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May 12, 2011

Most States Do Not Protect Patients From Substandard Physicians, Public Citizen’s Annual State Medical Board Ranking Finds

Minnesota Is Overall Worst While Louisiana Is Best; Rates of Disciplining Doctors Decline Slightly Over Last Year

WASHINGTON, D.C. – Most states, including one of the largest – Florida – are not living up to their obligations to protect patients from doctors who are practicing substandard medicine, according to Public Citizen’s annual ranking of state medical boards, released today.

Public Citizen’s analysis found that the rate at which doctors are disciplined by state medical boards has declined significantly over the past 10 years, and some of the worst states have been consistently poor performers. Nationally, in 2010 state medical boards took 2.97 serious actions per 1,000 physicians – down 3 percent from last year and 20 percent from the peak rate of discipline in 2004 of 3.72 per 1,000 physicians. Had the national rate of doctor discipline remained at the 2004 peak rate, there would have been 745 additional serious disciplinary actions in 2010 against U.S. physicians compared to the number actually taken.

Minnesota was the worst state when it came to disciplining doctors and, along with South Carolina and Wisconsin, has consistently been among the bottom 10 states for each of the past eight rankings. Connecticut has been in the bottom 10 for each of the past five rankings. For the third time in a row, Florida – one of the largest states in the country – is among the 10 states with the lowest rates of serious disciplinary actions. And for the first time ever, Utah joined the ranks of the worst-performing state medical boards, with a rate of 2.15 serious actions taken per 1,000 physicians.

The worst states, in order, are Minnesota, South Carolina, Wisconsin, Connecticut, Massachusetts, Rhode Island, Florida, New Hampshire, Utah and Vermont. The states whose rank has declined the most since their peak rate are Vermont (8 to 42), Utah (10 to 43), Massachusetts (23 to 47), Montana (8 to 32) and Georgia (15 to 40).

Louisiana was the best state when it came to disciplining doctors, taking 5.98 serious actions per 1,000 physicians. Five states – Alaska, Arizona, Colorado, Ohio and Oklahoma – have been in the top 10 for all eight rankings. Only one of the nation’s 15 most populous states, Ohio, is represented among those 10 states with the highest disciplinary rates. Other states in the top 10 are Wyoming, North Dakota, New Mexico and Nebraska.

The best states when it comes to doctor discipline, in order, are Louisiana, Alaska, Ohio, Oklahoma, Wyoming, North Dakota, New Mexico, Arizona, Nebraska and Colorado. The states whose rank has improved the most since their lowest rate are Hawaii (51 to 11), Delaware (50 to 13), Maine (46 to 19), North Carolina (41 to 16), Washington (42 to 18) and Arkansas (45 to 23).

“One reason for medical boards’ declining rate of discipline is likely tighter state budgets,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “The ability of certain states to rapidly increase or decrease their rankings, even when calculated based on three-year averages, can only be due to changes in practices at the board level. The prevalence of physicians eligible for discipline cannot possibly change so rapidly.”

“There is, unfortunately, considerable evidence that most boards are inadequately disciplining physicians,” Wolfe said. “Action must be taken, legislatively and through public pressure on medical boards themselves, to increase the amount of discipline, and thus, the amount of patient protection.”

The annual rankings are based on data from the Federation of State Medical Boards, specifically on the number of serious disciplinary actions taken against doctors in 2008-2010. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state for each of these three years, then averaged the rates over the past three years to establish the state’s rank.

Boards are likely to do a better job disciplining physicians if most, if not all, of the following conditions exist:
• They receive adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);
• They have adequate staffing;
• They engage in proactive investigations, rather than only reacting to complaints;
• They use all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;
• They have excellent leadership;
• They have independence from state medical societies;
• They are independent from other parts of the state government; and
• A reasonable legal framework exists for disciplining doctors (the “preponderance of the evidence” rather than “beyond reasonable doubt” or “clear and convincing evidence” as the legal standard for discipline).

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