HEALTH AND SAFETY

» Drug, Devices, and Supplements

» Physician Accountability

» Consumer Product Safety

» Worker Safety

» Health Care Delivery

» Auto and Truck Safety

» Global Access to Medicines

» Infant Formula Marketing

 

More Information on State Medical Boards' Disciplinary Actions

Ranking of State Medical Boards' Serious Disciplinary Actions in 2002

March 27, 2003 

Based on data we obtained from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2002 against doctors, Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state and compiled a national report ranking state boards by the rate of serious disciplinary actions per 1,000 doctors in the year 2002 (See Table 1).

Our calculation of rates of serious disciplinary actions (revocations, surrenders, suspensions and probations/restrictions) per 1,000 doctors by state is created by taking the number of such actions (columns A and B from the FSMB data) and dividing it by the American Medical Association data on nonfederal M.D.s as of December 2000 (adding to this the number of osteopathic physicians if the board is a combined M.D./D.O. board) then multiplying the result by 1,000 to get state disciplinary rates per 1,000 physicians.

Nationally, there were 2,864 serious disciplinary actions taken by state medical boards in 2002, up 5.8% from the 2,708 serious actions taken in 2001. The latest published data on the number of doctors is from 2000; thus some of this increase may be attributable to the fact that there were certainly more doctors in 2002 than in 2000. State rates ranged from 1.07 serious actions per 1,000 doctors (Hawaii) to 11.87 actions per 1,000 physicians (Wyoming) an 11.1-fold difference between the best and worst states. If all the boards did as good a job as the lowest of the top five boards, the rate for #5, Oklahoma, being 7.56 serious disciplinary actions per 1,000 physicians or 0.756 percent, this would have amounted to a total of 6,089 (0.756 percent of 805,372 non-federal doctors) serious actions a year. This would be 3,225 more serious actions than the 2,864 that actually occurred in 2002.

Worst States

Those with the lowest rate of serious disciplinary actions

As can be seen in Table 1, the bottom 15 states, those with the lowest serious disciplinary rates in 2002, were, starting with the lowest: Hawaii (1.07 per 1,000 physicians), Delaware (1.35), Wisconsin (1.40), Tennessee (1.47), South Carolina (1.77), Maryland (1.78), North Carolina (2.06), Florida (2.08), Pennsylvania (2.10), Minnesota (2.11), Washington (2.23), Nevada (2.31), South Dakota (2.39), Connecticut (2.40) and Michigan (2.41).

Of these 15 states with the worst serious disciplinary records, six – Maryland, Hawaii, Delaware, South Dakota, Minnesota, and Washington – were also in the bottom 15 states in 2001 and 2000 (see Table 2). In 2002, the bottom 16 states all had rates of serious disciplinary action that were one-third or less than the rate of all of the top six states.

These data again raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians. It is extremely likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistent top performances.

Best States

Those with the highest rates of serious disciplinary actions

Table 1 lists each state's ranking and rate in descending order. The top 10 states, or those with the highest rate of serious disciplinary actions per 1,000 physicians are (in order): Wyoming (11.87 per 1,000 physicians), North Dakota (8.76), Alaska (8.57), Kentucky (7.58), Oklahoma (7.56), Arizona (7.46), Ohio (7.45), Colorado (7.40), Montana (6.80) and Utah (6.13). Five of these 10 states (North Dakota, Alaska, Kentucky, Oklahoma and Ohio) were also in the top 10 in 2001, 2000 and 1999 and one state, Alaska, has been in the top 10 for more than 10 straight years. Kentucky, 4th this year and Oklahoma, 5th this year, have been in the top 10 states for seven and nine of the last ten years, respectively. Arizona, 6th this year, has been in the top 10 states for 4 of the last 10 years. Ohio, 7th this year, has been in the top 10 for the last eight years in a row. And Colorado, 8th this year, returns to the top 10 for the 6th time in the last 10 years. (See Table 2).

It is clear that state-by-state performance is spotty. Only one of the nation's 15 largest states, Ohio, is represented among those 10 states with the highest disciplinary rates. Other large states such as New York, California and Michigan ranked 20th, 24th and 37th respectively in 2002. Michigan dropped from 29th in 2001 to 37th in 2002, New York from 14th in 2001 to 20th in 2002. Another large state, Massachusetts, improved from 45th in 2000 to 21st in 2002.

What Makes a Difference?

