California patients beware: You might not be the only one due for a check-up. The entire system that monitors the quality of care provided by your doctor could use an overhaul according to a report by Public Citizen, a consumer advocacy group.
The study says California is one of the least effective states in the country when it comes to disciplining its physicians and revoking their medical licenses. But what does this mean to you and me? The report indicates the California Medical Board’s inadequate disciplinary measures, poor budgeting, and untimely investigations could seriously jeopardize patient care by failing to protect them from doctors who are practicing bad medicine.
Public Citizen ranks California’s Medical Board 43rd in the nation, a dramatic slip from the middle of the pack, at 23rd, in 2005. Despite being one of the most populous states and having over 100,000 physicians, the study says California’s sharp decrease in rank means that far fewer doctors are being seriously disciplined for their actions when reprimand would be appropriate.
As a result of California’s budget constraints, the state medical board, responsible for enforcing the most important health laws, has felt the ripple effects from consumer complaints.
Raising the issue of where the board’s funding goes, Sidney Wolfe, Director of Health Research Group at Public Citizen, explained that the board “takes in more money than they spend...the money coming in isn’t being spent as it should be on licensing and enforcing state medical practice actions. It’s not fair to people in California.”
Distinguishing the top medical boards from the bottom tier, Dr. Wolfe explained that adequate funding, excellent leadership, independence from the state medical association, and constant analysis of both state and national databases is what sets state boards apart.
Public Citizen’s latest annual report found that out of 6,539 complaints that the medical board received in 2009, only 276 charges were issued by the administration. Between 2% to 3% of these complaints resulted in the loss of the doctor’s medical license. While this small fraction of doctors may seem insignificant, in a large state like California, this minority could seriously impact tens of thousands of patients.
Surprisingly, determining whether or not a physician has demonstrated negligent behavior worthy of investigation is not as black and white as it may seem. The board’s process to complete investigations often takes twice as long as it should. The state’s statute of completion is within 6 months of receiving a complaint; many investigations take a year or more.
“A pattern of negligent behavior worthy of suspension is difficult when the Board evaluates cases one at a time, as recognizing concerning behavior requires a longitudinal perspective,” explained Dr. John Maa, Assistant Professor of Surgery at the University of California, San Francisco. “It is difficult for the Board to employ sufficient quality 'peer reviewers' who can accurately judge the outcomes of a single practitioner, given the broad range of medical procedures performed and care delivered in 2011.”
Complaints and accusations of suspect doctors can be reported to the medical board from competitors in their field, from lawyers who use the board as a leverage to win cases for their own benefit, from hospitals that have filed disciplinary actions against them, from angry patients or simply litigious ones, and from a collection of erratic sources.
Of the Board’s 52-page list of doctors who have received substantiated complaints, the majority were reprimanded or put on probation, but they are still allowed to continue treating patients while another doctor looks over their shoulder.
Through the medical board’s records available on their website, NBC Bay Area found dozens of northern California physicians who were placed on temporary probation. While only a small handful have actually lost their licenses as a result of complaints ranging from doctor/patient sexual offenses, insurance fraud or prescription drug abuse, the large majority of the doctors listed on the board’s website continue to practice and prosper regardless of the multiple disciplinary actions that seem to pile up each year.
In some cases, patients have died as a result of seriously negligent acts, including the failure to recognize the severity of a mother’s uterine scarring and recommending a C-section. In another case, a patient died of cardiac arrest after accidental acetaminophen overdose. That patient’s doctor still has permission to treat patients.
While dozens of doctors do lose their licenses each year, these disturbing complaints filed against multiple northern California doctors seem to reveal what the medical board will tolerate in regards to what it considers as less significant crimes.
“Too often, decisions made by the staff of the board to do something, are overturned by the board itself because they are too sympathetic,” Said Wolfe, Director of Health Research Group at Public Citizen.
“Both nurses and physicians must be aware that negligence will carry serious consequences.....while a single instance or two may not trigger discipline, a repeated pattern of concerning behavior can affect their licensure,” Dr. Maa added.
When asked to provide an explanation of California’s downturn, the Board’s Chief of Legislation Jennifer Simoes explained, “it is important to point out that unless criteria and laws are identical from state to state, which they are not, it is not possible to rank states using a ‘one evaluation fits all’ approach and come up with a ranking that is truly equivalent to the Board's performance in its Enforcement Program.”
But Wolfe says it is precisely these differences between state medical boards that leads to differing results in a range of disciplinary actions. “That is the reason we do comparisons,” said Wolfe, “to ask questions if one board is much better than the others. States that are doing better are at least paying attention to a small fraction of doctors who need to be disciplined.”
In addition to making the state’s own medical disciplinary actions public, Dr. Wolfe explained that other state’s actions should be made public as well so that people are aware if their doctor was previously disciplined in another state. He also suggested that if California’s medical board made hospital disciplinary actions and malpractice payouts available on their website, people would have access beyond just whether the state disciplined the doctor.
“The Board needs to function to serve as a deterrent, and for oversight,” says Dr. John Maa of UCSF, “It serves a complementary role to hospital credentialing and peer review committees, and as our nation ponders the concept of 'accountable care organizations' one of the key ingredients is a robust Medical Board.”
In light of the Public Citizen's ranking and California’s slide to the bottom of the chart, it is a patient’s right to access information about his or her doctor. Being aware of your doctor’s medical history could potentially save your life.
“At end of day, all we have is the website and the Medical Board. That’s the only real layer of protection between ourselves and our doctors. If the board isn’t doing a good job, patient care suffers,” said Dr. Wolfe.
To find out more about your doctor’s history, click here to visit the California Medical Board website.