In October I discussed the case of Dr. Christopher Dunstch, a Texas neurosurgeon, who was so incompetent that he injured or killed 33 of the 37 patients upon whom he performed spine surgery. One of the surgeons who was called treat some of Dr. Duntsch’s injured patients reported him to the Texas Medical Board. The Board opened an investigation, but refused to suspend Dr. Duntsch’s medical license while it investigated the charges against him. Due to the Board’s inaction, he was allowed to continue to operate and injure patients for another six months. At the end of the six months, the Board’s investigation was still pending, but the news of Dr. Duntsch’s incompetence and the injuries and deaths he had caused were all over the TV and newspapers. Suddenly, the Texas Medical Board decided that it had enough information to summarily suspend his license while continuing its investigation. A medical board charged with protecting the public should not act only when it is getting bad publicity for protecting doctors. Sadly, what happened in Texas is commonplace throughout the country. Even the worst doctors have little to fear from the boards that are supposed to be protecting the public from them.
As I know all too well from my years of practice, medical malpractice is a real thing and it injures many people on a daily basis. I am not the only one saying this. The federal government has concluded that over 30,000 Medicare beneficiaries alone are injured in hospitals each month due to substandard care. I understand mistakes happen and that even good doctors make them from time to time. What I don’t understand, and what we should not tolerate, is doctors who commit repeated acts of malpractice being permitted to practice with little or no consequence.
Public Citizen, a consumer advocacy group, recently published a review of state medical boards using data from the National Practitioners’ Data Bank. The Data Bank collects information about malpractice settlements, the disciplinary actions of medical boards, and the disciplinary actions taken by hospitals against the doctors who practice there. While the information collected by the Data Bank is not available to you or to me, it is available to state medical boards and, with some restrictions, to researchers such as those at Public Citizen.
Every few years, Public Citizen reviews the actions of all of the medical boards in the United States. This year’s review showed that Michigan has the highest rate of doctor discipline per 1,000 doctors of all of the states. Notably, Arizona was fourth in this review. The state with the fewest disciplinary actions per thousand doctors was nine times less likely to discipline a doctor than Michigan. The investigators also found that rates of doctor discipline were less in this review than they had been in a similar review four years before. Even in the leading state, Michigan, doctor disciplines were few and far between.
Among the significant findings was that, since the founding of the Data Bank in 1990, 9,200 physicians have had five or more reported malpractice settlements. This puts them in the top 1% of doctors, most of whom may never have even one malpractice settlement. Many of these 9,200 doctors are bad actors who have engaged in multiple acts of malpractice. Even though these are reported settlements and the state medical boards have access to this information, 75% of these doctors have never even had an investigation of their conduct by their state medical board, much less been disciplined or required to change their ways.
The investigation also found that the Data Bank had received over 16,000 reports of hospitals which disciplined doctors by taking away privileges or limiting them for more than 30 days because of patient safety concerns. Only half of those doctors have ever had any action taken against them by their state medical board. This means that over 8,000 doctors, whose peers on hospital staffs thought should be limited in their ability to practice at the hospital, were never given any discipline by their state medical board. Of the 16,000 doctors who had their privileges limited by their hospitals, 888 were deemed “immediate threats” by the hospital. Only half of these doctors who were considered by their peers to be immediate threats to the public had any disciplinary action taken against them by their medical board.
Despite the availability of the information in the Data Bank, the regulators at state medical boards only rarely inquired about their doctors. The only possible conclusion would seem to be that they don’t care.
Among the reforms suggested by Public Citizen is to populate state medical boards with people who really want to see the public protected from dangerous or unethical doctors. The statistics show that even bad doctors are only rarely investigated and, when they are, are rarely punished in any significant way that protects the public.
Another possible change is to make the information in the Data Bank available to the public. We talk a lot about choice in this country but frequently keep important information concealed from the public. You can’t make a choice if you don’t have the information necessary to differentiate one doctor from another. Until the end, Dr. Duntsch, the Texas neurosurgeon, had no record of discipline at the Texas Medical Board and had glowing reviews on line.
Put more citizens on state medical boards and fewer physicians. Increase state legislative oversight over medical boards. Assure medical boards have adequate budgets and staffing. Insist that medical boards be proactive rather than just relying on complaints. We, the public, have a right to competent, ethical medical care. State medical boards must do a better job to get us the quality of care we deserve.
