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May 17, 2012 

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

South Carolina Is Overall Worst While Wyoming Is Best; Many Large States Are Inadequately Disciplining Doctors

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, in part because of budget cuts, according to Public Citizen’s annual ranking of state medical boards, released today.

“There is considerable evidence that most boards are inadequately disciplining physicians,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “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. Ensuring that medical boards are adequately funded is an important prerequisite to achieving this, especially because doctors’ licensing fees, intended to fund medical board functions, are sometimes taken to fund other state functions, which has recently occurred in California.”

South Carolina was the worst state when it came to disciplining doctors, and, along with Minnesota and Wisconsin, has consistently been among the bottom 10 states for each of the past nine Public Citizen rankings. Connecticut has been in the bottom 10 for each of the past six rankings. For the fourth time in a row, Florida is among the 10 states with the lowest rates of serious disciplinary actions even though it is beginning to improve. Other large states, such as Texas, Pennsylvania and Michigan, have been in the bottom half of state rankings for all nine rankings and California has been in the bottom half for the past six rankings.

 “One likely reason for some medical boards’ declining rate of discipline is tighter state budgets,” Wolfe said. “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 and staffing at the board level. The prevalence of physicians eligible for discipline cannot possibly change so rapidly.”

Public Citizen’s analysis of medical board data from all states and the District of Columbia found that the rate at which doctors are disciplined by state medical boards has declined significantly over the past seven years, and some of the worst states have been consistently poor performers. Nationally, in 2011 state medical boards took 3.06 serious actions per 1,000 physicians – up slightly (3 percent) from last year but still down 18 percent from the peak rate of discipline in 2004 of 3.72 per 1,000 physicians.

The worst states, in order from the worst, are South Carolina; Washington, D.C.; Minnesota; Massachusetts; Connecticut; Wisconsin; Rhode Island; Nevada; New Jersey; and Florida.

Wyoming was the best state when it came to disciplining doctors, taking 6.79 serious actions per 1,000 physicians, a rate five times higher than South Carolina. Three states – Alaska, Ohio and Oklahoma – have been in the top 10 for all nine rankings. Only one of the nation’s 15 most populous states, Ohio, is represented among those 10 states with the highest disciplinary rates. The best states when it comes to doctor discipline, in order from the best, are Wyoming, Louisiana, Ohio, Delaware, New Mexico, Nebraska, Alaska, Oklahoma, Washington and West Virginia.

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 2009-2011. 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, and 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). In an era of especially tight state budgets, money allocated to board revenue from doctors’ licensing fees frequently has been transferred to fund other parts of state executive branch functions;
• 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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