WASHINGTON, D.C. - State medical boards have failed to discipline 55 percent of the nation's doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, a new Public Citizen analysis of data from the National Practitioner Data Bank (NPDB) shows.
Of 10,672 physicians listed in the NPDB for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards. That means 55 percent of them - 5,887 doctors - escaped any licensing action by the state. The study examined the NPDB's Public Use File from its inception in 1990 to 2009.
"One of two things is happening, and either is alarming," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group and overseer of the study. "Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed."
Hospital disciplinary reports are peer-review actions and, as such, are one of the most valuable sources of information for medical board oversight. Subsequent state medical board action against a physician's license is a crucial next step to protect patients. Boards have the authority to oversee and even limit the practice of a disciplined physician, which not only yields a more complete record for the purpose of patient safety but also serves to inform other state boards and future employers.
Public Citizen today sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, urging the agency's Office of Inspector General to reinstitute investigations of state medical boards, something it has not done since 1993. Public Citizen also is notifying the 33 medical boards that have had the worst records in disciplining these doctors.
A physician must have serious deviations of behavior or performance to warrant clinical privilege actions. Of the 5,887 physicians who the state medical boards failed to discipline - many of whom also had a history of medical malpractice payments - 1,119 of them were disciplined because of incompetence, negligence or malpractice, 605 were disciplined for substandard care and 220 of them were identified as an immediate threat to health or safety. Other categories of serious deviations of physician behavior and/or performance that resulted in clinical privilege revocation or restrictions included sexual misconduct; inability to practice safely; fraud including insurance fraud, fraud obtaining a license and fraud against health care programs; and narcotics violations. A total of 2,071 physicians were disciplined by their hospital employers for one or more of these violations, considered the most serious.
In addition to the seriousness of the offenses leading to hospital actions but no state licensing actions, the seriousness of the hospitals' disciplinary actions against these physicians is also striking: 3,218 physicians in our study lost their clinical privileges permanently, and an additional 389 physicians lost privileges for more than one year. Thus, more than 61 percent of these 5,887 physicians lost their admitting privileges permanently or for at least a year.
The implications of this lack of licensing action against physicians with serious medical practice problems can be seen in specific examples. In Florida, a doctor had hospital privileges permanently revoked in 2002 for incompetence and racked up 10 medical malpractice reports totaling $1 million between 1992 and 2009 for, among other things, an unnecessary procedure, leaving a foreign body in a patient and misdiagnosis. Two patients died. Yet the state of Florida took no disciplinary action against the doctor.
In Illinois, a doctor had clinical privileges permanently revoked in 1999 and accumulated 10 medical malpractice reports between 1992 and 2006 totaling $7 million for, among other things, improperly managing cases, failing to diagnose and failing to identify fetal distress. One patient suffered a major permanent injury while another became a quadriplegic due to a brain injury. Yet Illinois did not discipline the doctor.
"Why have 5,887 physicians who have been disciplined by hospitals not been disciplined by state medical boards? Why have 220 physicians who have been found by peer review to be an immediate threat to health or safety of patients not had a medical board action?" Wolfe asked. "The public deserves to know."
Due to the public safety implications of the findings, Public Citizen is sending its report with supporting documentation to the District of Columbia and the following states, in each of which 50 percent or more of the physicians with clinical privilege reports in the NPDB did not have a licensure action: Alabama, Alaska, Arkansas, California, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington and Wisconsin.