An article Sunday about doctor discipline should have said that states discipline one of every 252 doctors who have had a malpractice case filed against them, rather than doctors involved in malpractice settlements.
States do such a poor job of regulating physicians that only a fraction of doctors who are dangerous, senile, alcoholic, drug-addicted or operating fraudulently are ever disciplined, according to congressional reports, medical critics and the states' discipline bank.
States disciplined 1,381 of the nation's 430,000 doctors last year, according to figures compiled by the Federation of State Medical Boards, a 73-year-old voluntary organization that has yet to achieve full reporting by all 50 states.
In 1983, the states either revoked, suspended licenses or took other significant actions against 1,154 doctors, according to federation director Dr. Bryant Galusha.
The federation's figures on serious disciplinary actions represent only one of every 252 doctors involved in malpractice settlements, according to a study by the Health Research Group, a Washington advocacy group.
"There is a tremendous and dangerous gap between the amount of malpractice and the amount of doctor discipline," said Dr. Sidney Wolfe, coauthor of the study, which urged an improvement in medical discipline as one solution to rising malpractice claims.
In addition to incompetent doctors, the American Medical Association estimates that 10,000 doctors in the United States are alcoholics and 4,000 are drug addicts. Between 5 percent and 10 percent of all U.S. doctors are impaired or are engaged in unethical practices that present a danger to patients, yet few are disciplined, according to congressional estimates.
A recent study by the New England Journal of Medicine noted, "Even the highest reported rates among the states are still less than 1 percent per year . . ." which lends "credence to popular suspicions that the medical boards have not been dealing effectively with this problem . . . ."
The relatively new problems of fake degrees and the lack of standard requirements for foreign medical practitioners are overwhelming medical boards that, like the District of Columbia's board, have problems simply issuing licenses every year.
Lax monitoring by state medical boards has been detailed in news accounts over the last decade and has caused some legislatures to add staff and money to the boards.
But the malpractice crisis, along with new concern by employers and their insurance companies over spiraling health care costs, is prompting new attention. Even the AMA, long a foe of federal action in state affairs, is endorsing a bill to give federal incentives to states that improve regulation of doctors.
"Lay the blame at the state boards," said Dr. James Todd, executive vice president of the AMA. "We're not seeing the ability of the state boards to handle" the need for increased reporting, he said. ". . . The AMA has been heading in this direction for so long."
There has been little change, however, in the secrecy, lack of public accountability and poor coordination between state boards, the AMA and other medical monitors.
Galusha said that in answering queries from state boards alone, the federation discovers about 30 disciplined doctors each month who have set up practices elsewhere. A recent General Accounting Office report on 181 doctors who had been sanctioned in three states found that 33 of them moved elsewhere and continued to practice.
But Galusha says, "The net is tightening. Doctor-hopping has become a thing of the past."
However, because state boards are unable to stop the practice, private companies have formed to conduct their own credentials checks for their client hospitals.
"There's hardly a hospital in the United States that can keep track of the credentials of its doctors," said Dr. William Jacott, a member of the Minnesota Board of Medical Examiners.
One problem is the sparse communication between state and federal agencies.
The Food and Drug Administration, for example, sanctions doctors yearly for drug testing frauds, and the Department of Health and Human Services also keeps records on doctors and other health professionals who have defrauded Medicare or Medicaid.