Past efforts to strengthen the Maryland Commission on Medical Discipline, the 11-member volunteer agency responsible for policing the medical profession, have largely failed. Most have been opposed by organized medicine, and most have met with little success in the General Assembly.
This year things may be different. Doctors themselves are actively debating the need for stronger discipline. Legislators, who have reluctantly gone along with changes in the law making it harder to sue for medical malpractice, are now demanding that the profession help bring down the cost of insurance by weeding out bad doctors more aggressively.
Perhaps most important, state Attorney General J. Joseph Curran Jr. is pressing for a tougher disciplinary system, and on the eve of the 90-day legislative session Gov. William Donald Schaefer is weighing legislative proposals that are likely to focus attention on the system's failings.
Dr. William Finney, a well-known neurosurgeon active in lobbying on medical issues, said the disciplinary system is "near disaster," due to lack of staff at the commission, its unwillingness to take strong action against doctors, years of delays in resolving complaints, and an "incestuous" relationship between the commission and the state medical society.
Rising malpractice costs have prompted some states to improve their systems for disciplining on bad doctors. For example:
California put more consumers on its medical discipline board and hired more investigators -- it currently has 49 -- to monitor 66,000 doctors. The Maryland Commission has no investigators of its own and regulates 11,000 doctors.
California authorities can require a doctor to have a psychiatric exam or be tested in clinical competency if his or her skills are in doubt.
In California, hearings now take place before an administrative law judge, who renders a decision and recommends a penalty. The disciplinary board has the power to overturn the decision or change the penalty. In the 1985-86 fiscal year, 131 cases went to hearings. By contrast, in Maryland the commission itself is burdened with the task of reviewing all complaints and deciding the penalties. It held four hearings last year.
Gov. Mario Cuomo has proposed that doctors in New York be reviewed for competency every three years, when they are required to renew their medical licenses. New York would be the first state with such a competency review if the plan is adopted.
Massachusetts legislators found that the failures of the disciplinary board there added to the cost and incidence of malpractice claims. They overhauled the system in 1986, expanding the staff to include five investigating lawyers, five prosecuting lawyers and two full-time hearing examiners.
Wisconsin now allows a court finding of physician negligence in a malpractice suit to serve as conclusive evidence for the disciplinary board to rule that a doctor is guilty of negligent treatment of a patient.
In Maryland this winter, the attorney general's office has been compiling data on delays in the system and is preparing legislative recommendations for the governor.
Paid investigators and hearing officers may be needed, Curran said, because doctors on the commission and in the state medical society -- known as Med-Chi -- are often too busy with their own practices to devote time to disciplinary matters. Curran said that he may recommend that doctors convicted of serious crimes automatically lose their licenses.
Schaefer has considered the creation of a "superboard" to oversee the activities of two boards -- the commission and the Board of Medical Examiners, which issues medical licenses. The idea behind the superboard, according to those familiar with the plan, would be to lessen the state medical society's involvement with disciplinary agencies and to make those agencies more directly accountable to the governor.
The superboard, as originally outlined, would be made up of the chairmen of the commission and the Board of Medical Examiners (both of whom are nominated to their agencies by Med-Chi), the president of the state medical society and the deans of the medical schools at Johns Hopkins and the University of Maryland.
But the concept has already run into trouble, and some government officials say they doubt that Schaefer will actually propose it. Med-Chi, for one, is resisting the idea, and it favors instead the creation of a task force to study the problem of discipline.
Dr. Israel Weiner, cochairman of Med-Chi's legislative committee and one of its most outspoken proponents of reform, said a superboard would not make any difference "unless there's a change in mechanics and attitudes."
Weiner and others said the administration should focus attention on legislation that would provide more staff for investigations and prosecutions. Also, critics of the current system are pushing for stronger sanctions against criminal or incompetent doctors and less reliance on organized medicine to regulate itself.
Although the administration has not specifically endorsed these ideas, Lt. Gov. Melvin A. Steinberg said state officials are evaluating whether to push for new methods of handling cases of physician incompetence, improper conduct and bill disputes.
Changes in physician discipline have come slowly, but a few significant revisions were approved two years ago. Legislation passed in 1986 dictates that the commission is to be notified of all malpractice lawsuits and that hospitals are to report any instance in which a doctor loses privileges to practice. Also, the commission has gained the services of a full-time assistant attorney general and is moving toward computerization.
Commission members have been meeting to discuss how to handle complaints about physician fees, which take up much of their time, and whether to mandate specific penalties for violations of the medical practice act. They are also looking for ways to reduce delays.