Tyrannical State Medical Boards?

May 24, 2006 in Health Policy by RangelMD

A few questions about state medical boards (To ponder).

In general; Why do doctors fear the state medical board (esp. here in Texas)?

The general perception among physicians is that the board’s primary motivation is political. While the board may claim that their primary mandate is to “protect the public” their real priorities lie not in protecting the public or the integrity of the medical profession but in reacting to the political winds coming out of Austin.

This is best exemplified by the fact that the Texas medical board ramped up its disciplinary actions in 2002 based not on any study or evidence that linked hard core disciplinary action to improved quality and safety of health care but rather to several articles in the Dallas morning news criticizing apparent lax disciplinary actions taken by the board in a few extreme cases. So I have a few questions about how medical boards work and why they continue to work like this.

  1. Why is there no separate category for “administrative violations” i.e. violations pertaining to documentation, advertising, medical records, etc. etc. that don’t directly put the public at risk. More effort and time should be spent on investigating and disciplining serious violations.
  2. Why is there no leeway given for private warnings especially in administrative violations? Warnings given for minor violations can reduce the board caseload. A second violation after a warning can carry higher penalties then usual.
  3. Why is the board 100% dependent upon complaints to discipline doctors? Why is the concept of a proactive monitoring board so alien? Many problem physicians believe that if they can just stay “under the radar” they won’t get into any trouble. Random chart reviews, practice visits, even drug screens for high-risk specialties are all options.
  4. Why is the board alienating and marginalizing local medical societies? When the Dallas morning news criticized the board as a “good ‘ol boy” system that protects its own, the backlash against self-policing began. But this has gone too far. Local societies can still be of great value in assisting physicians with substance abuse problems, behavioral and psychiatric problems, and disabilities before they become a threat to patient care. The board can benefit by essentially outsourcing cases for these societies to handle before official action is required. There just needs to be much better cooperation between these entities. Physicians need to know that the board will accept the assistance of local medical societies and the public needs to rest assured that these societies will not hesitate to report to the board any activity that is a threat to public health.
  5. Why doesn’t the board have “whistleblower” protections like those provided by federal law? Far too many physicians are being reported to state medical boards by hospital administrators and being labeled as “disruptive” when they try to stop or bring attention to substandard or dangerous care in some institutions.
  6. Why doesn’t the board supply legal council for the defendant physician? In every proceeding the board has the advantage of legal council from one or more lawyers. Accused physicians must hire their own lawyer often at enormous cost ($10,000 just for the retainer is not uncommon) that can drain their entire financial reserves over the course of an investigation that may last years. The physician can face economic ruin or face the fact that the odds are stacked against him/her and accept whatever judgment the board feels like handing down. Was the system designed to be this unequal?
  7. MDs sit on the board but why are not most investigators MDs as well? Would this be a case of the inmates guarding the prison? Why? Is there any proof that this would not work? Is there any proof that RNs make better investigators? I would think that MDs would know more about the subtle “tricks” that problem physicians use and what to look for.
  8. Why do all proceedings need to take place in the state capital? Decentralize the board. Expand regional offices that can better handle complaints, investigations, and regular procedures. Let the important cases go to Austin.

The Texas state medical board shows every sign of begin overwhelmed and over zealous. They’ve bitten off more than they can chew. They need to start prioritizing and becoming more efficient. And for God’s sake they need to dispense with the notion that self-policing is automatically incompatible with their mandate. Start working better with local medical societies and the TMA and stop alienating physicians. This perception as a doctor hating institution is not going to protect the public any more than fanatical cops will reduce community crime by going around harassing the citizenry. The last thing Texas needs is to gain a reputation as a “doctor unfriendly state”. The last thing we need is fewer physicians willing to move here.

Please share.