Just out of prison? Go practice medicine on the poor, says Washington state

It's not often that a veteran physician pleads poverty. Once a doctor gets through residency and spends a few years establishing a practice, patient billings tend to provide a good living.

That money can dry up, though, if you are caught committing insurance fraud by federal investigators and sent to prison.

That's where Dr. Craig Edward Swanson found himself a few years ago. After being banned from practicing medicine in California, he turned to the more sympathetic ears of the Washington Medical Quality Assurance Commission.

When he was in California, Swanson had run three businesses and billed Medicaid, Medicare and other insurers for services he never provided. He was ordered to pay $120,000 in restitution and spend five months in prison after a 2005 conviction of "illegal remuneration." He also was banned from billing the federal government for any health services for at least 13 years. That left him a little tight. The commission wrote  that Swanson experienced "financial difficulties" and ultimately had to file for Chapter 7 bankruptcy.

Then the board listed all the reasons Swanson was better than that. He has thee doctorate degrees: one in pharmacy, one in medical chemistry and one in medicine. And, the commission noted, before he was convicted, he went through the state of California's Physician Assessment and Clinical Education (PACE) program. "In the PACE program, [Swanson] demonstrated clinical competency and the quality of his work was above the standard of care."

The key detail, though, was that Swanson, newly poor, cared a lot about poor people.

The Commission was persuaded by [Swanson's] motivation to practice family medicine where there is a shortage of physicians to serve low-income populations.

To give Swanson a chance to put his charitable spirit into action, the commission in 2006 suspended his license but said he could return to practicing if he met a few conditions, mainly that he have his practice monitored by another physician, a physician that he was allowed to pick himself. The commission also prevented him from supervising physician assistants, because his supervision of physician assistants, or lack thereof, was part of what got him in trouble with the feds in the first place.

One year later, Swanson returned to the commission. He said he was ready to return to practice and have his suspension lifted. He wanted to go help prisoners by working for the Washington State Department of Corrections. But, in order to do so, he would need to be able to supervise physician assistants. Even though Swanson was supposed to wait until at least 2009 before asking for a modification of his license restrictions, the commission thought his request sounded grand, saying that Swanson's "employment with the Department of Corrections is consistent with the intent of the 2006 Order that [Swanson] be allowed to practice in an underserved area and under the supervision of another physician."

Following this order, "the Commission began treating [Swanson's] license as if it were no longer suspended."

But Swanson never went to work for the prisons, and the state of Washington never bothered to follow up on him. It wasn't until more than two years later that the commission started writing Swanson to ask "whether you are working at the Department of Corrections." Does it seem odd for one state agency to ask a doctor whether he is working at another state agency?

Swanson never wrote back, and the commission suspended his license again in May 2010.

Final question: Should doctors with criminal convictions and other problems be required to work in a "low income population," which often is largely made up of immigrants who have to pay cash for their care? This practice of disciplining a physician by restricting his practice to the less fortunate and the incarcerated cries out for investigation. The Office of Inspector General for the Department of Health and Human Services used to conduct these types of investigations, and it would be an incredible public service for the OIG, a Congressional committee or even a really ambitious reporter to take up this line of inquiry.

Jenn Harris contributed to this report.

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