WASHINGTON - April 20 - Public Citizen's annual ranking of state medical boards shows that most states, including two of the largest, are not living up to their obligations to protect patients from doctors who are practicing substandard medicine, according to the report released today.
For the first time since Public Citizen has been publishing the rankings, California, the largest state in the country, and Florida, one of the largest, are among the 10 states with the lowest rates of serious disciplinary actions. Minnesota was the worst state when it came to disciplining doctors and, along with Maryland, South Carolina and Wisconsin, has consistently been among the worst 10 states for each of the last six rankings.
Overall, the rate of discipline for doctors in 2008 was 21.5 percent lower than the peak year of 2004. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, compared to 3.72 actions per 1,000 physicians in 2004. This means that if the higher 2004 rate of discipline were still occurring, 770 more doctors would have been subject to serious disciplinary actions in 2008 than actually were.
The annual rankings are based on data from the Federation of State Medical Boards, specifically on the number of disciplinary actions taken against doctors in 2008. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state. The number of actions in 2008 was averaged over the past three years to establish the state's rank.
California is one of five states with the largest decrease in rank for doctor discipline since the 2001-2003 period, dropping from a rank of 22 to 43. The four other states with the biggest decline are Alabama (13 to 36), Georgia (15 to 42), Mississippi (20 to 48) and New Hampshire (25 to 46). All of these states had large decreases in the actual rates along with the decrease in rank.
The best states when it comes to doctor discipline, in order, are Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado and Maine. The five states whose rank has improved the most since 2001-2003 are Hawaii (51 to 13), North Carolina (41 to 14), Maine (34 to 10), the District of Columbia (42 to 17) and Illinois (35 to 15). The progress in these states is commendable because the medical boards have figured out ways - often with legislatively mandated increases in funding and staffing - to improve the protection for patients from doctors who need to be disciplined but, in the past, were disciplined much less rigorously.
"The overall national downward trend of serious disciplinary actions against physicians is troubling because it indicates many states are not living up to their obligations to protect patients from bad doctors," said Sidney Wolfe, M.D., Public Citizen's acting president and director of its Health Research Group. "State lawmakers must give serious attention to finding out why their states are failing to discipline doctors and then they need to take action - either legislatively or by applying pressure on medical boards. Otherwise, they will continue to allow doctors to endanger the lives and health of their residents because of inadequate discipline."
Boards are likely to do a better job disciplining physicians if most, if not all, of the following conditions exist:
- They have adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);
- They have adequate staffing;
- They undertake proactive investigations rather than only responding to complaints;
- They use all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;
- They have excellent leadership;
- They are independent from state medical societies and other parts of the state government; and
- A reasonable legal framework exists for disciplining doctors (the "preponderance of the evidence" rather than "beyond reasonable doubt" or "clear and convincing evidence" as the legal standard for discipline).