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Disciplining Doctors

Thursday, April 14, 2005; Page A26

ADOCTOR WHOSE examination room is filled with garbage, a surgeon who stole painkillers from his patients, and another doctor who kept practicing despite a felony: All of these stories were featured this week in The Post's three-part series on the lack of disciplinary standards in the medical profession. Among other things, reporter Cheryl W. Thompson found that the D.C. Board of Medicine disciplines physicians far less than do the boards in Maryland and Virginia, or almost anywhere else; that doctors who have been disciplined in one state can move to another and continue practicing, even though their previous records are available to state medical boards; and that long histories of alcohol and drug abuse are often not sufficient to get doctors barred from the medical profession.

Above all, the series demonstrates that the methods used to investigate and discipline incompetent doctors are deeply flawed. On the one hand, this country's tort system is so expensive that good doctors are being forced out of business. At the same time, many of the state medical boards, which are responsible for monitoring doctors' performance, are grossly underfunded or politically powerless.

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Across the country, there are big variations in the operations of state medical boards. States such as Kentucky, Wyoming and North Dakota investigated and disciplined more than 10 out of 1,000 of their resident doctors, according to a survey conducted by Public Citizen. By contrast, the District and Maryland investigated fewer than three out of 1,000. The Federation of State Medical Boards and consumer groups agree that these differences are due not to the competence of different doctors in different states but to differences in the way state medical boards operate. Some are underfunded: The District's board is unable to hire its own investigators, which means it rarely initiates investigations and must simply respond to complaints. Others, such as Maryland's, are not sufficiently independent of local doctors' professional organizations. But states do change: Arizona, once ranked 38th in rate of annual investigations, is now near the top, after several of its doctors garnered bad publicity and the state medical board became more active. Those that improve have better funding, more independence and leaders who are willing to use all available resources to check up on doctors who move into the state.

The solutions vary from state to state. But in this region, where the District, Maryland and Virginia are lacking active or efficient medical boards, local politicians, physicians' associations and health insurers would do well to reexamine their legal structure and financing. All should consider naming more board members who are not doctors, funding more investigators and ensuring that they and their consumers have greater access to Internet information. Above all, states should make records of malpractice settlements and patient complaints available to other patients and insurance companies. No one should die because a medical board is negligent.

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