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More Information on State Medical Boards' Disciplinary Actions

Ranking of State Medical Boards' Serious Disciplinary Actions in 2000

April 6, 2001

Based on data we obtained today (April 6, 2001) from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2000 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 number of serious disciplinary actions taken against doctors in the year 2000 (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.Ds as of December 1999 (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 1000 physicians.

Nationally, there were 2,746 serious disciplinary actions taken by state medical boards in 2000, up slightly from the 2,696 serious actions taken in 1999. However, there were more physicians practicing in 2000 and the rate, per 1000 physicians, was essentially the same in the two years: 3.50 serious actions per 1000 physicians in 1999 and 3.49 in 2000.

State rates ranged from 12.43 serious actions per 1,000 doctors (North Dakota) to 0.85 per 1,000 physicians (Idaho), a 14.6-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 lowest rate for #5, Oklahoma being 6.68 serious disciplinary actions per 1,000 physicians or 0.668 percent, this would amount to a total of 5,255 (0.668 percent of 786,685 non-federal doctors) serious actions a year. This is 1.9 times as many (2,509 more serious actions) than the 2,746 that actually occurred in 2000.

Worst States

those with the lowest rate of serious disciplines

As can be seen in Table 1, the bottom 15 states, those with the lowest serious disciplinary rates in 2000, were, starting with the lowest: Idaho (0.85 per 1,000 physicians), South Dakota (1.24), Hawaii (1.33), Delaware (1.39), Minnesota (1.53), Massachusetts (1.58), Illinois (1.67), Washington (1.78), Montana (1.91), New Mexico (2.13), Maryland (2.21), Nebraska (2.39), Texas (2.42), Kansas (2.53), and West Virginia (2.54). Of the 15 states with the worst serious disciplinary records, eight of the states, Massachusetts, Illinois, Maryland, Washington, Minnesota, Kansas, Hawaii, and Delaware were also in the bottom 15 states in 1999 and 1998 (see Table 2). In 2000, the bottom 24 states all had rates of serious disciplinary action that were one-half or less than the rate of all of the top five states.

These data 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 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 disciplines

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): North Dakota (12.43 per 1,000 physicians), Alaska (11.47), Kentucky (8.51), Wyoming (8.10), Oklahoma (6.68), Utah (6.27), Arizona (6.18), Ohio (5.89), Georgia (5.35), and New York (5.08). Four of these 10 states (Alaska, Oklahoma, Wyoming, and Ohio) were also in the top 10 in 1998 and 1999 and one state, Alaska, has been in the top 10 for ten straight years. Oklahoma, 5th this year, has been in the top 10 states for nine of the last ten years. Wyoming, 4th this year, has been in the top 10 for eight of the last ten years and Ohio, 8th this year, have been in the top ten for six of the last ten years. (See Table 2)

It is clear that state-by-state performance is spotty. Only two of the nation's 15 largest states, Ohio, and New York, are represented among those 10 states with the highest disciplinary rates. Other large states such as, Michigan and California (14th and 19th respectively in 2000) have shown improvement from 40th and 37th in 1991. But other large states such as Texas, Illinois, and Massachusetts (38th, 44th, and 45th in 2000) have not done very much doctor discipline for many of the last 10 years.

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:

  • Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)
  • Adequate staffing
  • Proactive investigations rather than only following complaints
  • The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions
  • Excellent leadership
  • Independence from state medical societies and other parts of the state government
  • 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.

" src="/CuteSoft_Client/CuteEditor/Images/anchor.gif">Table 1. Ranking of Serious Doctor Disciplinary Actions By State Medical Licensing Boards--2000 

