\SUMMARY

• 20,125 doctors disciplined by either state medical boards or federal agencies are listed in the national books. This represents an increase of 6,185 new physicians since the last version of this report.
• These 20,125 doctors had a total of 38,589 disciplinary actions taken against them, the most common of which were probation (7,431 times), license suspension (3,704 times), fine (3,708 times) and license revocation (3,045 times). (See other types of disciplinary actions in Table D.) Although these and other serious actions made up 70% of all actions, far too many physicians received slaps on the wrist in the form of fines or reprimands despite having committed serious offenses. (see Tables F through J)
• For those doctors with disciplinary actions for which the states or federal agencies supplied specific information on the offenses they had committed, the following numbers of doctors committed the five most serious offenses (see other types of offenses in Table E):

1. Sexual abuse of or sexual misconduct with a patient: 547 doctors
2. Substandard care, incompetence or negligence: 3,215 doctors
3. Criminal Conviction (includes plea of guilty or no contest): 2,963 doctors
4. Misprescribing or overprescribing of drugs: 1,318 doctors
5. Substance abuse: 1,715 doctors

Of the 24,042 disciplinary actions for which offenses were listed (See Table E) for 7,132, the reason listed was "disciplinary action taken by another state or agency," leaving 16,910 offenses with specific details as to the nature of the offense. For 15,310 of these offenses or 90.6% of them, the offense was one of the five listed above or another serious offense such as providing false information, loss of hospital privileges or insurance fraud.

An analysis of the 2,366 doctors who were the subjects of DEA disciplinary actions revealed that hundreds were not the subject of any state disciplinary action even though their federal narcotics license had been revoked or restricted.

Similarly, of the 3,232 Medicare doctors who were the subjects of Medicare disciplinary actions, hundreds were not disciplined by their state boards even though most had involved exclusion from Medicare.

Thus, many states are not acting promptly, if at all, against physicians about whom a federal agency has already compiled sufficient information to discipline them for very serious offenses. Even for those states which do discipline these doctors, for most of the serious offenses involved in DEA or Medicare actions, some states frequently do little more than slap physicians on the wrist, leaving the majority free to practice with few if any restrictions.

Overall, the majority of physicians who were disciplined for the five most serious offenses--sexual abuse or sexual misconduct, substandard care, incompetence, or negligence, criminal conviction, misprescribing or overprescribing of drugs, or substance abuse were not required to stop practicing even temporarily. The most common disciplinary action for each of these five offenses was probation, the severity of which varies widely from state to state. Following are the percentages and numbers of physicians for each offense who did not have to stop practicing despite the offenses which they had committed:

• Sexual abuse of or sexual misconduct with a patient: 547 doctors.
  Only 52.3% of these physicians had to stop practicing, even temporarily. 47.7% or 261 doctors were not required to stop.
• Substandard care, incompetence or negligence: 3,215 doctors.
  Only 29.3% of these physicians had to stop practicing, even temporarily. 70.7% or 2,273 were not required to stop.
• Criminal conviction (includes plea of guilty or no contest): 2,963 doctors.
  Only 39.2% of these doctors had to stop practicing, even temporarily. 60.8% or 1,802 were not required to stop.
• Misprescribing or overprescribing of drugs: 1,318 doctors.
  Only 27.9% of these physicians had to stop practicing, even temporarily. 72.1% or 950 were not required to stop.
• Substance abuse: 1,715 doctors.
  Only 32.4% of these doctors had to stop practicing, even temporarily. 67.6% or 1,159 were not required to stop.

(See Tables F through J.)

Thus, it is likely that most of the doctors in these above five categories of very serious offenses are currently practicing medicine, with few if any of their patients aware of these offenses.

Precisely because regulators provide so many protections for these health care practitioners, in 1988 the Congressional Office of Technology Assessment concluded that a formal disciplinary action against a doctor provides a good reason to question his or her care.

Our study of the nation's medical quality control system led us to conclude that:

• Too little discipline is still being done. The rate of serious disciplinary actions by state medical boards was only 3.50 serious actions per 1,000 doctors or 2,696 serious actions in 1999. Therefore only an extremely small fraction of the nation's doctors face any serious state sanctions each year despite the fact that at least 80,000 patients are killed and 234,000 injured as a result of negligence in hospitals, most cases involving doctors.
• Far too few state medical board disciplinary actions are for medical negligence or incompetence. Of the 16,910 disciplinary actions in which we knew the basis (the offense) for which the action was taken and for which the basis of the action was not an action by another state, only 3,184 of those cases (18.8%) were for substandard care, incompetence or negligence.

This country's system for ensuring medical quality needs to be made much stronger. We suggest several avenues towards improvement. Most states need to strengthen their medical practice statutes, restructure their medical boards, and dramatically increase both funding and staffing. Most states should also establish programs to audit and weed out bad doctors so that patient injuries can be prevented rather than simply reacted to.

The total number of serious state disciplinary actions against physicians decreased from 2,803 reported for 1995 to 2,696 in 1999 for a nationwide rate of 3.50 serious actions per 1,000 physicians. A difference greater than 10-fold exists between Alaska, the state with the highest rate (10.34 per 1,000), and Delaware, with the lowest rate, (0.96). (See Table A.)

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. It is not unreasonable to estimate that a nationwide average rate of at least 10 serious disciplinary actions per 1,000 doctors can be attained (the number was 3.50 in 1999) since, in most years, one or more states (Alaska, in 1999) actually takes this many actions. This would amount to 7,703 serious disciplinary actions a year, far in excess of the 2,696 serious disciplinary actions in 1999. If this had occurred, there would have been 5,007 more serious disciplinary actions that year--almost three times the number of actions which actually were taken.

Recommendations

Congress should require cooperation and routine data-sharing between state medical boards, Medicare Peer Review Organizations, state Medicaid agencies, the Drug Enforcement Administration and hospitals in catching and sanctioning malfeasant physicians.

The National Practitioner Data Bank, which began collecting information on questionable doctors in September 1990, should be opened to the public. This change will require legislation. Although there have been Congressional hearings on this topic in 2000, there is not any evidence that Congress has enough guts to take on the A.M.A.

The Drug Enforcement Administration should routinely tell the public and pharmacists which doctors' controlled substances prescription licenses it has pulled or restricted.

State medical boards should be required to promptly make public all their disciplinary actions and the offenses for which their actions were taken, and to regularly distribute lists of actions to consumers, the press, and other health care consumer organizations. In addition, boards should publicly disclose information they have concerning final hospital disciplinary actions and malpractice payouts against doctors.

In the past two years, many medical boards have started putting varying degrees of disciplinary information on their web sites. (for a report on the status of these sites--with grades A to X for completeness--check out the report on our web site at http://www.citizen.org/hrg/publications/1506.htm) Unfortunately, most states either have no web site with disciplinary information or an inadequate amount of information about this important topic. Combined with the fact that only slightly more than half of the people in this country have access to the internet, this means that probably 75% of the people in this country do not have internet access to an adequate amount of this information. It is inexcusable that all states do not have detailed information about actions and offenses about every doctor who has been disciplined, including a copy of the board's order spelling out the details as to why the action was taken