Doctor abuses show shortfalls in state licensing boards

California leads the nation in its number of practicing physicians─and some of those doctors are so awful they’re dangerous, Consumer Reports has found in its deep dive into state licensing boards and MD discipline. The magazine, in a cover story headlined “What you don’t know about your doctor could hurt you,” compiles some ghastly illustrations of bad doctors, including:

• A pediatrician with a fetish who fondled the feet of patients’ moms during exams;
• An ob-gyn who surgically removed the wrong ovary from a patient;
• An orthopedist who so ignored a patient’s fractured thigh bone that the whole leg needed be amputated;
• A cardiologist who perforated a patient’s artery with a stent and subjected that patient to needless diagnostic radiation;
• A neurosurgeon who allowed unlicensed medical assistants to administer narcotic painkillers through infusion pumps; one patient received four times the proper dose and was found dead a day later.
• Numerous MDs abusing drugs or prescription privileges, one of whom ordered 4 million hydrocodone-containing painkiller prescriptions in a 15-month period; another who filled prescriptions for 41,000 methadone tablets in a 28-month period; and another who was caught─while his license was on probation for substance abuse─ using a prosthetic penis and bladder to circumvent mandatory drug testing.

The magazine details the daunting numbers for patients who seek remedy through the Golden State’s physician licensing board for harms they have suffered. There are 100,000 physicians licensed in California; in 2014-15, there were 8,267 complaints filed against MDs with the board; it opened 1,381 cases;  it revoked 45 licenses, 85 doctors surrendered their licenses before board action, and 136 MDs were put on suspension (14 of those doctors already were on temporary suspensions).

The board says its paltry few revocations result from the stringent legal standards it operates under, or as a spokesman describes it:  “The disciplinary rate is that low in part because the burden of proof is high. There needs to be clear and convincing evidence’ that a violation has occurred and that it meets the guidelines to move forward.”

Doctors policing other doctors?

But others disagree. They say, simply, that doctors won’t or can’t police themselves.

Indeed, a newly published study in a peer-reviewed, academic medical journal calls out these boards nationwide for the huge variance in their disciplinary actions, saying in politic tones:

There is a significant, fourfold variation in the annual rate of medical board physician disciplinary action by state in the USA. When indicated, state medical boards should consider policies aimed at improving standardization and coordination to provide consistent supervision to physicians and ensure public safety.

Here’s an eyebrow raising aspect of the magazine article: Consumer Reports says it chose to scrutinize California partly because it may be one of the better regulators of MDs through its licensing board. The magazine rated medical boards of California, New York, Massachusetts, Illinois, and North Carolina as its five best, chiefly due to the transparency and data made available via websites.

Consumer Reports says it will keep digging into physicians and patient safety. It promises to champion campaigns to get much more information–potentially including an existing but now secret national database on bad doctors–on these oft-confidential topics into public view.

That’s great news. We all have lots of constant work to do in this area, as the medical establishment is powerful, entrenched, and slow to change. Using Florida’s Sunshine Laws and lots of tough digging, my colleagues and I─when I was a young journalist at the Miami Herald─reported a series we called “dangerous doctors” who were enabled by a do-nothing state licensing board. So it’s sad to see that the need for reforms is unceasing. Many injured patients find their day through the civil justice system, not with state regulators. But we need to stop bad doctors from practicing, period.

There also may be hope with new technologies like the Internet to spread information about the harms that doctors can do─kudos, for example, to this government-sponsored, free database on patient safety─ and to ensure that wretched MDs don’t get around discipline by skipping around the country. Alas, one of the physicians described in the Consumer Reports article lost his license in California for failing to fess up that Maine had limited his prescribing privileges, and that he failed to disclose his disciplinary actions when applying to practice in Virginia.