Ranking of State Medical Boards’ Serious Disciplinary Actions in 1999

April 2000

Sidney M. Wolfe M.D.

Based on the Federation of State Medical Boards (FSMB) data on the number of disciplinary actions taken in 1999 against doctors, Public Citizen 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 extent to which they are taking serious disciplinary actions against doctors (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 and dividing it by the American Medical Association data on nonfederal M.Ds as of December, 1998 (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.

Nationally, there were 2,696 serious disciplinary actions taken by state medical boards in 1999, down slightly from the 2,732 serious actions taken in 1998. State rates ranged from 10.34 serious actions per 1,000 doctors (Alaska) to 0.96 per 1,000 physicians (Delaware), a 10.8-fold difference between the best and worst states. If all the boards did as good a job as the top five boards, the lowest rate for #5,Oklahoma being 5.95 serious disciplinary actions per thousand physicians or .595%, this would amount to 4,583 (.595% of 770,320 non-federal doctors) serious actions a year, 1.7 times as many (1887 more serious actions) as the 2,696 that actually occurred in 1999.

Worst States

those with the lowest rate of serious disciplines

The bottom 15 states, those with the lowest serious disciplinary rates in 1998, were, starting with the lowest: Delaware 0.96 per 1,000 physicians), Nebraska (1.23), Tennessee (1.25), Minnesota (1.58), Hawaii (1.69), Connecticut (1.78), Kansas (1.82), South Dakota (1.92), Illinois (2.05), Wisconsin (2.06), D.C. (2.18), Maryland (2.42), Massachusetts (2.43), Florida (2.49), and Washington (2.49). Massachusetts, Tennessee, Minnesota, Wisconsin, Kansas, Hawaii, and Delaware were also in the bottom 15 states in 1997 and 1998. In 1999, the bottom 20 states all had rates of serious disciplinary action that were one-half or less than the rate of all of the top five states.

These data 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 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 discipline

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): Alaska (10.34/1,000 physicians), North Dakota (8.77), Wyoming (8.15), Idaho (7.02), Oklahoma (5.95), Kentucky (5.92), Ohio (5.90), Mississippi (5.87), Vermont (5.34), and Colorado (5.24). Five of these 10 states (Alaska, Oklahoma, Mississippi, Wyoming, and Ohio) were also in the top 10 in 1997 and 1998 and two, (Mississippi and Alaska) have been in the top 10 for nine straight years. Oklahoma, 5th this year, has been in the top 10 states for eight of the last nine years. Wyoming, 3rd this year, has been in the top 10 for seven of the last nine years and Vermont, 9th this year and Ohio, 7th this year, have been in the top ten for five of the last nine 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, 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.

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:

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

Table 1. Ranking of Serious Disciplinary Actions by State Medical Licensing Boards — 1999

Rank 1999	State	Number of Serious Actions 1999	Total Number of Physicians 1998	Serious Actions Per 1,000 Doctors
1	Alaska	12	1160	10.34
2	North Dakota	14	1596	8.77
3	Wyoming	8	981	8.15
4	Idaho	16	2278	7.02
5	Oklahoma	37	6216	5.95
6	Kentucky	54	9115	5.92
7	Ohio	190	32220	5.90
8	Mississippi	30	5107	5.87
9	Vermont	11	2061	5.34
10	Colorado	59	11253	5.24
11	Iowa	33	6602	5.00
12	Arkansas	27	5486	4.92
13	Alabama	45	9559	4.71
14	New York	366	77781	4.71
15	Georgia	82	17961	4.57
16	Indiana	60	13267	4.52
17	West Virginia	19	4249	4.47
18	New Hampshire	14	3309	4.23
19	Michigan	101	24001	4.21
20	California	367	90940	4.04
21	Arizona	42	11025	3.81
22	Virginia	70	18441	3.80
23	Louisiana	43	11581	3.71
24	Maine	11	3195	3.44
25	Nevada	11	3373	3.26
26	North Carolina	62	19615	3.16
27	New Mexico	13	4138	3.14
28	New Jersey	89	28432	3.13
29	South Carolina	27	8923	3.03
30	Oregon	27	8984	3.01
31	Missouri	45	15211	2.96
32	Montana	6	2036	2.95
33	Utah	13	4770	2.73
34	Texas	124	45707	2.71
35	Rhode Island	10	3784	2.64
36	Pennsylvania	97	38080	2.55
37	Washington	38	15254	2.49
38	Florida	105	42169	2.49
39	Massachusetts	67	27622	2.43
40	Maryland	51	21116	2.42
41	District of Columbia	9	4121	2.18
42	Wisconsin	28	13567	2.06
43	Illinois	73	35581	2.05
44	South Dakota	3	1562	1.92
45	Kansas	12	6577	1.82
46	Connecticut	23	12910	1.78
47	Hawaii	6	3555	1.69
48	Minnesota	21	13275	1.58
49	Tennessee	18	14412	1.25
50	Nebraska	5	4070	1.23
51	Delaware	2	2092	0.96
Total		2696	770320	3.50

