Report: Dangerous docs not sanctioned

WASHINGTON, D.C. (KXAN) - Fifty-eight percent of Texas doctors who have been sanctioned for serious offenses by health care entities, mainly hospitals, during the past two decades have never been disciplined by the state medical board, according to information from Public Citizen.

In a letter and accompanying report , Public Citizen presented its findings of an analysis of 21 years of data in the National Practitioner Data Bank via a letter to Gov. Rick Perry on Wednesday.

The organization found that 459 Texas physicians who have been sanctioned by hospitals, HMOs or other health care institutions — some multiple times — have yet to be disciplined by the state medical board.

• Read the full report.
• View the table of statistics on investigations from 1999 to 2011
   

Public Citizen found a key problem is that the medical board lacks money and staff to investigate complaints. The board receives only a third of the $30 million it collects annually in licensing fees, professional fees and fines. The state takes the rest and puts it in the general fund. This has resulted in major staffing shortages and a case backlog.

According to a Texas Medical Board report to the Legislature, as of August 31, 2011, 454 cases had been open for at least a year, including cases going back as far as 2007, 2006 and 2005. This indicates that the board has not been following its own standards for more prompt review, which is especially dangerous in light of the grievous nature of many of the violations.

By law, any cases open for more than a year must be reported to the state Legislature.

Some facts contained in the 18-page report regarding the severity of the doctors' offenses include:

• Many of the physicians were disciplined by hospitals and other health care institutions because they were deemed an immediate threat to the health and safety of patients, incompetent or negligent, they committed sexual misconduct or insurance fraud, they abused drugs or alcohol, or they provided substandard care to patients.
• A quarter of the 459 physicians have been sanctioned by health care facilities more than once.
• Nearly half of the 459 physicians had one or more medical malpractice reports.

One of the physicians had clinical privileges restricted by a peer review committee in 2010 for substandard care. The physician had 11 medical malpractice payments between 1993 and 2011 for a total payout of $2.1 million, the reasons for which included: failure to diagnose (four cases); improper performance (two cases); improper management (two cases); failure to treat; improper technique; and performing an unnecessary procedure. One of the cases involved the death of a patient.

“These violations are not minor,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “In our investigation we’ve identified physicians who have committed gross breaches of medical and ethical standards, yet they have not been sanctioned by the state medical board, the institution whose primary duty is to make sure practitioners taking care of Texas patients are qualified to do so.”

Public Citizen urged Perry to:

1. Allow the medical board to keep all — not just one-third — of the revenue it generates so it can hire more staff and complete more investigations in a timely manner.
2. Appoint an independent medical board enforcement monitor, similar to what California did to address a comparable set of problems. This independent monitor would evaluate the disciplinary system and the board’s enforcement procedures, as well as play an active role in maintaining integrity of these processes into the future.
3. Consider instituting random practice audits of physicians, as recommended by the Health and Human Services’ Office of the Inspector General. When implemented, these types of random audits have been proven to be effective in identifying practice deficiencies.

Texas has ranked in the bottom half of states since 1997, according to the organization's ranking of medical boards' actions to protect patients.

The Texas Medical Board regulates the licensing and enforcement of about 69,000 physicians (including doctors of osteopathic medicine), 5,000 physician assistants, 940 acupuncturists, and 270 surgical assistants.

“The failure of the Texas state government to properly fund the medical board and the damaging effect of inadequate funding on board discipline of Texas physicians threatens the safety of thousands of patients who walk through the door of hospitals in the Lone Star State,” Wolfe said.

The report was written by Sidney M. Wolfe, M.D., Alan Levine and Robert Oshel.

Public Citizen is a national nonprofit organization with more than 225,000 members and supporters. It represents consumer interests through lobbying, litigation, administrative advocacy, research, and public education on a broad range of issues, including consumer rights in the marketplace, product safety, financial regulation, safe and affordable health care, campaign finance