As Cicero said, "Quis Custodiet Ipsos Custodes." Or, can any group police itself?
For nearly two centuries, the Maryland medical society has held a virtual monopoly over the practice of medicine statewide. Since its creation by the General Assembly in 1798, the Medical and Chirurgical Faculty--the medical equivalent of the lawyer's bar--has had the major responsibility of determining who licenses and disciplines doctors.
That power would be eroded under a new bill that would give more appointment power to the governor, a measure that would continue recent reforms in how the state's 10,000 practicing doctors are disciplined. It's a measure supported even by Med-Chi itself because the group wants an end to the years of complaint that it biases the disciplinary process.
"Times have changed," said Dr. Jose Martinez, legislative chairman of Med-Chi. "There is a taint by the fact that a private association --although created by an act of the assembly--is making these nominations."
Currently, Med-Chi controls at least seven appointments to the 11-member Commission on Medical Discipline, which monitors Maryland doctors, including three from the Board of Medical Examiners, a licensing agency that is elected by Med-Chi.
The association's control over the state's regulatory units was cited as a "potential for bias" this November by the state's Department of Fiscal Services. Med-Chi's role in the disciplinary commission also was challenged in an unsuccessful court suit in 1980. Last year, the General Assembly added two consumer group members to the commission.
Under the proposed measure, the governor and the secretary of the Health Department would have the final say over nominations, with Med-Chi simply making recommendations.
The proposed changes would further alter the 11-member disciplinary commission, which has shifted from an organization that rarely took action into a powerful state panel that last year suspended 39 doctors' licenses and revoked 17 more.
"It used to be true, they never took a physician's license," said Del. Torrey C. Brown (D-Baltimore), a practicing physician who chairs the House Environmental Matters committee that oversees the commission. " But their sentences now are tough . . . And they've become much more creative with the discipline," handing out punishments such as ordering incompetent doctors to return to school.
Still there are problems.
"We're attempting to clear our backlog," said new administrator Robert Dobart, saying there are more than 200 cases awaiting investigation.
Gov. Harry Hughes has proposed giving the commission $182,956 for the next fiscal year, just about $4,000 less than what the commission requested. And Brown said he again will push a bill, which passed the House last year but died in the Senate, to increase doctors' license fees to $20 from $2.50, with the added revenue helping to run all of the professional licensing boards within the Department of Health and Mental Hygiene.
The commission is yielding to its critics, Dobart said, and is backing the bill to reduce Med-Chi's appointments influence.
The commission also is backing bills to give it disciplinary powers over doctors who fail to supervise persons under their authority, and to allow the commission to share its information with other medical investigatory bodies--such as the boards regulating pharmacists and nurses--in Maryland and other jurisdictions.