 

Table 2. Ranking of States 1991-1999: Seriously Disciplinary Actions

Rank 1999	Rank 1998	Rank 1997	Rank 1996	Rank 1995	Rank 1994	Rank 1993	Rank 1992	Rank 1991
1	1	2	6	8	2	8	7	6	Alaska
2	11	9	2	34	10	3	5	13	N. Dakota
3	7	3	31	3	1	21	4	9	Wyoming
4	25	30	21	36	30	37/38	23	34/35	Idaho
5	2	5	7	12	5	2	1	2	Oklahoma
6	14	7/8	14	14	4	4	16	5	Kentucky
7	10	7/8	8	9	24	22/23	19	23	Ohio
8	3	1	1	1	9	9	6	6	Mississippi
9	6	25/26	10	6	39	17	15	10	Vermont
10	18	6	4	5	12	6	8	17	Colorado
11	23	4	3	2	7	5	2	3	Iowa
12	4	13	15	23	28	26	18	29	Arkansas
13	17	23/24	38	30	43/44	29	30	31	Alabama
14	16	16	18	17	29	34	39	49	New York
15	12	23/24	19	4	8	10	9	4	Georgia
16	21	19/20	33	28	16	7	14	15	Indiana
17	5	12	11	7	6	1	3	8	W. Virginia
18	30	46	51	49	49	47	47	44	New Hampshire
19	13	15	28	21	34/35	35	40	40	Michigan
20	27	18	27	20	34/35	32	42	37	California
21	38	19/20	5	10	17	16	22	22	Arizona
22	40	34/35	50	41/42	32	30	37	32	Virginia
23	15	34/35	44	13	18	11	12	7	Louisiana
24	9	22	17	32	33	41	44	46	Maine
25	26	32	9	11	31	20	25	26	Nevada
26	43	33	48/49	35	36	40	34	42/43	N. Carolina
27	8	50	23	15	43/44	49	33	33	New Mexico
28	35	42	20	25	19	18	28	20	New Jersey
29	22	40	45	44	14	15	11	11	S. Carolina
30	31	28/29	29	16	20	22/23	24	14	Oregon
31	48	17	30	37	13	12	13	12	Missouri
32	34	11	13	18	3	14	10	19	Montana
33	20	25/26	16	38	46	39	43	18	Utah
34	28/29	37	35	19	23	28	29	21	Texas
35	24	10	25	26	26	42	41	50/51	Rhode Island
36	45	27	32	43	47	48	48	47	Pennsylvania
37	36/37	28/29	40	24	27	24	17	24	Washington
38	49	36	22	22	25	25	21	27	Florida
39	47	45	43	40	37	45	46	48	Massachus.
40	36/37	38	41	29	21	19	27	42/43	Maryland
41	33	44	36	50	51	51	45	45	District of   Columbia
42	46	39	34	47	41	27	26	34/35	Wisconsin
43	41	21	46	45	40	31	36	36	Illinois
44	19	14	42	33	11	13	32	50/51	S. Dakota
45	44	41	12	46	22	37/38	20	25	Kansas
46	32	31	37	27	42	36	35	30	Connecticut
47	39	49	39	51	50	46	50	41	Hawaii
48	42	51	47	39	45	33	31	28	Minnesota
49	51	48	48/49	31	38	44	49	38	Tennessee
50	28/29	43	24	41/42	15	50	38	39	Nebraska
51	50	47	26	48	48	43	51	16	Delaware