CONCLUSIONS

2. All states, especially those with the worst records, need to strengthen the structure and functions of their licensing boards.

3. The increase in the total number of disciplinary actions in a given state may not indicate that more doctors are being caught. Much of the disciplinary activity, in states such as New York, involves insuring that doctors, once caught by one state, are disciplined when they move to another. There has also been a noticeable increase in sanctioning doctors for administrative purposes.

4. Questionable doctors can still cross state borders, though with less impunity than before. The extent to which one board shares information with another still varies widely by state.

• In many instances discipline is still too slow although the case backlogs in some states have been greatly reduced. Wisconsin sanctioned a number of doctors only after they had already retired from practice.
• The vast majority of states continue to require reporting of hospital disciplinary actions and malpractice claims or payments to the medical board, but few check whether the required reports have actually been filed. And some still fail to act promptly, if at all, on the information they receive.
• Medical boards are much too forgiving. Many still see their priority as "rehabilitation," and their disciplinary actions are too light. Probation is the most common sanction against doctors for all of the five most serious offenses: sexual abuse or misconduct; substandard care; conviction; prescription violations, or substance abuse. Arizona, for example, interprets the Americans with Disabilities Act to indicate that action for substance abuse is a "voluntary agreement" between the physician and the Board, not a disciplinary action.
• Far too few board actions, only 18.8% of the 16,910 identified offenses (other than those listed as action by another state), were for medical negligence or incompetence. Instead boards focus on more easily documentable offenses such as prescription violations and fraud convictions or disciplinary action in another state as potential indicators of substandard care. Other instances of incompetence may be overlooked because the investigations soak up resources like a sponge.

To date, legislation--mainly at the state level--on medical malpractice, the injury and death of patients caused by doctor negligence, has been to punish the victim instead of disciplining the perpetrator. Legislative attention must be given to requiring states to significantly improve the discipline of physicians in order to prevent future death and injury.