Peruse the Commonwealth of Virginia's online profile of Ravi K. Veluri, a 49-year-old physician who practices in Alexandria and Dale City, and it appears he has an untarnished record: no disciplinary actions by any hospital, federal agency or state medical board.
There's no mention on the state-sponsored Web site of the general practitioner's 1992 misdemeanor conviction in U.S. District Court in Alexandria for unlawful sexual contact with a patient, a crime for which he was sentenced to 30 days' incarceration and three years' probation.
There's no way for a prospective patient to tell that in 1991 his privileges at DeWitt Army Community Hospital at Fort Belvoir in Fairfax County were restricted to require the presence of "a chaperon in all patient encounters with women and children."
And there's no indication that Veluri's Pennsylvania medical license was suspended for three years in 1994 as a result of his conviction in Virginia, the same year he was placed on probation for one year by the Virginia Board of Medicine, or that in 1998 he was excluded from the federal Medicare and Medicaid programs for the same reason.
Or consider the profile of anesthesiologist Kwok Wei Chan, 50, who practices in Massachusetts but holds an active Virginia medical license. According to the profile Chan submitted to the Virginia Board of Medicine in July, his record is clean: No other state has taken disciplinary action against him. But documents from Massachusetts, Texas, Ohio, California, Georgia and Pennsylvania indicate otherwise.
In 1993 Chan was fined $10,000 by the Massachusetts medical board and ordered to undergo psychotherapy after a 1991 fistfight with a surgeon in an operating room in the presence of an anesthetized patient. State records show that he subsequently surrendered his medical licenses in Texas and California, was placed on at least four years' probation by the Ohio medical board and reprimanded by the boards in Georgia, Pennsylvania and Virginia. Chan did not respond to several telephone messages left at his office and his home.
Veluri, who last May submitted his profile to the Virginia Web site, which requires doctors to report disciplinary action by Virginia as well as any "action taken by a professional licensing board in a state other than Virginia, or federal agency" offered conflicting explanations in a brief telephone interview. (He was not required to report the criminal conviction.)
"I think I mentioned that," Veluri said initially of the actions by Pennsylvania and Medicare. When told that neither sanction appears on his profile -- and that doctors are required to approve their entries before they are posted -- Veluri offered a different explanation: "I don't practice in Pennsylvania so I don't have to [report it]" and "I don't see Medicare patients."
He then told a reporter to call back several days later so he could check his records. When reached again, Veluri refused to discuss the matter.
The absence of relevant information from the profiles of Veluri and Chan, and omissions from or misrepresentations on the profiles of a dozen other physicians examined for this story raise questions about the completeness and accuracy of some data on vahealthproviders.com, the state's new physician Web site.
Launched seven weeks ago, the site, which already has recorded more than 106,000 hits, is designed to be a comprehensive source of information for patients about Virginia's 31,000 physicians and osteopaths.
But in Virginia, as in some other states, most of the data on the profile -- which includes training, credentials, a 10-year history of malpractice payments and disciplinary actions by hospitals and state and federal agencies -- is furnished by doctors themselves and is not independently verified. The Virginia site warns prospective patients of this and states that "assessing the accuracy and validity of this information . . . is the sole responsibility of the consumer." Doctors are responsible for accurately reporting the required information, the site adds, "and board regulations deem it unprofessional conduct to falsify any data submitted."
Charles Inlander, president of the People's Medical Society, a patients' rights group based in Allentown, Pa., says that many consumers assume that what they see on a state Web site is accurate and complete.
The only way to check a doctor's complete disciplinary history is to determine every state in which he or she has practiced and search records in each of those jurisdictions, Inlander noted.
Hospitals and managed care organizations don't provide such information to the public. Malpractice payments, unless they are the result of a jury verdict, are typically sealed as a condition of settlement. They can be hard to unearth because lawsuits can be filed in either state or federal court. In some jursidictions, malpractice cases are filed in the name of the patient, rather than the doctor.
Even finding out whether a doctor is licensed to practice in more than one state can require a herculean effort: State medical boards often have this information but do not release it to the public.
