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More Information on State Medical Boards' Disciplinary Actions

Ranking of State Medical Boards' Serious Disciplinary Actions in 1999

April 2000

Sidney M. Wolfe M.D.

Based on the Federation of State Medical Boards (FSMB) data on the number of disciplinary actions taken in 1999 against doctors, Public Citizen 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 extent to which they are taking serious disciplinary actions against doctors (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 and dividing it by the American Medical Association data on nonfederal M.Ds as of December, 1998 (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.

Nationally, there were 2,696 serious disciplinary actions taken by state medical boards in 1999, down slightly from the 2,732 serious actions taken in 1998. State rates ranged from 10.34 serious actions per 1,000 doctors (Alaska) to 0.96 per 1,000 physicians (Delaware), a 10.8-fold difference between the best and worst states. If all the boards did as good a job as the top five boards, the lowest rate for #5,Oklahoma being 5.95 serious disciplinary actions per thousand physicians or .595%, this would amount to 4,583 (.595% of 770,320 non-federal doctors) serious actions a year, 1.7 times as many (1887 more serious actions) as the 2,696 that actually occurred in 1999.

Worst States

those with the lowest rate of serious disciplines

The bottom 15 states, those with the lowest serious disciplinary rates in 1998, were, starting with the lowest: Delaware 0.96 per 1,000 physicians), Nebraska (1.23), Tennessee (1.25), Minnesota (1.58), Hawaii (1.69), Connecticut (1.78), Kansas (1.82), South Dakota (1.92), Illinois (2.05), Wisconsin (2.06), D.C. (2.18), Maryland (2.42), Massachusetts (2.43), Florida (2.49), and Washington (2.49). Massachusetts, Tennessee, Minnesota, Wisconsin, Kansas, Hawaii, and Delaware were also in the bottom 15 states in 1997 and 1998. In 1999, the bottom 20 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 discipline

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): Alaska (10.34/1,000 physicians), North Dakota (8.77), Wyoming (8.15), Idaho (7.02), Oklahoma (5.95), Kentucky (5.92), Ohio (5.90), Mississippi (5.87), Vermont (5.34), and Colorado (5.24). Five of these 10 states (Alaska, Oklahoma, Mississippi, Wyoming, and Ohio) were also in the top 10 in 1997 and 1998 and two, (Mississippi and Alaska) have been in the top 10 for nine straight years. Oklahoma, 5th this year, has been in the top 10 states for eight of the last nine years. Wyoming, 3rd this year, has been in the top 10 for seven of the last nine years and Vermont, 9th this year and Ohio, 7th this year, have been in the top ten for five of the last nine 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, as it also was in 1996, 1997 and 1998. Other large states such as, New York, Michigan and California (14th, 19th and 20th respectively in 1999) have shown improvement from 40th, 49th and 37th in 1991. But other large states such as Texas, Pennsylvania, Massachusetts and Illinois (34th, 36th, 39th and 43rd in 1999) 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).  

Table 1. Ranking of Serious Disciplinary Actions by State Medical Licensing Boards — 1999

