The board charged with disciplining Virginia's doctors is dangerously slow, taking years to revoke and suspend licenses in even the most serious cases of malpractice or misbehavior, a report by state auditors said today.
Board of Medicine officials acknowledged many of the problems cited by the auditors and said they hoped to expand their investigative staffs by nearly doubling the annual fees paid by the 27,000 doctors with licenses in Virginia.
The auditors also recommended lowering the standard for discipline from "gross negligence" to "negligence," a standard used by the boards regulating several other medical professions in Virginia.
Today's report by the Joint Legislative Audit and Review Commission detailed several cases of doctors continuing to practice medicine long after serious complaints were made. Some cases that resulted in malpractice awards of more than $100,000 in court were dismissed without a board hearing.
Del. Vincent F. Callahan Jr. (R-Fairfax) called the report "extremely disturbing" and one of the most serious findings of any audit since 1974, when Callahan became a founding member of the auditing commission.
"It's all the more devastating because it's dealing with people's health," he said.
Medical boards across the country are inadequately funded and staffed to police doctors, critics say. But Virginia, Maryland and the District of Columbia consistently rank low in national rankings of the aggressiveness of disciplinary boards for doctors, according to Public Citizen's Health Research Group, an advocacy group based in Washington.
In 1998, for example, Virginia ranked 40th while Maryland and the District tied for 36th in frequency of serious disciplinary actions against doctors. Virginia's rate of 2.87 serious disciplinary actions per 1,000 doctors was about a quarter less than the national average of 3.76.
"It's hard to imagine anything that's more important to public health," said physician Sidney M. Wolfe, director of the advocacy group. "This is really jeopardizing the health of the people in Virginia."
Virginia's 17-member Board of Medicine receives 2,000 complaints a year and investigates half of those. About 130 result in quasi-judicial disciplinary hearings, and most of those, about 100 a year, lead to actions such as a reprimand or the suspension or revocation of a medical license. Doctors have a right to be represented by lawyers in these cases and can appeal rulings to state circuit court. In most cases, doctors whose licenses are revoked can petition for reinstatement after one year.
Board officials blamed the problems highlighted by auditors on staffing shortages caused by slim funding. The Department of Health Professions, which provides staffing for 12 medical profession boards, had 132 employees in 1994 but plunged to 98 a year later. Staffing has rebounded to 120 and is headed higher, officials said.
Auditors found that the average Board of Medicine case takes more than 2 1/2 years to resolve. They also found that 40 percent of the cases that involved a malpractice award and were closed without a board investigation appeared to warrant further inquiry.
In one case, a physician whose surgery caused partial facial paralysis in the patient saw the complaint dropped without a formal hearing despite a $602,000 malpractice settlement.
Doctors in Virginia pay $62.50 a year in licensing fees, the source of the medical board's $4.2 million annual budget. Board officials are proposing an increase to $120, but the change needs the approval of Gov. James S. Gilmore III (R) and the General Assembly. Aides to Gilmore, saying they had not yet seen the report, declined to comment.
Officials are also hoping to raise license fees for several other medical professions. Auditors found similar problems for the boards that discipline nurses, psychologists, dentists and others.
"I think it's a pretty fair report," said John W. Hasty, director of the Department of Health Professions. "The whole process is very slow."
The Medical Society of Virginia, a doctors group based in Richmond, praised the effort to hire more investigators for the board, even if that means higher fees. But it warned that lowering the standard for disciplinary action from "gross negligence" to "negligence" could lead to more malpractice suits and eventually higher costs for consumers.
"This could have some potentially far-reaching consequences," said medical society spokesman Bill Cimino. "That's something we want to evaluate very carefully."