The only centralized source of disciplinary actions and malpractice payments, the 11-year-old National Practitioner Data Bank, is closed to the public, accessible only to hospitals, managed care plans and medical boards.
"That's the problem with self-reported data: It's very hard, if not impossible, for consumers to check," Inlander said. He noted that many state medical boards are understaffed and anemically funded, and most do a poor job of policing doctors. "It's the fox guarding the henhouse, and consumers have to be skeptical. That's why the National Practitioner Data Bank should be opened; it should be the national profiling system," he said.
Sidney M. Wolfe, a physician who directs the Washington-based Public Citizen Health Research Group, a consumer advocacy organization, agrees. Wolfe, whose organization has for years published large directories of disciplined doctors culled from the public records of every state medical board and several federal agencies, notes that state physician profile Web sites, all of which have sprung up in the past five years, vary tremendously in the amount of useful information they provide.
The best sites, Wolfe said, provide links to the full text of medical board orders so consumers can see why a doctor was disciplined. Maryland and North Carolina are among the few states that furnish this information. Virginia was set to join their ranks but was blocked in mid-July, five days before the launch of the Web site, by Gov. James S. Gilmore (R), who signed into law an emergency bill championed by the Fairfax County Medical Society.
The new law bars the posting of disciplinary orders and "notices" -- detailed charging documents similar to indictments -- that are issued after a formal investigation and a finding of probable cause. Although these documents don't appear online, they are obtainable by fax or mail but a consumer checking the record of a particular doctor would need to know to ask for them, a fact not mentioned anywhere on the site. Even if a doctor has been disciplined, all a consumer who checks the Web site will see is the statement that "This portion of the site is currently under construction."
State officials say they hope to have at least some information about Virginia disciplinary orders online soon.
"We are committed to making this site as good as it can be," said Robert A. Nebiker, deputy director of the Virginia Department of Health Professions, which oversees the medical board and its Web site.
Nebiker said he is not surprised that some profiles are incomplete or inaccurate. "I suspected there would be a number of missteps of one kind or another by people who do reporting," he said. "But it is impossible -- or would be extremely costly -- to try and verify all this data. Of course, if we have reason to believe someone has falsified data -- either through omission or commission -- we will do something about it. We want to know." A doctor who fails to report or who falsifies data is subject to sanctions, the most serious of which is the loss of his or her license.
Nebiker said the board would investigate discrepancies in the profiles of Veluri and Chan and of other doctors mentioned in this story.
Patients who search the Virginia database encounter an additional obstacle: There is no information about doctors who lost their licenses before March 13, 2001; they simply don't appear online. Nebiker noted that some information about these physicians is posted on another Virginia site: www.dhp.state.va.us.
This means that doctors with the most serious disciplinary actions -- revocation, surrender or suspension -- can continue to practice undetected by the public in another state for months or even years -- unless they are among the relative few who lost their licenses after March 13.
While states often taken reciprocal action based on sanctions imposed by another jurisdiction, discipline is not automatic, and the process can be lengthy.
Sometimes doctors who have been stripped of their right to practice -- but still call themselves "doctor" because they possess a medical degree -- find new employment with a weight loss clinic or counseling center where a medical license is not required. Unless the patient knows which state a doctor came from, it may be nearly impossible to check the physician's history.
Occasionally doctors continue to practice after they have been stripped of their licenses, unbeknown to patients. Urologist David T. Schwartz, now serving a four-month jail sentence in Alexandria for practicing medicine without a Virginia license, treated as many as 65 patients in his offices in McLean and Alexandria after Nov. 22, 2000, the date his license was suspended on an emergency basis by the Virginia medical board, which found that he posed a danger to public health.
The only practical way a patient would have learned that Schwartz had no license was to call the board in Richmond.
Because Schwartz surrendered his license March 9 -- four days before the profile Web site began including doctors who had been stripped of their right to practice -- there is no information about him on the site.