Boards are likely to be able to do a better job in disciplining physicians if most, if not all, of the following conditions are true:

  1. Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)
  2. Adequate staffing
  3. Proactive investigations rather than only following complaints
  4. The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts
  5. Excellent leadership
  6. Independence from state medical societies and other parts of the state government
  7. A reasonable statutory framework for disciplining doctors (preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence). 

Given the importance of medical boards in protecting patients in a state from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents of those states, most states are not living up to this obligation. Serious attention must be given to finding out which of the above variables are deficient in each state and taking action, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.  

Table 1. Ranking of Serious Doctor Disciplinary Actions By State Medical Licensing Boards – 2002

Rank 2002

State

Number of Serious  Actions, 2002

Total Number of Physicians, 
2000

Serious Actions Per 1,000 Doctors

1

Wyoming

12

  1,011

11.87

2

North Dakota

14

  1,599

8.76

3

Alaska

11

  1,283

8.57

4

Kentucky

72

  9,500

7.58

5

Oklahoma

48

  6,353

7.56

6

Arizona

88

   11,791

7.46

7

Ohio

247

   33,138

7.45

8

Colorado

89

   12,029

7.40

9

Montana

15

  2,205

6.80

10

Utah

31

  5,056

6.13

11

New Mexico

23

  4,327

5.32

12

Alabama

52

  9,954

5.22

13

West Virginia

22

  4,296

5.12

14

Idaho

12

  2,412

4.98

15

Iowa

33

  6,784

4.86

16

Oregon

44

  9,473

4.64

17

Georgia

84

   18,995

4.42

18

Louisiana

50

   12,068

4.14

19

Mississippi

22

  5,346

4.12

20

New York

322

   80,134

4.02

21

Massachusetts

107

   28,851

3.71

22

Maine

13

  3,528

3.68

23

New Jersey

109

   29,757

3.66

24

California

329

   95,038

3.46

25

Texas

163

   47,994

3.40

26

District of Columbia

14

  4,134

3.39

27

Nebraska

14

  4,290

3.26

28

Virginia

64

   19,673

3.25

29

Illinois

120

   37,138

3.23

30/31

Indiana

44

   13,929

3.16

30/31

New Hampshire

11

  3,480

3.16

32

Vermont

7

  2,280

3.07

33

Arkansas

17

  5,738

2.96

34

Missouri

40

   15,572

2.57

35

Rhode Island

10

  3,919

2.55

36

Kansas

17

  6,847

2.48

37

Michigan

60

   24,901

2.41

38

Connecticut

32

   13,312

2.40

39

South Dakota

4

  1,672

2.39

40

Nevada

9

  3,893

2.31

41

Washington

36

   16,154

2.23

42

Minnesota

30

   14,218

2.11

43

Pennsylvania

82

   39,052

2.10

44

Florida

93

    44,747

2.08

45

North Carolina

43

   20,851

2.06

46

Maryland

39

   21,883

1.78

47

South Carolina

17

  9,607

1.77

48

Tennessee

22

   14,954

1.47

49

Wisconsin

20

    14,241

1.40

50

Delaware

3

  2,219

1.35

51

Hawaii

4

  3,746

1.07

 

United States

2,864

  805,372

3.56

 

