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Who’s your doc?

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A year-long investigation by the website MedPage Today and the Milwaukee Journal Sentinel into how well states police physicians is out, and Alaska didn’t score well.

“States of Disgrace: A Flawed System Fails to Inform the Public” is the title of the report, which outlines how hard it is for patients to find information on incompetent or unscrupulous physicians. 

The story focuses on doctors who “sexually harass patients, bungle surgeries, or ignore complications in patients who then die….(and how) they can get away with it by taking advantage of lags and gaps in the medical licensing system. By hopping state lines, or having a fistful of licenses issued by different states, they can continue to practice wherever the grass is greenest.”

The story highlights Alaska’s weakness in publicly disclosing information about doctors. The Alaska State Medical Board publicly reveals when it takes action against doctors, the story says, but doesn’t regularly report on:

  • Doctors losing hospital privileges.
  • Doctors with felony convictions.
  • Doctors disciplined by board in others states
  • Doctors facing malpractice claims and/or payments
  • Doctors excluded from Medicare/Medicaid or facing related fraud investigations.
  • Or doctors against whom the Drug Enforcement Administration is taking action.

Alaska is not alone. Sixty licensing boards across the country were surveyed by reporters for Medpage and the Sentinel, and no state clicked off all seven public disclosure criteria.

“…There is significant variation in both quantity and quality of information each board publishes,” reporters on the project later wrote.

“Consider Julie Sullivan, MD, of Oceanside, Calif. That state’s licensing website shows a clean record. No hospital disciplinary actions. No action taken by other states. No court orders or anything else that might raise eyebrows.

“It does not mention the problems listed on the Texas Medical Board’s website, stemming from her care of a patient who complained of headaches and photophobia. Despite the patient’s prior similar symptoms and history of aneurysms, Sullivan did not perform a fundoscopic exam, and discharged him with a diagnosis of a severe headache.

“Less than six hours later, the patient went to an emergency room where a CT exam showed a ventricle colloid cyst in the man’s brain. He then suffered a fatal cardiac arrest on the way to another hospital.

“Texas ordered Sullivan to take CME courses on various topics, including headache treatment. It also told her to provide a copy of the order to all institutions where she had or was applying for privileges.

“Of course, that applied only within the state of Texas. California records show nothing about it.”

Public disclosure

And yet California scored far better than Alaska on publicly outing failing doctors. It clicked five of the boxes for the seven criteria.

California also had better public representation on its medical licensing board with seven of 15 positions reserved for the general public. Only three members of the public serve on Alaska’s nine-member board.

Still, Alaska disciplines almost twice as many doctors (4.9 per 1,000) as California (2.9 per 1,000), according to the report, which says that a British Medical Journal study in 2016, “found annual rates of discipline (nationally) ranged from 1.7 per 1,000 physicians in Washington, D.C., to 10.3 per 1,000 in Delaware, looking at numbers averaged over five years at the start of the decade.”

None of those numbers  are particularly encouraging when considered at the rate per 100,000 at which risks are generally measured in the U.S. They would indicate patients face a 170 per 100,000 to 1,030 per 100,000 risk of encountering a doctor with issues.

The numbers are disconcerting given that the top-10 killers in America are diseases, starting with cardiovascular disease (193 per 100,000 deaths) and dropping down to kidney disease (15 per 100,000).

On an individual level, the quality of medical care can play a key role in improving the odds of beating a serious illness, which makes the issue of finding a competent doctor important.

Were this not enough, there is the danger posed by doctors themselves and hospitals. A 2016 John Hopkins Medical study that warned medical errors should probably be ranked as the “third leading cause of death in the U.S.”

The latter study underlined the importance of choosing doctors carefully, but how is that possible if so little information is available?

State answer

Alaska tries to keep patients and potential patients informed, emailed Debora Stovern, the executive administrator for the State Medical Board.

But the “Board is not a reporting agency and only has jurisdiction over their licensees,” she said.

Stovern said “information about accusations, disciplinary actions, and other orders of the Board is public information and these actions are available to the public,” but accusations do not appear to be available online nor is information on loss of hospital privileges or the other measures the MedPage/Journal concluded key to determining the qualifications of doctors.

The Board’s website would indicate patients can file a public records request to obtain more information. There is a link for filing for that.

“To fully understand this process, you may want to review the Alaska Public Records Act and the regulations created under its authority,” it cautions. “You also may want to discuss your request with an attorney of your choosing. Please note: the Division cannot provide legal advice, nor can it recommend an attorney.

