Outrage of the Month: Maryland Lawmakers Introduce Legislation to Protect Dangerous Doctors

Health Letter, March 2019

By Michael Carome, M.D.

outrage

If you’re not outraged,
you’re not paying attention!

Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.

climatechange
Image: serato/Shutterstock.com

State medical boards are responsible for licensing medical doctors, investigating complaints of medical negligence or unprofessional conduct, and taking appropriate disciplinary action against licensees who engage in such conduct. The medical boards’ primary mission is to protect the health, safety and welfare of patients, and their authority is established by state statutes known as medical practice acts.

Too often, state medical societies have pushed state legislatures to pass bills that would weaken the authority of state medical boards, protect dangerous doctors and endanger the public. The most recent such effort occurred in Maryland when four state senators on January 31 introduced Senate Bill 372 (SB 372), Physicians — Discipline — Procedures and Effects — legislation that apparently was crafted by the Maryland State Medical Society, the professional organization representing Maryland doctors.[1],[2]

The most troubling provision of SB 372 would require the Maryland medical board — known as the Maryland Board of Physicians — to expunge all records of any public reprimand or probation action taken against a licensed physician after three years. Of note, among the more than 40 reasons that the Maryland medical board may reprimand a licensed physician or place a licensed physician on probation under Maryland law are the following:

  • Immoral or unprofessional conduct in the practice of medicine
  • Professional, physical or mental incompetence
  • Abandonment of a patient
  • Habitual intoxication
  • Addiction to or habitual abuse of any narcotic or controlled dangerous substance
  • Provision of professional services while under the influence of alcohol or while using any narcotic or controlled dangerous substance or other drug that is in excess of therapeutic amounts or without valid medical indication
  • Promotion of the sale of drugs, devices, appliances or goods to a patient so as to exploit the patient for financial gain
  • Gross overutilization of health care services
  • Failure to meet appropriate standards as determined by appropriate peer review for the delivery of quality medical and surgical care performed in an outpatient surgical facility, office, hospital or any other location in Maryland
  • Failure to keep adequate medical records as determined by appropriate peer review

Currently, Maryland law requires the Maryland medical board to disclose on its website a description of any disciplinary action that it takes, including a copy of the public order, for at least 10 years, and patients and other members of the public can download from the board’s website the orders for all disciplinary actions taken by the board against any physician licensed in Maryland.

Expunging all records of a public reprimand or probation after three years would deprive patients of the right to know a physician’s complete disciplinary history, information that is clearly relevant to making a fully informed decision when choosing a physician. Indeed, research has shown that physicians who have been disciplined by state medical boards have a high rate of recidivism and are far more likely to be disciplined again than physicians who have never been disciplined.[3]

Public Citizen’s Health Research Group’s analysis of publicly available deidentified data in the National Practitioner Data Bank (NPDB) shows that over the last 10 years (2009 through 2018), a total of 1,687 licensure actions were reported by the Maryland medical board to the NPDB. Of these, 342 (20 percent) involved probations and 471 (28 percent) involved reprimands or censures. Thus, if SB 372 is enacted, nearly half of all disciplinary actions taken by the board over the last 10 years would be expunged from the public record.

Notably, among the reasons for the Maryland medical board’s actions in the 342 probation cases reported to the NPDB, 107 (31 percent, or nearly a third) involved “substandard or inadequate care”; another 40 (12 percent) involved the catchall category “other unprofessional conduct,” and an additional two cases involved sexual misconduct. Likewise, among the reasons the board took action in the 471 cases involving reprimands or censures, 122 (26 percent, or more than a quarter) involved “substandard or inadequate care,” and another 58 (12.3 percent) involved “other unprofessional conduct.”

These are serious matters about which patients in Maryland and the public have a right to know, even after three years. Who wouldn’t want to know that physicians they were considering seeing for treatment have been reprimanded or placed on probation by the Maryland medical board for providing substandard or inadequate care or for engaging in various types of unprofessional conduct, including even sexual misconduct? Why, considering the rights and welfare of Maryland patients, would the General Assembly of Maryland want to limit patient access to such critical information to a brief three-year period?

SB 372 also would make it more difficult for the Maryland medical board under certain circumstances to investigate and discipline physicians who allegedly failed to meet appropriate standards as determined by appropriate peer review for the delivery of quality medical care. New procedural requirements imposed by legislation would place unreasonable constraints on the board’s ability to investigate and discipline physicians who engage in substandard practice and will endanger patients treated in Maryland.

SB 372 is a clear attempt to undermine the Maryland medical board’s mission to protect the health, safety and welfare of patients. The General Assembly of Maryland must resist the overtures from the Maryland State Medical Society and soundly reject this legislation.


References

[1] MedChi, the Maryland State Medical Society. House of Delegates. Resolution 38-18: Expungement of the Public Reprimands and Probation on a Physician’s Public Record. Adopted September 22, 2018. https://www.medchi.org/Portals/18/files/Events/18HODFall/Resolution%2038-18%20FINAL%20adopted.pdf?ver=2018-10-15-113052-057. Accessed February 20, 2019.

[2] MedChi, the Maryland State Medical Society. House of Delegates. Resolution 39-18: Peer Review Findings in a Board of Physicians Investigation. Adopted September 22, 2018. https://www.medchi.org/Portals/18/files/Events/18HODFall/Resolution%2039-18%20FINAL%20adopted.pdf?ver=2018-10-15-113145-650. Accessed February 20, 2019.

[3] Grant D, Alfred KC. Sanctions and recidivism: An evaluation of physician discipline by state medical boards. J Health Polit Policy Law. 2007;32(5):867-885.