Public Citizen | Publications - Ranking of State Medical Board Serious Disciplinary Actions in 2002 (HRG Publication #1658)

Ranking of State Medical Board Serious Disciplinary Actions in 2002 (HRG Publication #1658)



Based on data we obtained from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2002 against doctors, Public Citizen’s Health Research Group has 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 rate of serious disciplinary actions per 1,000 doctors in the year 2002 (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 (columns A and B from the FSMB data) and dividing it by the American Medical Association data on nonfederal M.D.s as of December 2000 (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 per 1,000 physicians.

Nationally, there were 2,864 serious disciplinary actions taken by state medical boards in 2002, up 5.8% from the 2,708 serious actions taken in 2001. The latest published data on the number of doctors is from 2000; thus some of this increase may be attributable to the fact that there were certainly more doctors in 2002 than in 2000. State rates ranged from 1.07 serious actions per 1,000 doctors (Hawaii) to 11.87 actions per 1,000 physicians (Wyoming) an 11.1-fold difference between the best and worst states. If all the boards did as good a job as the lowest of the top five boards, the rate for #5, Oklahoma, being 7.56 serious disciplinary actions per 1,000 physicians or 0.756 percent, this would have amounted to a total of 6,089 (0.756 percent of 805,372 non-federal doctors) serious actions a year. This would be 3,225 more serious actions than the 2,864 that actually occurred in 2002.

Worst States (those with the lowest rate of serious disciplines).

As can be seen in table 1, the bottom 15 states, those with the lowest serious disciplinary rates in 2002, were, starting with the lowest: Hawaii (1.07 per 1,000 physicians), Delaware (1.35), Wisconsin (1.40), Tennessee (1.47), South Carolina (1.77), Maryland (1.78), North Carolina (2.06), Florida (2.08), Pennsylvania (2.10), Minnesota (2.11), Washington (2.23), Nevada (2.31), South Dakota (2.39), Connecticut (2.40) and Michigan (2.41).

Of these 15 states with the worst serious disciplinary records, six – Maryland, Hawaii, Delaware, South Dakota, Minnesota, and Washington – were also in the bottom 15 states in 2001 and 2000 (see table 2). In 2002, the bottom 16 states all had rates of serious disciplinary action that were one-third or less than the rate of all of the top six states.

These data again 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 extremely 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 disciplines).

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): Wyoming (11.87 per 1,000 physicians), North Dakota (8.76), Alaska (8.57), Kentucky (7.58), Oklahoma (7.56), Arizona (7.46), Ohio (7.45), Colorado (7.40), Montana (6.80) and Utah (6.13). Five of these 10 states (North Dakota, Alaska, Kentucky, Oklahoma and Ohio) were also in the top 10 in 2001, 2000 and 1999 and one state, Alaska, has been in the top 10 for more than 10 straight years. Kentucky, 4th this year and Oklahoma, 5th this year, have been in the top 10 states for seven and nine of the last ten years, respectively. Arizona, 6th this year, has been in the top 10 states for 4 of the last 10 years. Ohio, 7th this year, has been in the top 10 for the last eight years in a row. And Colorado, 8th this year, returns to the top 10 for the 6th time in the last 10 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. Other large states such as New York, California and Michigan ranked 20th, 24th and 37th respectively in 2002. Michigan dropped from 29th in 2001 to 37th in 2002, New York from 14th in 2001 to 20th in 2002. Another large state, Massachusetts, improved from 45th in 2000 to 21st in 2002.

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:

  1. Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)
  2. Adequate staffing
  3. Proactive investigations rather than only following complaints
  4. The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts
  5. Excellent leadership
  6. Independence from state medical societies and other parts of the state government
  7. A reasonable statutory framework for disciplining doctors (preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence). 

Given the importance of medical boards in protecting patients in a state from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents of those states, most states are not living up to this obligation. Serious attention must be given to finding out which of the above variables are deficient in each state and taking action, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.  

Table 1
Ranking of Serious Doctor Disciplinary Actions

 

By State Medical Licensing Boards – 2002

 

 

 

 

 

Rank 2002

State

Number of Serious  Actions 2002

Total Number of Physicians 
 2000

Serious Actions Per 1,000 Doctors

1

Wyoming

12

  1,011

11.87

2

North Dakota

14

  1,599

8.76

3

Alaska

11

  1,283

8.57

4

Kentucky

72

  9,500

7.58

5

Oklahoma

48

  6,353

7.56

6

Arizona

88

   11,791

7.46

7

Ohio

247

   33,138

7.45

8

Colorado

89

   12,029

7.40

9

Montana

15

  2,205

6.80

10

Utah

31

  5,056

6.13

11

New Mexico

23

  4,327

5.32

12

Alabama

52

  9,954

5.22

13

West Virginia

22

  4,296

5.12

14

Idaho

12

  2,412

4.98

15

Iowa

33

  6,784

4.86

16

Oregon

44

  9,473

4.64

17

Georgia

84

   18,995

4.42

18

Louisiana

50

   12,068

4.14

19

Mississippi

22

  5,346

4.12

20

New York

322

   80,134

4.02

21

Massachusetts

107

   28,851

3.71

22

Maine

13

  3,528

3.68

23

New Jersey

109

   29,757

3.66

24

California

329

   95,038

3.46

25

Texas

163

   47,994

3.40

26

District of Columbia

14

  4,134

3.39

27

Nebraska

14

  4,290

3.26

28

Virginia

64

   19,673

3.25

29

Illinois

120

   37,138

3.23

30/31

Indiana

44

   13,929

3.16

30/31

New Hampshire

11

  3,480

3.16

32

Vermont

7

  2,280

3.07

33

Arkansas

17

  5,738

2.96

34

Missouri

40

   15,572

2.57

35

Rhode Island

10

  3,919

2.55

36

Kansas

17

  6,847

2.48

37

Michigan

60

   24,901

2.41

38

Connecticut

32

   13,312

2.40

39

South Dakota

4

  1,672

2.39

40

Nevada

9

  3,893

2.31

41

Washington

36

   16,154

2.23

42

Minnesota

30

   14,218

2.11

43

Pennsylvania

82

   39,052

2.10

44

Florida

93

    44,747

2.08

45

North Carolina

43

   20,851

2.06

46

Maryland

39

   21,883

1.78

47

South Carolina

17

  9,607

1.77

48

Tennessee

22

   14,954

1.47

49

Wisconsin

20

    14,241

1.40

50

Delaware

3

  2,219

1.35

51

Hawaii

4

  3,746

1.07

 

United States

2,864

  805,372

3.56

 
Table 2: Ranking for the Last Ten Years

Table 2