Maryland Sanction Omitted
Until 10 days ago, the Virginia profile of Vienna physician David Geoffrey Allingham, 41, listed no disciplinary actions. Two orders issued by the Virginia board -- on June 23, 1999, and April 11, 2001 -- don't appear online because of the law Gilmore signed.
And until Sept. 14, about a week after a reporter asked Allingham about his profile, there was no mention of a reprimand last year by the Maryland board. On Sept. 14, the Maryland reprimand was posted on his profile at Allingham's behest.
"My license there was inactive," Allingham said earlier this month of Maryland, which took its action as a result of Virginia's. "I wasn't even practicing there, and they just tried to get another $3,000 out of me."
When asked why he didn't mention Maryland's action on his Virginia profile, Allingham said he didn't know what the profile said because his attorney completed and submitted it.
When told that Virginia requires that he alone approve the profile before it appeared on the Web site, Allingham became flustered. "I suppose the Maryland thing was a separate [action], and I probably didn't put it down." Did that mean his lawyer did not fill out his profile? "Probably not," said Allingham, who then hung up.
Board documents show that on June 23, 1999, Allingham signed a consent order with the Virginia board, which officially reprimanded him. He was fined $3,000, ordered to undergo a comprehensive psychological evaluation and to submit to an unannounced inspection of his practice. The board found that Allingham, then director of the Oakton Primary Care Centers in Herndon and Oakton, had permitted three employees who were not licensed in Virginia as physician's assistants to practice and to prescribe drugs without his advance approval.
The board also found that on four occasions, Allingham filed insurance forms listing himself as both patient and provider.
A psychological evaluation was ordered because of Allingham's behavior during a board hearing in January 1999 at which he "appeared both confused and upset to the point where Committee members wanted to ensure that Dr. Allingham was fit and stable to engage in the practice of medicine."
More than a year later, on June 28, 2000, Allingham signed a consent order with the Maryland medical board. That order requires that Allingham obtain the board's approval should he decide to resume practicing in Maryland.
Ten months later, on April 11, 2001, Allingham was back before the Virginia board on charges that he had violated a condition of the 1999 agreement. During an unannounced inspection of his practice on May 16, 2000, inspectors found that Allingham had failed to keep adequate records of drugs received and dispensed and "failed to separate expired drugs from stock used for selling."
The board again reprimanded him and ordered another unannounced inspection.
A Flurry of Changes
While doctors are permitted to make changes in their online profiles, and must update them "when the data they are required to report changes" such as the addition of new malpractice payments, the recent alterations by Alexandria otolaryngologist Stephen X. Giunta raise questions about the accuracy of his profile.
On July 16 the 62-year-old ear nose and throat doctor, who specializes in performing penile enlargement surgery in his office, approved a profile that listed board certification in two specialties and one sub-specialty: otolaryngology (1975), plastic and reconstructive surgery (1985) and otolaryngology: plastic surgery within the head and neck (1991).
He also reported two malpractice payments made to settle cases in 1995 and 1998. Both were characterized by the medical board -- which does not report dollar amounts to the public but classifies payments as average, below or above average -- as average for otolaryngology.
On Sept. 6, after he was told that a reporter was examining his profile, board records show that Giunta changed it.
He dropped the plastic surgery certification and added a third malpractice payment in 1993, which the board classified as "above average." The 1995 payment was also reclassified as "above average."
On Sept. 14, Giunta changed his profile again. He added a fourth malpractice settlement to his list, this one made in 1992. All four payments were classified by the board as "average."
But according to the American Board of Medical Specialties (ABMS), Giunta's board certification listings on both the July and September profiles are inaccurate. Records maintained by ABMS and the American Board of Plastic Surgery show Giunta was never board certified in plastic surgery. And officials of the ABMS and American Board of Otolaryngology say Giunta did not earn a 1991 sub-specialty certificate in "plastic surgery within the head and neck."