Table 2: Ranking for the Last Ten Years

Rank 2002

Rank 2001

Rank 2000

Rank 1999

Rank 1998

Rank 1997

Rank 1996

Rank 1995

Rank 1994

Rank 1993

State

 1

38/39

4

3

7

3

31

3

1

21

Wyoming

 2

6

1

2

11

9

2

34

10

 3

North Dakota

 3

3

2

1

1

2

6

8

2

8

Alaska

 4

5

3

6

14

7/8

14

14

4

4

Kentucky

5

2

5

5

2

5

7

12

5

2

Oklahoma

6

1

7

21

38

19/20

5

10

17

16

Arizona

7

8

8

7

10

7/8

8

9

24

22/23

Ohio

8

17

31

10

18

6

4

5

12

6

Colorado

9

19

42

32

34

11

13

18

3

14

Montana

10

9

6

33

20

25/26

16

38

46

39

Utah

11

30/31/32

41

27

8

50

23

15

43/44

49

New Mexico

12

12

12

13

17

23/24

38

30

43/44

29

Alabama

13

11

36

17

5

12

11

7

6

1

West Virginia

14

7

50

4

25

30

21

36

30

37/38

Idaho

15

4

11

11

23

4

3

2

7

5

Iowa

16

15

17

30

31

28/29

29

16

20

22/23

Oregon

17

10

9

15

12

23/24

19

4

8

10

Georgia

18

24

20

23

15

34/35

44

13

18

11

Louisana

19

13

13

8

3

1

1

1

9

9

Mississippi

20

14

10

14

16

16

18

17

29

34

New York

21

27/28

45

39

47

45

43

40

37

45

Massachusetts

22

38/39

22

24

9

22

17

32

33

41

Maine

23

23

26

28

35

42

20

25

19

18

New Jersey

24

25

19

20

27

18

27

20

34/35

32

California

25

30/31/32

38

34

28/29

37

35

19

23

28

Texas

26

51

 

41

33

44

36

50

51

51

District of Columbia

27

34

39

50

28/29

43

24

41/42

15

50

Nebraska

28

22

18

22

40

34/35

50

41/42

32

30

Virginia

29

45

44

43

41

21

46

45

40

31

Illinois

30/31

41

24

16

21

19/20

33

28

16

7

Indiana

30/31

21

23

18

30

46

51

49

49

47

New Hampshire

32

35

16

9

6

25/26

10

6

39

17 

Vermont

33

16

15

12

4

13

15

23

28

26

Arkansas

34

27/28

25

31

48

17

30

37

13

12

Missouri

35

42

33

35

24

10

25

26

26

42

Rhode Island

36

20

37

45

44

41

12

46

22

37/38 

Kansas

37

29

14

19

13

15

28

21

34/35

35

Michigan

38

40

28

46

32

31

37

27

42

36

Connecticut

39

48

49

44

19

14

42

33

11

13

South Dakota

40

18

21

25

26

32

9

11

31

20

Nevada

41

37

43

37

36/37

28/29

40

24

27

24

Washington

42

44

46

48

42

51

47

39

45

33 

Minnesota

43

36

29

36

45

27

32

43

47

48

Pennsylvania

44

26

34

38

49

36

22

22

25

25

Florida

45

30/31/32

32

26

43

33

48/49

35

36

40

North Carolina

46

43

40

40

36/37

38

41

29

21

19

Maryland

47

47

27

29

22

40

45

44

14

15

South Carolina

48

33

35

49

51

48

48/49

31

38

44

Tennessee

49

46

30

42

46

39

34

47

41

27

Wisconsin

50

49

47

51

50

47

26

48

48

43

Delaware

51

50

48

47

39

49

39

51

50

46

Hawaii

Copyright © 2014 Public Citizen. Some rights reserved. Non-commercial use of text and images in which Public Citizen holds the copyright is permitted, with attribution, under the terms and conditions of a Creative Commons License. This Web site is shared by Public Citizen Inc. and Public Citizen Foundation. Learn More about the distinction between these two components of Public Citizen.


Public Citizen, Inc. and Public Citizen Foundation

 

Together, two separate corporate entities called Public Citizen, Inc. and Public Citizen Foundation, Inc., form Public Citizen. Both entities are part of the same overall organization, and this Web site refers to the two organizations collectively as Public Citizen.

Although the work of the two components overlaps, some activities are done by one component and not the other. The primary distinction is with respect to lobbying activity. Public Citizen, Inc., an IRS § 501(c)(4) entity, lobbies Congress to advance Public Citizen’s mission of protecting public health and safety, advancing government transparency, and urging corporate accountability. Public Citizen Foundation, however, is an IRS § 501(c)(3) organization. Accordingly, its ability to engage in lobbying is limited by federal law, but it may receive donations that are tax-deductible by the contributor. Public Citizen Inc. does most of the lobbying activity discussed on the Public Citizen Web site. Public Citizen Foundation performs most of the litigation and education activities discussed on the Web site.

You may make a contribution to Public Citizen, Inc., Public Citizen Foundation, or both. Contributions to both organizations are used to support our public interest work. However, each Public Citizen component will use only the funds contributed directly to it to carry out the activities it conducts as part of Public Citizen’s mission. Only gifts to the Foundation are tax-deductible. Individuals who want to join Public Citizen should make a contribution to Public Citizen, Inc., which will not be tax deductible.

 

To become a member of Public Citizen, click here.
To become a member and make an additional tax-deductible donation to Public Citizen Foundation, click here.