Wednesday, March 16, 2011

Should state medical boards do more to punish bad doctors?

State medical boards failed to discipline 55 percent of the nation's doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, according to an analysis by Washington-based Public Citizen. Would this have kept Michael Jackson alive?

Dr. Conrad Murray failed to notify the Nevada State Board of Medical Examiners that his child support payments were in arrears as required when he renewed his medical license in 2007 and 2009, according to the California board’s public letter of reprimand, filed Friday and made public Monday.

The letter noted that Murray’s actions constituted a violation of California law concerning “unprofessional conduct,” grounds for a reprimand.

State Medical Boards not doing enough?

A public reprimand is a lesser form of discipline doctors can negotiate for minor violations to avoid formal charges.

Murray has pleaded not guilty to involuntary manslaughter charges in connection with Jackson’s death.

Jackson died June 25, 2009, of an overdose of the surgical anesthetic propofol, which Murray has acknowledged using to treat his insomnia. Murray’s lawyers have suggested Jackson injected or drank a fatal amount of the drug when the physician wasn't looking. Prosecutors contend that Murray violated the standards of medical care by administering the drug improperly and concealing his actions after the singer died.

The group, Public Citizen, founded by Ralph Nader, came up with the figure by analyzing the public-use file of the National Practitioner Data Bank from its inception in 1990 to 2009. (The data bank was established by Congress in 1986 so doctors would not be able to hide malpractice, or actions by hospitals, licensing boards or professional societies. Although names in the databank are not open to everyone, they can be accessed by hospitals, and some medical practices and government agencies.)

During those two decades in Missouri, 96 out of 181 doctors with at least one clinincal-privilege action had no action taken against their license -- or about 53 percent. In Illinois, that was true of 215 of 328 doctors, or 66 percent.

"One of two things is happening, and either is alarming," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group and overseer of the study. "Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed."

The Public Citizen report notes that a doctor "must have serious deviations of behavior or performance to warrant clinical privilege actions."

Public Citizen previously reported that from 1990 to 2007, nearly half of hospitals had never made a databank report.

Now, the group says that of 10,672 physicians listed in the NPDB for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards.

That means 55 percent of them - 5,887 doctors - escaped any licensing action by the state. The study examined the NPDB's Public Use File from its inception in 1990 to 2009.

Public Citizen said it sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, for further investigation, and notified the 33 medical boards that had the worst records in disciplining these doctors.

Here is a case where the state board is not doing enough:

Authorities say Dr. Tyrrell prescribed more than one 1,000 Demerol and Oxycontin pills to 35-year-old Tammy Daniels last year. Investigators say Daniels died of an overdose after crushing and injecting Demerol.
The Oklahoma state medical board has now suspended Dr. Mickey Tyrrell's medical license for 30 days, and temporarily restricted his practice to pre-natal and obstetrics.

Dr. Tyrrell also has to pay a $25,000 fine and do 200 hours of community service.

The medical board did not put any restrictions on his ability to write prescriptions.

Is this enough?

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