State medical boards leave patients in danger and in the dark

Medical boards from coast to coast are inconsistent, inefficient and ill-equipped to monitor the hundreds of thousands of doctors licensed under their watch, Antidote's investigation of every state board has found. There are some standouts, but, overall, they do a terrible job protecting patients and informing the public.

It bears repeating that most doctors do a great job and are focused on one thing: helping their patients heal and lead healthier lives. The mission of this tour was to explore what happens to that minority of doctors who don't follow the rules.

Over the past year, we reviewed records from more than 100 physicians in every state and the District of Columbia. We selected 51 to highlight in weekly "Doctors Behaving Badly" profiles, starting with Delaware and ending with Nevada. (Don't ask how why things went in that order.)

Along the way, we interviewed state lawmakers, patients, union representatives, doctors, and other health writers. We made appeals to several boards for interviews with board executives or members, but, so far, we have not had any takers.

We examined 128 disciplinary actions, ranging from assurances of compliance, which have about as much effect on dangerous doctors as love letters, to full-on license revocations, which work as long as the board follows up to make sure the doctor is not still practicing without a license.

Here's the scary part. Those 51 doctors were responsible for injuring or killing 290 patients. These include overdosing patients, blinding them, and making the wrong diagnoses. 

The majority of these doctors are still in practice: 82%. This is in part because the state boards take so long to act or mete out weak discipline. It also is because so many doctors are licensed in multiple states; doctors who get in trouble in one state tend to move around. About 70% of the doctors on this tour have had licenses in more than one state, some in as many as five.

Rarely did Antidote find a board that took it as a warning sign when it saw a doctor hopping from state to state trying to get another license. Instead, they mostly welcomed doctors, regardless of their baggage, either because the board did not bother to check the doctor's history or because the board made excuses.

In some of these board documents, medical boards can seem like those friends of yours who always ends up in destructive relationships. They are perpetually hoping that they will be the one who can change that bad seed for the better. "But this time it will be different," they tell themselves.

In comparing boards and in comparing how different boards deal with doctors within one state, dangerous inconsistencies can be seen. For the same offense, one state will revoke a doctor's license, while another will write a letter and file it in a drawer never to be seen, or require a doctor to take a class. We found multiple instances where doctors who had failed to pay their taxes or fell behind on their licensing fees lost their licenses while doctors who had actually harmed patients were allowed to continue practicing.

Overall, Antidote found three particularly troubling trends:

First, states seem to think that doctors who have a tendency to molest their patients will only do so if they are above or below an arbitrary age limit. Instead of banning these doctors from seeing patients (the most prudent option) or requiring a chaperone to be present for all patients, they will say that all women over 60, or 50 or 34 and any girls under 18 may be seen without fear that the doctor will touch them inappropriately. These age limits do not appear to be rooted in anything more than what the doctors do, and, as Antidote found in Utah, when the limits like this are set, the doctors just pivot their practices to see only patients outside the restrictions.

Second, multiple states have made a habit of funneling doctors with histories of fraud, negligence and abuse into areas where patients are already vulnerable, namely poor communities, addiction treatment centers and prisons. Consider this Alice in Wonderland situation: a doctor in Maine who had been criminally convicted of defrauding the federal Medicaid program, which serves the poor, was later required by a state medical board to "treat 15% of indigent patients without charge until he becomes an approved provider for Medicare and Mainecare," which is the state of Maine's Medicaid program.

And third, it's not just the medical boards who are failing the public. In case after case, Antidote found doctors who were in trouble with criminal investigators, federal prosecutors, or the U.S. Drug Enforcement Administration (DEA). Still, years would pass before the state medical board took action.

In some cases, doctors literally called the FBI showing signs of addiction or degenerating mental health. Calls like that should sound fire alarms for medical boards. In some cases, this has to be blamed squarely on the board, but it's not always clear that anyone bothered to tell the board about a problematic doctor. These boards usually have small staffs and, while it would be nice for them to broadly monitor physicians, they rely on complaints and tips.

Hospitals and physicians' groups clearly are shirking their responsibilities to warn boards about bad doctors. It should not be noteworthy that other doctors stood up and testified against a doctor whose patients were habitually showing up in the ER strung out on painkillers or nearly dead from an overdose. Antidote called it out because it was so unusual.

Kent County Hospital in Rhode Island took the more typical course. After a doctor was accused of molesting a patient while she was under anesthesia, it placed the doctor on administrative leave rather than suspending him or firing him, specifically avoiding any action that would necessitate a report to the state medical board. This same doctor has gone on to work at Guam Memorial Hospital, where management has been similarly acquiescent, but the hospital staff has fought the hiring.

Boards work harder at giving these doctors second, third, fourth, and fifth chances than they do in giving patients clear information about what these doctors have done. But there are exceptional performers when it comes to transparency. Antidote found nine that provide consumers with websites that are intuitive, easy to use and full of good details about physician histories, often going back many decades: California, Georgia, Iowa, Maryland, North Carolina, Ohio, Oregon, Texas and Wisconsin.

And the worst? These seven made Antidote want to cry: Alaska, Illinois, Maine, Mississippi, Nevada, New Jersey and Utah. Their sites are clunky. The information provided is scant. And the public has to pay for copies of records.

Different boards excel in different areas. The South Dakota board was the only one Antidote found that regularly checked to see if doctors were being honest on their licensure applications. The Vermont medical board was one of the few to actually check patient charts to look for patterns of behavior. Yet both of these boards do a terrible job of informing the public about what they found.

Some states, such as Kentucky, have actually taken a step backwards since Antidote started the tour. Records that were easily available online have been removed inexplicably. We hate to think that the extra publicity given to some of these misbehaving MDs would lead boards to pull files out of public view.

But other states told Antidote over the course of the year that they were working on providing more information for the public. Pennsylvania, for example, told Antidote that it is "working at this very time to get all the disciplinary action history for our 29 Boards out on the web.  It is quite a lengthy process, but it is in the works."

On Friday, we will post some ideas for making that process a little less lengthy and other tips for making boards tougher and more transparent.

We'd love to hear your ideas, too. Post a comment below or write askantidote@gmail.com. Check out the Doctors Behaving Badly Google map, or to read more Doctors Behaving Badly posts, click here.

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