Louisiana ranked best among the states in disciplining doctors who practice substandard medicine, according to an analysis of disciplinary actions from 2008-10 by consumer advocacy group Public Citizen.
The analysis uses figures provided by the Federation of State Medical Boards to arrive at the average number of serious disciplinary actions over a three-year interval. In each of the last three intervals, 2006-08, 2007-09 and 2008-10, Louisiana ranked in the Top 10 states in rates of doctor discipline.
“They’re just getting better,” said Dr. Sidney M. Wolfe, lead author of the report.
For 2008-10, the Louisiana State Board of Medical Examiners took 5.98 serious actions per 1,000 physicians, according to Public Citizen. Serious disciplinary actions include license revocations, surrenders, suspensions and probation/restrictions.
Wolfe said he was not familiar with the details of Louisiana’s board and regulations, but in general, the boards that do a better job have a number of things in common.
According to Public Citizen, those factors include:
- Adequate funding, with the money generated by license fees funding board activities instead of into the state treasury for general purposes;
- Adequate staffing;
- Pro-active investigations rather than only reacting to complaints;
- Excellent leadership;
- Independence from other parts of state government, which allows a board to develop its own budgets and regulations;
- The use of all available/reliable data from other sources, such as Medicare and Medicaid sanctions, hospital sanctions, malpractice payouts and the criminal justice system;
- A reasonable legal framework for disciplining doctors – the preponderance of evidence is the standard for discipline rather than requiring that evidence be “beyond reasonable doubt.”
“There’s not a shred of evidence that the overall quality of doctors in one state is any different than the other,” Wolfe said. “It’s really this less than 1 percent (who are responsible for the serious infractions).”
Even in Louisiana, the rate of serious disciplinary actions essentially amounts to less than 1 percent of all the doctors, Wolfe said.
According to the report, most states are not living up to their obligations to protect patients from the doctors practicing substandard medicine.
The rate of serious disciplinary actions has fallen 20 percent to 2.97 per 1,000 physicians since the peak year of 2004.
Part of that decrease may be that boards’ funding levels have been cut, Wolfe said.
“But given how tiny a fraction of a state budget funding the board is, it does not seem to be a very good or safe idea,” Wolfe said.
Enforcing the state medical practice act is one of the most important duties of a state medical board, and the boards really need to have adequate funding to do so, Wolfe said.
Dr. Robert Marier, executive director of the Louisiana State Board of Medical Examiners, said the state’s Medical Practice Act is the most important factor in the board’s disciplinary ranking.
“It creates the framework for everything we do,” Marier said.
In creating the act, the state Legislature gave the board the authority, flexibility and funding necessary to enforce the law, Marier said. The act also provides legal protections for the board and its investigative staff.
The board members, practicing doctors from throughout the state, are and have historically been very dedicated to their duties, Marier said. Each month, board members give up a great deal of their time.
That time includes a couple of days a month for board meetings, and the additional time involved in disciplinary hearings, quasi-judicial processes that can sometimes be quite lengthy, he said. The physicians are always represented by attorneys, the board has attorneys, and board members make up the hearing panel.
“It’s an extraordinary commitment, absolutely,” Marier said.
Marier said the board’s high ranking in terms of disciplinary actions built up over time, with many board members contributing to the current level of success, he said.
A third important factor is the very strong investigations division, led by Dr. Cecilia Mouton, Marier said. The investigative division has around a dozen staff members, including two nurses and another doctor; that gives the LSBME more full-time clinical investigators than many other boards.
The strength of the investigative staff allows the board to conduct its own evaluations of practices and to develop cases that are much stronger than would be possible otherwise, Marier said.
“The great majority of complaints are settled,” Marier said. “They never come to a hearing because the cases are so tight that the respondents realize that it’s best to agree to terms that in many cases involve probation, fines, and that sort of thing.”