Bioethics Discussion Blog: Doctors' Bad Doctoring and the Their Penalty

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Saturday, January 19, 2008

Doctors' Bad Doctoring and the Their Penalty

Many visitors on my blog have been concerned that doctors' bad behavior or incompetency may be missed by state licensing boards or that doctors simply get a slap on the wrist by those boards as punishment. I can’t speak for medical boards outside of California. I thought it might be informative to present here some of the publicly published administrative actions by the Medical Board of California during the period of August 1, 2007 to October 21, 2007. To be fair and not appear selective, I decided to present every 5th case which had been documented in alphabetical order of the physician’s last name in the January 2008 quarterly Medical Board of California Newsletter. As you may note some of California’s actions are taken because of the actions taken by other states. For a pdf file of the entire Newsletter so that you can read all the administrative actions, just click on this link. Go to the link and read more cases and responses of the Board and let me know if you think that the bad doctors are getting, in a fair and proportionate manner, what they deserve. ..Maurice.



Explanation of Some of the Disciplinary Language:
Date at the bottom of summary means the date the disciplinary decision goes into action.
Gross Negligence-Extreme deviation from the standard of practice
Incompetence-Lack of knowledge or skills in discharging professional obligations.
Judicial Review Pending- Action is being challenged through the court system.
Public Letter of Reprimand- The licensee is discipline in the form of a public letter.
Revoked-The licence is canceled, voided, annulled, and rescinded. The right to practice is ended.
Stayed-the revocation of license is postponed. Professional practice may continue as long as licensee complies with specific probationary terms and conditions. Violation of probation may result in revocation.
Stipulated Decision- A form of plea bargaining. The case is formally negotiated and settled prior to trial.
Suspension from Practice-The licensee is prohibited from practicing for a specific length of time.



Example Cases:
5. Committed acts of repeated negligence in his case and treatment of a cosmetic surgery patient, and failed to maintain adequate and accurate medical records for 3 patients. Revoked, stayed placed on 3 years probation with terms and conditions including, but not limited to completing a clinical training program and a medical record keeping course. September 26, 2007. Judicial review pending.

10. Failed to maintain adequate and accurate medical records in the care and treatment of a patient. Physician completed a medical record keeping course and a physician-patient communication course. Reprimand. August 24 2007.

15. Stipulated Decision. Disciplined by Florida for practicing medicine while impaired or under influence of drugs or alcohol. Revoked, stayed, placed on 5 years probation with terms and conditions including, but not limited to, abstaining from the personal use or possession of controlled substances and alcohol, and submitting to biological fluid testing.

20. Stipulated Decision. Physician has a condition affecting his ability to practice medicine safely; and, misdemeanor conviction for battery related to domestic abuse. Surrender of license. October 26, 2007.

25. Criminal conviction for having sexual relations with a patient. Revoked, stayed, placed on 7 years probation with terms and conditions including, but not limited to, completing an ethics course, an educational course in addition to required CME and must have a third party chaperone present while consulting, examining or treating female patients. October 10, 2007.

30. Stipulated Decision. Convicted of driving under the influence of alcohol on 4 different occasions between September 2005 and November 2006. Revoked, stayed and placed on 7 years probation with terms and conditions including, but not limited to, 1 year of actual suspension, abstain from the use of controlled substances and alcohol, submit to biologic fluid testing, successful participation in ethics course, and complete the Board’s Diversion Program on her license will be automatically revoked effective October 12, 2007. License was automatically revoked effective October 17, 2007 when she was terminated from the Board’s Diversion Program for non-compliance.

35. Stipulated Decision. Disciplined by Florida for failure to practice within the standard of care and failure to maintain adequate medical records related to her care of a patient. Disciplined by New York for failure to evaluate and document her evaluation of 5 patients during their colonoscopies. Physician must complete a medical record keeping course. Public Reprimand. September 12,2007.

40. Violated the terms and conditions of his board-ordered probation by being convicted of a felony for knowingly, intentionally and unlawfully distributing and dispensing controlled substances. Revoked August 1, 2007.

45. Stipulated Decision. Disciplined by Washington related to the performance of spinal surgery on 3 patients. The physician, a board-certified anesthesiologist, failed to disclose that he was not qualified professionally to perform these procedures, and failed to inform the patients of the potential risks involved with each procedure. Revoked, stayed, placed on 3 years probation with terms and conditions including, but not limited to, must complete a clinical training program, obtain a practice monitor, and complete an ethics course and an educational course in addition to required CME. September 26, 2007.

