should not practice medicine. It took away his license as well.

Ohio acted promptly on the Alabama doctor thanks to the Disciplinary Alert Service of the Federation of State Medical Boards. The service alerts medical boards by e-mail within 24 to 48 hours when one of their licensees is disciplined in another state.

Before the service began in 2000, boards relied on a monthly federation report that required individual state board staff members to comb the paper report to see if one of their licensed doctors was disciplined elsewhere. With the alert service, boards are doing a better job of tracking and cracking down on disciplined doctors who might try to move across state lines and set up practice.

From 2003 to 2006, the federation said reciprocal actions jumped 37%, from 786 to 1,073. Those include discipline for sexual misconduct, substance abuse and probation violations. Reciprocal actions made up 19% of the 5,574 total actions medical boards took in 2006.

"The large jump in reciprocal actions is arguably directly related to the Disciplinary Alert Service," said James N. Thompson, MD, the federation's president and CEO. He added that the number of boards participating in the program grew from 24 in 2000 to nearly 70 today.

Medical board leaders agree that the alerts make a difference in keeping watch for physician problems.

"[The service] affords us the opportunity to learn much earlier where we might have a problem with one of our licensees. This has become a really, really important tool," said Richard Whitehouse, executive director of the State Medical Board of Ohio. David Henderson, executive director of the North Carolina Medical Board, said, "It has virtually stopped the ability of disciplined physicians to seek a geographic solution to their problem."

Keeping track of physicians

Board leaders said the need to monitor doctors across states has grown because society has become more mobile and more physicians are licensed in multiple states. Telemedicine has enabled more doctors to practice in many states via the Internet.

Another motivation: 88% of physicians disciplined in 2006 had two or more licenses.

"The whole telemedicine thing is burgeoning. There are many specialties where physicians will have many licenses in other states," said Randal Manning, executive director of the Maine Board of Licensure in Medicine. "It's still unusual, but it's not a shock, to see a physician with licenses in 45 or 50 states."

The federation said board officials' widespread use of alerts has helped prevent disciplined doctors from changing states without notice. Boards have used the information to revoke licenses and identify doctors who moved to their state without reporting discipline from a previous state.

For example, Delaware received an alert last year about a physician who was disciplined in Pennsylvania for a mental impairment that was endangering patients. At the time, the doctor had applied to the Delaware Board of Medical Practice to reinstate his lapsed license in Delaware.

The Delaware board denied the license reinstatement.

"Safetywise, I knew we had a concern based on the discipline from Pennsylvania," said board Executive Director Gayle MacAfee.

Nevada revoked one physician's license after it found out that California had taken away the doctor's license there. And Nevada has used the alerts for physicians who came to the state without revealing discipline against them in other states.

"We've had a lot of success with it, where we might not otherwise have known about [discipline]," said Tony Clark, executive director of the Nevada State Board of Medical Examiners.

The National Practitioner Data Bank is hoping for similar success with its Proactive Disclosure Service, launched April 30. It was developed in response to growing interest in continuous monitoring of health care professionals, officials said. Under the program, hospitals, health plans and other subscribers are notified within one business day when the data bank gets a report on a physician or other practitioner. Reports include board discipline, malpractice payments and professional society actions.

"This service lets them find out quicker if a doctor is trying to hide or go under the radar," said Mark Pincus, who heads the data bank for the Health Resources and Services Administration. "The intent is to get the health care organizations the information as soon as possible."

The federation and data bank services are proactive approaches to ensure patient safety and monitor physicians, medical leaders said.

"There's been a steadily growing concern about getting bad physicians out of practice. [The alert] is a primary element of patient protection, and that's what the state boards are charged to do," Dr. Thompson said.

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Dual discipline

E-mail alerts, started in 2000, advise medical boards if a doctor has been disciplined in another state. It is credited for an increase in reciprocal actions.

1997 636
1998 644
1999 668
2000 713
2001 762
2002 801
2003 786
2004 1,017
2005 1,028
2006 1,073

Source: Federation of State Medical Boards Physician Data Center

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