Rank
1999

State

Number of Serious Actions 1999

Total Number of Physicians 1998

Serious Actions Per 1,000 Doctors

1

Alaska

12

1160

10.34

2

North Dakota

14

1596

8.77

3

Wyoming

8

981

8.15

4

Idaho

16

2278

7.02

5

Oklahoma

37

6216

5.95

6

Kentucky

54

9115

5.92

7

Ohio

190

32220

5.90

8

Mississippi

30

5107

5.87

9

Vermont

11

2061

5.34

10

Colorado

59

11253

5.24

11

Iowa

33

6602

5.00

12

Arkansas

27

5486

4.92

13

Alabama

45

9559

4.71

14

New York

366

77781

4.71

15

Georgia

82

17961

4.57

16

Indiana

60

13267

4.52

17

West Virginia

19

4249

4.47

18

New Hampshire

14

3309

4.23

19

Michigan

101

24001

4.21

20

California

367

90940

4.04

21

Arizona

42

11025

3.81

22

Virginia

70

18441

3.80

23

Louisiana

43

11581

3.71

24

Maine

11

3195

3.44

25

Nevada

11

3373

3.26

26

North Carolina

62

19615

3.16

27

New Mexico

13

4138

3.14

28

New Jersey

89

28432

3.13

29

South Carolina

27

8923

3.03

30

Oregon

27

8984

3.01

31

Missouri

45

15211

2.96

32

Montana

6

2036

2.95

33

Utah

13

4770

2.73

34

Texas

124

45707

2.71

35

Rhode Island

10

3784

2.64

36

Pennsylvania

97

38080

2.55

37

Washington

38

15254

2.49

38

Florida

105

42169

2.49

39

Massachusetts

67

27622

2.43

40

Maryland

51

21116

2.42

41

District of Columbia

9

4121

2.18

42

Wisconsin

28

13567

2.06

43

Illinois

73

35581

2.05

44

South Dakota

3

1562

1.92

45

Kansas

12

6577

1.82

46

Connecticut

23

12910

1.78

47

Hawaii

6

3555

1.69

48

Minnesota

21

13275

1.58

49

Tennessee

18

14412

1.25

50

Nebraska

5

4070

1.23

51

Delaware

2

2092

0.96

Total

2696

770320

3.50

 

Table 2. Ranking of States 1991-1999: Seriously Disciplinary Actions

Rank 1999

Rank 1998

Rank 1997

Rank 1996

Rank 1995

Rank 1994

Rank 1993

Rank 1992

Rank 1991

 

1

1

2

6

8

2

8

7

6

Alaska

2

11

9

2

34

10

3

5

13

N. Dakota

3

7

3

31

3

1

21

4

9

Wyoming

4

25

30

21

36

30

37/38

23

34/35

Idaho

5

2

5

7

12

5

2

1

2

Oklahoma

6

14

7/8

14

14

4

4

16

5

Kentucky

7

10

7/8

8

9

24

22/23

19

23

Ohio

8

3

1

1

1

9

9

6

6

Mississippi

9

6

25/26

10

6

39

17

15

10

Vermont

10

18

6

4

5

12

6

8

17

Colorado

11

23

4

3

2

7

5

2

3

Iowa

12

4

13

15

23

28

26

18

29

Arkansas

13

17

23/24

38

30

43/44

29

30

31

Alabama

14

16

16

18

17

29

34

39

49

New York

15

12

23/24

19

4

8

10

9

4

Georgia

16

21

19/20

33

28

16

7

14

15

Indiana

17

5

12

11

7

6

1

3

8

W. Virginia

18

30

46

51

49

49

47

47

44

New Hampshire

19

13

15

28

21

34/35

35

40

40

Michigan

20

27

18

27

20

34/35

32

42

37

California

21

38

19/20

5

10

17

16

22

22

Arizona

22

40

34/35

50

41/42

32

30

37

32

Virginia

23

15

34/35

44

13

18

11

12

7

Louisiana

24

9

22

17

32

33

41

44

46

Maine

25

26

32

9

11

31

20

25

26

Nevada

26

43

33

48/49

35

36

40

34

42/43

N. Carolina

27

8

50

23

15

43/44

49

33

33

New Mexico

28

35

42

20

25

19

18

28

20

New Jersey

29

22

40

45

44

14

15

11

11

S. Carolina

30

31

28/29

29

16

20

22/23

24

14

Oregon

31

48

17

30

37

13

12

13

12

Missouri

32

34

11

13

18

3

14

10

19

Montana

33

20

25/26

16

38

46

39

43

18

Utah

34

28/29

37

35

19

23

28

29

21

Texas

35

24

10

25

26

26

42

41

50/51

Rhode Island

36

45

27

32

43

47

48

48

47

Pennsylvania

37

36/37

28/29

40

24

27

24

17

24

Washington

38

49

36

22

22

25

25

21

27

Florida

39

47

45

43

40

37

45

46

48

Massachus.

40

36/37

38

41

29

21

19

27

42/43

Maryland

41

33

44

36

50

51

51

45

45

District of   Columbia

42

46

39

34

47

41

27

26

34/35

Wisconsin

43

41

21

46

45

40

31

36

36

Illinois

44

19

14

42

33

11

13

32

50/51

S. Dakota

45

44

41

12

46

22

37/38

20

25

Kansas

46

32

31

37

27

42

36

35

30

Connecticut

47

39

49

39

51

50

46

50

41

Hawaii

48

42

51

47

39

45

33

31

28

Minnesota

49

51

48

48/49

31

38

44

49

38

Tennessee

50

28/29

43

24

41/42

15

50

38

39

Nebraska

51

50

47

26

48

48

43

51

16

Delaware

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