50. Stipulated Decision. Committed an act of dishonesty by signing a certification under penalty of perjury that he had attended 65 hours of lectures at a conference where in fact he had only attended 1 day of the 5 day seminar and had returned to California to treat patients. Physician must complete an ethics course. Public Reprimand. September 26, 2007.

55. Stipulated Decision. No admission but charged with gross negligence and failing to maintain adequate and accurate medical records in his care and treatment of a patient. Physician must complete a medical record keeping course. Public Reprimand. October 25, 2007.

60. Engaged in unprofessional conduct by failing to timely comply with the board’s request for a patient’s medical records and failing to comply with an administrative citation and fine related to the failure to produce the requested medical records. Revoked, stayed, placed on 3 years probation with terms and conditions including, but not limited to, paying a civil penalty of $ 244,000. September 28, 2007. Judicial review pending.

65. Stipulated Decision. Committed acts of repeated negligence, gross negligence, incompetence and aided and abetted the unlicensed practice of medicine by allowing medical assistants and physician assistants to engage in unlicensed practice beyond their scope. Revoked, stayed, place on 2 years probation with terms and conditions including, but not limited to, completing an ethics course. September 4, 2007.

70. Disciplined by Florida for failure to practice medicine within minimal acceptable standards in the care and treatment of a patient. Public Letter of Reprimand. September 7,2007.

75. Committed acts of repeated negligence by continuing to prescribe controlled substances for 3 individuals after his employment with the county public health department was terminated and they were no longer his patients. Breached the terms of a prior Stipulated Decision by failing to complete a clinical training program. Revoked, stayed and placed on 3 years probation with terms and conditions including, but not limited to, completing a clinical training program, obtaining a practice monitor and maintaining a log of all controlled substances ordered, prescribed, dispensed or administered. October 18, 2007.

80. Stipulated Decision. Failed to maintain adequate and accurate medical records in the care and treatment of a patient. Physician completed a medical record keeping course. Public Reprimand. August 28, 2007.

85, Discipline by Florida for providing substandard care to a patient who presented with chest pain, shortness or breath and nausea. Public Letter of Reprimand. September 7, 2007.

90. Stipulated Decision. Aided and abetted the unlicensed practice of medicine by working for an unlicensed person at a weight control clinic, and dispensed prescription drugs in improperly labeled containers. Revoked, stayed, place on 4 years probation with terms and conditions, including but not limited to, completing a prescribing practices course and an ethics course and obtaining a practice monitor. October 4, 2007.

95. Committed acts of gross negligence in the care and treatment of a patient and failed to maintain adequate and accurate medical records in the care and treatment of 4 patients. Revoked, stayed, placed on 5 years probation with terms and conditions including, but not limited to, completing a medical record keeping course and obtaining a practice monitor. September 14, 2007.

100. Stipulated Decision. Discipline by Arizona for his care and treatment of a patient for failing to order further diagnostic studies and failure to diagnose a malignant breast mass. Physician completed a clinical training program. Public Reprimand. October 11, 2007.

105. Disciplined by Ohio for failing to disclose on his Ohio licensing application that the Florida Department of Health, Board of Medicine had issued a Uniform Non-Disciplinary Citation for failing to fulfill continuing education requirements. Public Letter of Reprimand. Oct 11, 2007

14 Comments:

At Saturday, January 19, 2008 8:50:00 PM, Anonymous AL said...

I've always thought that enforcement of physician discipline by other physicians (state boards) leads to poor oversight. In your post, only two physicians out of over 20 were prevented from continuing to practise for any period of time.

For comparison, I looked up the CA nursing board disciplinary actions, and it looks like about 2/3 of the nurses that were found guilty lost their license.

It seems to me that unless a lot more of the physicians were guilty of minor infractions, than the disciplinary actions were relatively weak.

I get the feeling that many physicians feel entitled to be allowed to continue a career that they have put so much time and effort into being trained to do, regardless of public safety. I don't understand why we as a society have accepted this. In other fields, pilots, truck drivers, nurses, teachers, etc seem to have a much greater threat of losing their licences if they don't tow the line, or if they develop a condition that puts public safety in jeapardy.

I wonder if malpractice insurance companies, and the courts, are the "de facto" enforcers of minimum competance and compliance. From what I've heard, many physcians are much more concerned with rising premiums or losing insurance than with losing their license. I would prefer a body that would set minimum standards fairly and equitably be the enforcement agency rather than a commercial (insurance) entity.

 
At Saturday, January 19, 2008 10:14:00 PM, Blogger Maurice Bernstein, M.D. said...

