Every state has a medical board. While there are some differences from state to state, they are all alike in that their primary job is to protect the public from bad doctors. They have been failing at this job for many years and continue to fail today. Although it is not alone, I am going to focus today on the Arizona Medical Board. It is emblematic of boards across the country.
The Arizona Medical Board describes its mission as “To protect public safety through the judicious licensing, regulation and education of all allopathic physicians.” Allopathic physicians are M.D.’s. There are similar boards for osteopaths, chiropractors, naturopaths and podiatrists. All of them profess essentially the same mission of protecting public safety. All of them have the same failings.
Generally, medical boards do a good job of evaluating brand new doctors and issuing licenses to them. They also do a good job of requiring that doctors take courses intended to keep their skills up-to-date. These courses are called CME for Continuing Medical Education.
We have now exhausted the areas in which the medical boards to a good job.
Perhaps the most important area of failure for state medical boards has to do with licensure. While some are better at it than others, you can find repeated instances of doctors credibly accused of wrongdoing in one state just pulling up stakes and moving on to another state and getting licensed there. Nothing like a nice, fresh start somewhere where no one knows about your past problems.
Sometimes this is the result of the new state failing to investigate the conduct of the doctor in her former state. Sometimes this happens because the doctor cut a deal with the old state to leave quietly in return for the old state’s medical board not publicizing his wrongdoing. Sometimes it is the doctor’s old hospital or practice that agrees to keep things quiet in return for the doctor leaving the state and not contesting the allegations of wrongdoing. After all, who needs bad publicity? Better to let this doctor go hurt people in another state than to see your name in the newspaper or on TV associated with physician misconduct.
Once a doctor has a license in a state, it is pretty hard to lose it, although there are some ways. One good way is to be convicted of a crime. The medical board can’t very well ignore that. Another good way is to be discovered to have a drug or alcohol abuse problem. Medical boards are very aggressive with these doctors.
What about other actions that endanger the public? Allegations from the public of poor medical care? Not much of a concern to the medical board. Allegations of medical malpractice, even when proved in court? Not so much either. There are some doctors in Arizona who have been sued repeatedly for malpractice and who are still allowed to practice. This is even more disturbing when you consider that very few instances of malpractice end up being the subject of a lawsuit. Doctors who are sued frequently for malpractice have usually left behind a trail of damaged patients.
So why are these doctors allowed to continue to practice? In addition to patient complaints of malpractice made directly to the board, all malpractice lawsuits are reported to the medical board. They know who these people are and what they are doing. The answer, in my experience, is twofold. In the first place, the medical board is controlled by doctors. They have a lot of sympathy for their fellow doctors. They know how hard it is to be a doctor and how difficult it is to please all patients. There is a sense of “There but for the grace of God go I,” which appears to affect their review of the conduct of other doctors. There is no such sympathy for the injured patients.
The second reason bad doctors are allowed to continue to practice is that medicine is a lucrative profession. Faced with the possible loss of position, prestige and income, doctors hire smart, experienced, capable counsel to represent them before the medical board. These lawyers know the ins and outs of the medical board. They know what plays well before the board. They know how to go about finding expert witnesses to testify in front of the board about how what the doctor in question did was not malpractice or, if it was, was just a little thing which should not affect the doctor’s license. These lawyers frequently send their clients off to take additional training about the area of malpractice so, when the hearing comes, they can show how proactive the doctor has been in correcting the problem. “See what the doctor has done to improve herself? She knows better now. You can be assured this won’t happen again.”
Surely, there is a better way to protect the public from malpracticing doctors. The Arizona Medical Board has shown it is not up to the task.