“This form is offered only for the convenience of the person making the request. You may also request records from our division by email or other written means. Please include the information requested on this form to ensure faster processing.”

Requesting information from the state of Alaska under the public information law is a process that can be slow and fraught with problems. Requests are sometimes met with demands for significant fees to covers the costs of searching for information and editing it before release.

The publicly available actions Alaska does take against doctors are available online as what Stovern described as “a summary of actions.”

It shows doctors no longer licensed to practice in Alaska or on suspension or probation. It reveals seven doctors surrendered their licenses last year and can no longer practice in the 49th state.

It provides very limited information on licenses that have been suspended. One doctor “was summarily suspended due to impairment and mental health issues posing a clear and immediate danger to public health and safety,” the website says.

Another got in trouble for failing to promptly report being arrested for driving under the influence, the website says, but in many cases there is little to indicate what the doctor’s issue might be.

One doctor on probation is in trouble, according to the website, for “license action in another state with practice restrictions. Probation and conditions to mirror Oregon order, including chaperone required when treating female patients.”

One can read various things into the information unwritten between the lines there.

In general, the information on the website would appear at best a minimal way to check on the qualifications of an Alaska doctor. Stovern added that the Alaska Board does cooperate with both the National Practitioner Data Bank (NPDB) and the Federation of State Medical Boards (FSMB) disciplinary data bank.

Federal no-versite

The NPDB is an information clearinghouse Congress created with the aim of improving health care quality, and reducing health care fraud and abuse in the U.S. It is no help to consumers.

The MedPage/Sentinel report said NPDB now contains “more than 1.3 million records of ‘adverse actions’ going back to 1990,” but “the same legislation that created the tool shrouded it in secrecy. Public versions of the database don’t include physicians’ names or other identifying information.

“That makes it impossible to determine what happened in cases where reporters asked officials why physicians with license problems in other states were allowed to practice in their state unfettered.

“In each case, officials said it was the first time they heard of the issue.”

The FSMB website isn’t much more help. It provides information on where doctors went to school, where they are licensed, and flags any actions against their licenses. The action section links back to state websites where a consumer might or might not be able to find more information.

“The (Alaska) Medical Board takes their public protection responsibilities very seriously and has well-established policies and procedures, in partnership with the Division of Professional Licensing, to investigate and take disciplinary action as appropriate on any of these reports,” Stovern said.

That may be true, but the Board provides only limited information to those trying to assess a doctor. As the MedPage/Sentinel investigation discovered, Alaska is one of many states that ignores many information sources that could provide a full picture of a physician’s history.

No state consistently reported all the pieces of the puzzle on their website, MedPage/Sentinel reported. And reporters found “only five states report six of these seven categories — Florida, Kansas, Maryland, Massachusetts, and North Carolina. Five other states regularly reported five categories: California, Georgia, Indiana, New York, and Tennessee.

“The majority report only their own disciplinary actions.

“‘Should all state medical boards list all of these elements? Absolutely,'” Dr.  Sidney Wolfe of the watchdog group Public Citizen told MedPage/Sentinel reporters. The reasoning behind Wolfe’s statement was simple:

“A background check on a doctor you have or one you’re thinking of going to may have more of an effect on your health than anything else.”

 

 

 

 

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2 replies »

  1. 250,000 medical error _deaths_, by definition avoidable, which the CDC currently doesn’t even bother tracking on the list of top killers.

    Astonishingly, the American Hospital Assoc, the Pharmaceutical Research & Manufacturer’s of America, and the doctor’s own lobby, the AMA, are 4, 5, and 6 of top lobbying spenders*.

    Strangely, the medical community, and the AMA in particular, pushes the CDC not to study their members, the doctors actually killing people, to save those lives, but instead to waste time and limited resources duplicating the actual criminological experts work on “gun violence.”

    “Gun violence” which, in total, kills only about 30K, mostly suicides, and injures about 90K per year. primarily criminals harming other criminals and less than half the doctors’ actual body count.

    * – NRA, a civil rights organization, not breaking the top 20.

    Like

  2. Craig, excellent article. It would be great if the hospitals in Alaska would provide data on medical errors, reasons for physicians losing hospital privileges, etc. The profession needs to police itself before the government steps in. I doubt that will happen. The legislature cannot even deal with the Certificate Of Need laws which protect the big player in AK–Providence.

    Liked by 1 person

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