Blog | Tuesday, May 22, 2012

QD: News Every Day--Most state medical boards substandard, watchdog group says

Most states don't protect patients from substandard doctors, in part because of budget cuts, according to an annual ranking of state medical boards by Public Citizen.

The annual rankings are based on the number of serious disciplinary actions taken against doctors in 2009-2011 as reported by the Federation of State Medical Boards. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state averaged over three years to establish each rank.

Starting with the worst, South Carolina had 1.33 serious actions per 1,000 doctors, compared to the national average of 3.06 per 1,000.

The rest of the bottom 10 are Washington, D.C.; Minnesota; Massachusetts; Connecticut; Wisconsin; Rhode Island; Nevada; New Jersey; and Florida.

South Carolina, Minnesota and Wisconsin have consistently been among the bottom 10 states for each of the past nine Public Citizen rankings. Connecticut has been in the bottom 10 for each of the past six rankings. For the fourth time in a row, Florida is among the 10 states with the lowest rates of serious disciplinary actions even though it is beginning to improve.

Other large states, such as Texas, Pennsylvania and Michigan, have been in the bottom half of state rankings for all nine rankings and California has been in the bottom half for the past six rankings.

Tighter state budgets are the likely cause, the organization said in a press release.

The best states when it comes to doctor discipline are Wyoming (6.79 serious actions per 1,000), followed by Louisiana, Ohio, Delaware, New Mexico, Nebraska, Alaska, Oklahoma, Washington and West Virginia.

Alaska, Ohio and Oklahoma have been in the top 10 for all nine rankings. Only one of the nation's 15 most populous states, Ohio, is represented among those 10 states with the highest disciplinary rates.

Nationally, the rate at which state medical boards take serious action has declined significantly over the past seven years. The average in 2011 was up 3% from 2010 but is still down 18% from the peak rate of discipline in 2004 of 3.72 per 1,000.

The report states, "Absent any evidence that the prevalence of physicians deserving of discipline varies substantially from state to state, this variability must be considered the result of the boards' practices. Indeed, the "ability" of certain states to rapidly increase or rapidly decrease their rankings (even when these are calculated on the basis of three-year averages) can only be due to changes in practices at the board level, often related to the resources available to have adequate staffing; the prevalence of physicians eligible for discipline cannot change so rapidly."

Public Citizen said that boards are likely to do a better job disciplining physicians when they:
--are well-funded, with all license fees going to fund board activities instead of other parts of the state treasury,
--are well-staffed,
--proactively investigate rather than only respond to complaints,
--consider Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts,
--are independent from state medical societies and other parts of the state government, and
--apply preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence as the legal standard for discipline.