The issue is whether the punishment is proportional to the professional misbehavior or criminality. Do you think one can answer this issue based on the documentation available on the Board newsletter or that there may be facts not presented which might mitigate the decision regarding the final punishment? If it is the former, I would tend to agree that many of the decisions of the Board seem a bit weak regarding the degree of punishment. ..Maurice.

 
At Sunday, January 20, 2008 10:55:00 AM, Anonymous Emily said...

There was an interesting set of Washington Post articles on reasons why physicians rarely pay the price for patient injury or death caused by poor performance or substance abuse. Some of them were:

1. the network of state medical boards are made up primarily of physicians who are unwilling to exact strict punishment on the bad apples.

2. the federal data bank designed to track problem doctors have loopholes such as - information is closed to the public - lawsuits often end in sealed settlements that keep patients from learning a doctor's full history.

3. when physicians were disciplined, the process is so slow that they could easily move to another state and become licensed before a paper trail surfaced detailing their transgressions.

4. the public believes the illusion that malpractice laws will protect them from incompetant or dangerous doctors.

Here is the Post link:

http://www.washingtonpost.com/wp-dyn/articles/A39677-2005Apr9.html

One interesting solution to this problem is from bioethisist, Arthur Caplan. He suggests:

"You can't trust what people (doctors) write in records because there's too much protection of one another. If we really want the truth we may need to create a no fault system like the airline systems use. When a plane crashes the FAA investigates, but their finding cannot be used in court. That's a system that may work well in medicine, too."

whole interview here:

http://www.washingtonpost.com/wp-dyn/articles/A44314-2005Apr11.html

I envy patients who might personally know an operating nurse at their hospital. Where else could you get better insider information about a doctor's performance than from this group.

 
At Tuesday, January 22, 2008 2:01:00 PM, Anonymous Anonymous said...

I would like your comments, Maurice, on this scenario:

1. Surgeon puts a full 2 page H & P in a patients file that he does surgery on and all of the information on the H & P is fraudulent. By this I mean to say that the surgeon stated he did a full check on the patients body as part of the surgical evaluation. This even included doing a rectal exam. The surgeon did none of it.

2. After the surgery the medical file was obtained from the ASC. It was then noted that the charting done by the PACU nurses was fraud. They charted the patient voided after surgery prior to discharge, they charted v.s. taken q 5 min. They were not the patient was alert during this time and not one was taken. It was charted ice pack to groin--NONE.

What do you think of these actions?

DS

 
At Tuesday, January 22, 2008 6:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Either significantly intentional or habitual incomplete charting or charting of intentionally misleading or dishonest data is unprofessional and should be investigated by licensing boards and, if documented, should be acted upon to penalize and educate those who are doing that kind of charting. The degree and nature of the penalty should depend on the intent of the act and/or the harm it has caused the patients or society. ..Maurice.

 
At Thursday, January 24, 2008 6:29:00 AM, Anonymous Anonymous said...

We did file complaints with the medical board in CA. Nothing was done. Also learned from the medical board that it is not against practice guidelines for a physician to lie to a patient.

We were very upset with the outcome. Seems the board review does nothing for a consumer. It is like the fox watching the hen house. A complete joke in our opinion. Unless a docs license is not current, drug use, sexual misconduct, wrong body part operating, or wrongful death, seems they do absolutely nothing.

It takes a lot of nerve and very unprofessional behavior to fraudulently put a H & P together. What kind of a doctor would ethically do that? Makes you wonder about what else does he do wrong? What other short cuts. He also has an employeee (RNFA) do solo work on the patient without being in the room or in the ASC. This is not disclosed to the patient. Found out afterwards he owned a piece of the ASC and that also is not disclosed to a patient. It should be.

 
At Thursday, January 24, 2008 7:29:00 AM, Anonymous Anonymous said...

I must say that when agencies that receive formal complaints regarding issues and process do nothing but obtain the medical file and read what is documented. That is usually the extent of the investigation. Then, if they speak to any of the parties involved, i.e., administrator etc. of course they deny any wrong-doing. It then becomes a he-said----she-said situation.

What kind of an investigation is that? It really amounts to nothing. It is a cushy government job that produces no positive results for a consumer.

 
At Friday, February 01, 2008 10:22:00 AM, Anonymous Anonymous said...

I personally have to wonder what happens to cases in jurisdictions with under servicing. Many areas in the free world are experiencing doctor/nursing shortages. If a doctor is removed it could leave thousands of patients stranded. I have to wonder if minor cases are thrown out just to minimize the loss of a doctor. I'd really like to believe it doesn't but it wouldn't surprise me otherwise.

