LA Progressive

Death by Medicine

More than 250,000 people in the U.S. dies because of medical mistakes, making it the third leading cause of death.  As might be expected, a large proportion of medical errors are due to a small percentage of doctors.      An analysis of “66,426 claims in the National Practitioner Data Bank that were paid against 54,099 MDs and DOs in the United States from 2005 through 2014” showed that “[a]lthough only 6% of all 915,564 active US physicians during that decade, as estimated by the American Medical Association, had a paid claim, about 1% of physicians with at least two paid claims accounted for 32% of all claims. Further, 12% of all claims were attributed to just 0.2% of physicians, all of whom had at least three paid claims. “

Dangerous doctors continue to be allowed to keep practicing, even in situations where they have been found guilty of malpractice.

If 1% of all physicians accounted for 32% of all paid errors, one would think that it would be normal to target that group to take away their licenses.  Yet dangerous doctors continue to be allowed to keep practicing, even in situations where they have been found guilty of malpractice.  “From 2001 to 2011, nearly 6,000 doctors had their clinical privileges restricted or taken away by hospitals and other medical institutions for misconduct involving patient care. But 52% — more than 3,000 doctors — never were fined or hit with a license restriction, suspension or revocation by a state medical board..

The problem appears to be a slow and cumbersome system in many states to take away licenses, even where justified.  “Among the nearly 100,000 doctors who made payments to resolve malpractice claims from 2001 to 2011, roughly 800 were responsible for 10% of all the dollars paid and their total payouts averaged about $5.2 million per doctor. Yet fewer than one in five faced any sort of licensure action by their state medical boards.”

This may be one of many unknown facts about the medical profession.  (Like this one: “Each year more than one million Americans lose their doctors to suicide.”  Have you ever heard of this before?  The medical profession is subject to less scrutiny than one might imagine.)

The discussion about medicine most recently has focused on the payment structure.  Should we have “single-payer” or stay with the complex Obamacare structure – or perhaps retreat to what we had pre-Obamacare?  But while this discussion is going on, it might be a good idea to look at the doctors themselves.

“In general, doctors can lose their license for professional incompetence, conviction of criminal offenses, gross negligence, bad character, immorality or misconduct. If a doctor abuses the authority granted through his license or practices medicine beyond the authority of his license, he lose his license. Reasons for suspension or revocation are set in state law.”  For example, one doctor lost his license for violating state law (he participated in physician-assisted suicide when his state treated that as against the law).  Another doctor lost his license for prescribing medical marijuana and OxyContin to male patients.  Another lost his license for practicing while under the influence of drugs and alcohol.  Another lost his license because of several instances when he practiced negligently.  Another engaged in sexual contact with a patient and provided prescriptions that were not medically required.

The latter three examples appear justified, while the first two do not.  But the diversity of examples comes from the fact that the Medical Boards are creatures of state law, and state law can be very diverse.  This is one area where uniform state laws might work a lot better.

In case studies of how Medical Boards disciplined physicians, the following report in 2006 stated:

Most sanctions taken by [Medical] Boards in 2003 fell into the most severe category–loss or restriction of license–on average 60% or more of all actions.  The case study Boards averaged 4.4 such actions per thousand physicians. Nationwide, the average for all Boards was similar, at 4.7 severe actions per thousand. Variation across Boards is wide. The top quarter of states had rates that were more than double those of the bottom quarter, as seen by the percentile spread. The six state study states showed less variation, as measured by the standard deviation of their distribution.

Backlogs are a major concern to Board management. Boards are seen as not fulfilling their primary mission to protect the public if they do not take prompt action on a respondent physician who is perceived as not practicing safely. Moreover, if a patient is harmed by a physician on whom one or more complaints is stuck in a backlog, a Board faces very unpleasant media and legislative response. Even absent a scandal, backlogs may be indicative of underperformance obvious to any outside observer. Inquiries found that Boards do not generate consistent data across states on backlogs at various points in process. But backlogs have consistently caused problems in all states within the recent memory of Board managers. For example: In California in the 1990s, a large backlog of uninvestigated complaints led to controversial administrative closures without investigation. In Iowa, by 2004 the backlog had reached about two years worth of investigations, and ultimately led to substantial changes in case handling procedures. Massachusetts’ large backlog of cases by 1999 generated bad publicity, a crash program of catch-up review, and a change in administrative leadership.

While there is certainly evidence that Medical Boards operate too slowly, there is other evidence that these Boards operate unfairly as to the doctor being investigated.   These charges and counter-charges strongly suggest that we way these Boards operate need to be changed, with increased focus on patient safety and improvement of the health system.

Michael Hertz