Rank
2000

State

Number of Serious Actions 2000

Total Number of
Physicians 1999

Serious Actions Per
1,000 Doctors

1

North Dakota

20

1,609

12.43

2

Alaska

14

1,221

11.47

3

Kentucky

80

9,401

8.51

4

Wyoming

8

988

8.10

5

Oklahoma

42

6,285

6.68

6

Utah

30

4,787

6.27

7

Arizona

71

11,487

6.18

8

Ohio

193

32,751

5.89

9

Georgia

99

18,497

5.35

10

New York

404

79,601

5.08

11

Iowa

33

6,693

4.93

12

Alabama

46

9,765

4.71

13

Mississippi

23

5,191

4.43

14

Michigan

102

24,551

4.15

15

Arkansas

21

5,638

3.72

16

Vermont

8

2,148

3.72

17

Oregon

34

9,234

3.68

18

Virginia

69

18,922

3.65

19

California

337

92,985

3.62

20

Louisiana

43

11,897

3.61

21

Nevada

13

3,611

3.60

22

Maine

12

3,356

3.58

23

New Hampshire

12

3,388

3.54

24

Indiana

47

13,647

3.44

25

Missouri

53

15,470

3.43

26

New Jersey

100

29,208

3.42

27

South Carolina

27

9,315

2.90

28

Connecticut

37

13,237

2.80

29

Pennsylvania

106

38,524

2.75

30

Wisconsin

37

13,933

2.66

31

Colorado

31

11,814

2.62

32

North Carolina

53

20,344

2.61

33

Rhode Island

10

3,854

2.59

34

Florida

113

43,835

2.58

35

Tennessee

38

14,774

2.57

36

West Virginia

11

4,323

2.54

37

Kansas

17

6,724

2.53

38

Texas

114

47,108

2.42

39

Nebraska

10

4,181

2.39

40

Maryland

48

21,715

2.21

41

New Mexico

9

4,231

2.13

42

Montana

4

2,094

1.91

43

Washington

28

15,688

1.78

44

Illinois

61

36,618

1.67

45

Massachusetts

45

28,456

1.58

46

Minnesota

21

13,713

1.53

47

Delaware

3

2,160

1.39

48

Hawaii

5

3,747

1.33

49

South Dakota

2

1,612

1.24

50

Idaho

2

2,354

0.85

United States

2,746

786,685

3.49

 

" src="/CuteSoft_Client/CuteEditor/Images/anchor.gif">Table 2. Ranking for Last 10 Years  

Rank 2000 

Rank 1999 

Rank 1998 

Rank 1997 

Rank 1996 

Rank 1995 

Rank 1994 

Rank 1993 

Rank 1992 

Rank 1991 

State 

1

2

11

9

2

34

10

3

5

13

North Dakota

2

1

1

2

6

8

2

8

7

6

Alaska

3

6

14

7/8

14

14

4

4

16

5

Kentucky

4

3

7

3

31

3

1

21

4

9

Wyoming

5

5

2

5

7

12

5

2

1

2

Oklahoma

6

33

20

25/26

16

38

46

39

43

18

Utah

7

21

38

19/20

5

10

17

16

22

22

Arizona

8

7

10

7/8

8

9

24

22/23

19

23

Ohio

9

15

12

23/24

19

4

8

10

9

4

Georgia

10

14

16

16

18

17

29

34

39

49

New York

11

11

23

4

3

2

7

5

2

3

Iowa

12

13

17

23/24

38

30

43/44

29

30

31

Alabama

13

8

3

1

1

1

9

9

6

6

Mississippi

14

19

13

15

28

21

34/35

35

40

40

Michigan

15

12

4

13

15

23

28

26

18

29

Arkansas

16

9

6

25/26

10

6

39

17

15

10

Vermont

17

30

31

28/29

29

16

20

22/23

24

14

Oregon

18

22

40

34/35

50

41/42

32

30

37

32

Virginia

19

20

27

18

27

20

34/35

32

42

37

California

20

23

15

34/35

44

13

18

11

12

7

Louisiana

21

25

26

32

9

11

31

20

25

26

Nevada

22

24

9

22

17

32

33

41

44

46

Maine

23

18

30

46

51

49

49

47

47

44

New Hampshire

24

16

21

19/20

33

28

16

7

14

15

Indiana

25

31

48

17

30

37

13

12

13

12

Missouri

26

28

35

42

20

25

19

18

28

20

New Jersey

27

29

22

40

45

44

14

15

11

11

South Carolina

28

46

32

31

37

27

42

36

35

30

Connecticut

29

36

45

27

32

43

47

48

48

47

Pennsylvania

30

42

46

39

34

47

41

27

26

34/35

Wisconsin

31

10

18

6

4

5

12

6

8

17

Colorado

32

26

43

33

48/49

35

36

40

34

42/43

North Carolina

33

35

24

10

25

26

26

42

41

50/51

Rhode Island

34

38

49

36

22

22

25

25

21

27

Florida

35

49

51

48

48/49

31

38

44

49

38

Tennessee

36

17

5

12

11

7

6

1

3

8

West Virginia

37

45

44

41

12

46

22

37/38

20

25

Kansas

38

34

28/29

37

35

19

23

28

29

21

Texas

39

50

28/29

43

24

41/42

15

50

38

39

Nebraska

40

40

36/37

38

41

29

21

19

27

42/43

Maryland

41

27

8

50

23

15

43/44

49

33

33

New Mexico

42

32

34

11

13

18

3

14

10

19

Montana

43

37

36/37

28/29

40

24

27

24

17

24

Washington

44

43

41

21

46

45

40

31

36

36

Illinois

45

39

47

45

43

40

37

45

46

48

Massachusetts

46

48

42

51

47

39

45

33

31

28

Minnesota

47

51

50

47

26

48

48

43

51

16

Delaware

48

47

39

49

39

51

50

46

50

41

Hawaii

49

44

19

14

42

33

11

13

32

50/51

South Dakota

50

4

25

30

21

36

30

37/38

23

34/35

Idaho

 

41

33

44

36

50

51

51

45

45

District of Columbia

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