TS

 
At Friday, February 01, 2008 10:47:00 AM, Blogger Maurice Bernstein, M.D. said...

TS, you might not have to look too far around the free world, such a situation you might describe could be simply in a rural area of the United States. The dilemma is no doctor vs a suspected or documented "bad doctor". Maybe, society will accept the doctor with a minor issue rather than have no doctor readily available. The way to mitigate this dilemma in distant rural areas is to fund the presence of good doctors. ..Maurice.

 
At Wednesday, July 09, 2008 12:39:00 PM, Blogger jodigirl1000 said...

I am most concerned about the inverse relationship between a state disciplinary board's willingness to investigate and discipline "bad doctors" & the number of filed medical malpractice cases.

I am in Illinois. I understand that the Illinois Medical Society in part funds the Illinois Department of Professional Regulation. No surprise that the DPR protects those from whom it receives money.

I do not believe that patients necessarily want to sue a doctor. Patients just want doctors who make errors to be held accountable. That could most easily be done by a disciplinary commission that took its responsibility to the public seriously

 
At Sunday, August 31, 2008 3:45:00 PM, Anonymous Anonymous said...

I cringe in fear of non medical beauracrats "policing" the practice of doctors. What is the definition of a "Bad" doctor. We all have our unique definition. But, to the public a bad doctor is one who does anything that produces a negative outcome or doesn't live up to our perception. Drs are subject to a scrutiny I doubt most of us would pass. As are pilots but, most certainly not nurses nor truck drivers.
My doctor made a serious mistake, the first in his life. It resulted indirectly in man's death. He admitted it and took responsibility. His life was destroyed. He settled a lawsuit and pled guilty to a minor felony to prevent his family from going through the ordeal and expense of a public trial. His license was suspended and placed on probation. He cannot practice his chosen field and pays exorbitant malpractice insurance. His family has sufferred immensely. Yet he saved my and many other lives. He is not a criminal,he and others are only human. When will we realize this fact and use the same yardstick We would use for ouselves.

 
At Thursday, January 09, 2014 11:47:00 AM, Anonymous Anonymous said...

I have got a physical every year of life for 64 yrs but never received an chest x-ray. The doctor said "no reason to give you one" and 14 months after my last physical a doctor x-rayed me an said "you have lymphoma cancer" which was later proved to be wrong. I had a Thymoma tumor that turned out to be 3 lbs, that should of been found by x-ray years ago with any physical. The tumor almost killed me so why don't doctors x-ray people when they have a physical at least every couple years? Currently by the time a doctor x-rays a person it is too late. I think the current policy by doctors is totally wrong.

Don K.

 
At Thursday, January 09, 2014 7:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Don K., I understand your frustration but the use of yearly or more often X-ray studies to find and make a diagnosis of "silent" masses or conditions is a continuing medical controversy. It is because X-rays themselves are potentially harmful as the effect of the X-rays on biologic tissue are compounded with each exposure. In fact previous studies have failed to find that yearly chest x-rays for lung cancer actually save lives.

The thing that patients and doctors must remember is that what conditions which was characterized as "silent" when finally discovered by X-ray were actually not silent if time was allowed for the patient to have given a more thorough history and the physician to perform a more thorough physical examination.

For example, with regard to a thymoma, its relationship to the respiratory tree may cause respiratory symptoms as simple as a slight and persistent cough. If a symptom such as a minor cough is not brought up by the patient and not explored with further questions by the doctor, to show that the symptom is of real significance, it will be missed. If the physical exam does not include the doctor examining the patient's trachea in the neck and noting that it is slightly deviated to one side, the thymoma can be missed. This defect in diagnosis which, in part, can be attributed to lack of time spent with a patient can make such a mass "silent" until later discovered by X-ray. But if time was given for a more complete history and physical followed by professional concern with the findings which led to a diagnostic
X-ray, yes, the presence of a thymoma then would no longer be considered "silent". Anyway, this is my opinion on the subject. ..Maurice.

 
At Friday, January 10, 2014 8:08:00 PM, Anonymous Anonymous said...

fai;ure to keep proper records, domestic assualt, etc are all ussues no doubt. But are you willing to hold yourself to the same standard? MD's are human, unfortunately the mistakes they make have dire consequences at times so they are held to a higher standard. But they pay a higher price to be a MD. While we were drinking beer they were studying, while we graduated and started earning money they were studying, while starting families they were starting residency. Not to say they should not be hild accountable or at a higher level, but they are not perfect, not human is and while some of the penalties seem light to me, some of the offenses seem pretty light as well...don

 

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