Looking at the Web site, it's not clear what constitutes an "average" payment. Court records in Alexandria show that in 1991 Giunta paid $675,000 to settle a case filed by the family of a 44-year-old man who died after a nose job performed in Giunta's office. In 1993 Giunta's insurance company agreed to pay $705,000 to settle a malpractice suit brought in the case of a woman left brain-damaged and legally blind after extensive facial surgery. The following year an Alexandria jury awarded $875,000 to Elaine K. Reeder of Arlington for facial nerve damage after a touch-up procedure following a face-lift.
Shortly after that verdict, which was cut by a judge to $750,000, Giunta declared bankruptcy, effectively ending three pending malpractice cases against him and jeopardizing Reeder's jury award. Several weeks earlier, his insurance carrier announced that it was insolvent. After three years of complex and expensive litigation, Reeder agreed to settle her case for $260,000.
Giunta, who has privileges at Sibley Hospital, did not return several telephone calls seeking comment about the changes and discrepancies. In an e-mail, he wrote: "I have found errors on my profile site on at least 4 different occasions. Apparently they are still trying to get it right. I have tried to update the material as of 9-6-01."
But Nebiker, deputy director of Virginia's health department, said that any errors were made by Giunta, not by the board. Records show that on at least three occasions between May and Sept. 6, Giunta made changes to his profile, Nebiker said. "There is no way any of these changes could be made without his approval," Nebiker said, adding that the board is investigating the alterations.
"If he failed to report a [malpractice] payment or misrepresented his credentials, I suspect that would be a violation," Nebiker said.
Giunta is already well-known to the Virginia board, which has placed him on probation twice in six years and officially reprimanded him three times for "false, misleading or deceptive" advertising.
In 1994 the board placed Giunta on probation for 13 months after the death of the nose job patient in his office. The board found the physician had failed to use a pulse oximeter, a device essential for monitoring anesthetized patients, "and left the patient in the care of an employee whom he failed to appropriately supervise," which resulted in the man's death.
On Sept. 19, 2000, the board issued an order placing Giunta on indefinite probation in connection with six cases, four involving penile enlargement surgery. The board wrote that "his practice was found to pose a danger to the health and safety of patients, upon use of advertisements which are false, deceptive and misleading and upon lack of appropriate documentation in patient records."
The board fined him $7,000, ordered that he complete a course in medical record-keeping, send a monthly log of patients to the board in Richmond and submit to an unannounced inspection. Giunta remains on probation but continues to practice.
Surrender Not Reported
Psychiatrist Igor Magier said he's not sure why he didn't list the surrender of his North Carolina license on his Virginia profile. "I really don't know why," Magier said. "It's probably not something I spent a lot of time thinking about."
Magier, a board certified psychiatrist who practices in Chesapeake, said he relinquished his North Carolina license in 1990, when the medical board told him it was contemplating disciplinary action based on sanctions imposed a year earlier by Virginia.
In 1989 Magier was placed on probation by the Virginia board, which reprimanded him for over-prescribing addictive drugs, restricted his prescription privileges and ordered that he receive weekly psychotherapy. Magier's Virginia license was fully restored in 1993.
Because he wasn't practicing in North Carolina, Magier said, he decided it was easier to relinquish his license than to defend it.
Magier said he did not deliberately omit the surrender from the Virginia form he completed. His profile, he said, "is like everything else on the Web site. It's as accurate as people make it."
State-sponsored physician profile Web sites, which are supposed to inform consumers about a physician's disciplinary history, frequently rely on information reported by doctors but not verified. It would be impossible to determine from the Virginia Web site (at right) that Massachusetts anesthesiologist Kwok Wei Chan has been disciplined by medical boards in seven states where he holds licenses, including Virginia. Some of that information is available on Web sites sponsored by Ohio (second from the top), California (third from the top) and Massachusetts (bottom).Changing Disclosures
The online physician profile submitted by Alexandria otolaryngologist Stephen X. Giunta, who has been disciplined three times by the Virginia board and is currently on indefinite probation, has been revised several times by the physician since July. Below are the two malpractice payments he listed in July. Several weeks ago, after he was called by a reporter examining his profile, Giunta added two payments, as shown in revision at right, and changed information about his credentials.