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Doctor Discipline Declines for Third Straight Year

Public Citizen finds 22% decrease in serious disciplinary actions

April 23, 2008
Public Citizen's annual ranking of state medical boards shows that the number and rate of serious disciplinary actions against physicians has decreased for the third consecutive year, a troubling trend that indicates many states are not living up to their obligations to protect patients from bad doctors, the organization said.

Since 2004, the number of serious disciplinary actions against doctors has decreased 17 percent -- resulting in 553 fewer serious actions in 2007 than in 2004. Taking into account the increasing number of U.S. physicians since 2004, the rate of serious actions has fallen 22 percent since then, from 3.72 actions per 1,000 physicians to 2.92 in 2007.

South Carolina was the worst state when it came to disciplining doctors, slipping one spot from last year's ranking. Of the 10 states at the bottom of the rankings, four - Maryland, Minnesota, South Carolina and Wisconsin - have been there for each of the past five years.

Three others - Nevada, South Dakota and Washington - have made the bottom 10 for each of the last three years.

Eleven states have experienced at least a 10-place drop in ranking between the 2001-2003 ranking and the 2005-2007 ranking: Alabama went from 13 to 34; California from 22 to 36; Georgia from 15 to 33; Idaho from 14 to 25; Massachusetts from 23 to 35; Mississippi from 20 to 49; Nevada from 33 to 46; New Jersey from 24 to 42; North Dakota from 3 to 13; and South Dakota from 37 to 47.

Ten states have accomplished at least a 10-place improvement in ranking between the 2001-2003 ranking and the 2005- 2007 ranking: Arkansas from 29 to 16; Delaware from 50 to 29; District of Columbia from 42 to 22; Hawaii from 51 to 21; Illinois from 35 to 12; Maine from 34 to 24; Nebraska from 28 to 5; Rhode Island from 46 to 23; Tennessee from 44 to 28 and Vermont from 19 to 8.

"The lack of doctor discipline in many states equates with a lack of patient protection for those patients whose physicians would have been disciplined in states with better enforcement of their state medical practice acts. These numbers show that many states are thereby continuing to allow doctors to endanger the lives and health of some of their residents because of inadequate discipline," said Sidney Wolfe, M.D., director of the Health Research Group at Public Citizen.

"Serious attention must be given to finding out why the worst states are failing to discipline doctors and then action must be taken, legislatively and through pressure on the medical boards, to bring about necessary changes."

The annual rankings are based on data from the Federation of State Medical Boards (FSMB), specifically on the number of disciplinary actions taken against doctors in 2007. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state.

The top 10 states at disciplining doctors, in order, are Alaska, Kentucky, Ohio, Arizona, Nebraska, Colorado, Wyoming, Vermont, Oklahoma and Utah.

Boards are likely to be able to do a better job in disciplining physicians when most, if not all, of the following conditions are true:

• They have adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);

• They have adequate staffing;

• They undertake proactive investigations rather than only responding to complaints;

• They use all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;

• They have excellent leadership;

• They are independent from state medical societies and other parts of the state government; and

• A reasonable legal framework exists for disciplining doctors (the "preponderance of the evidence" rather than "beyond reasonable doubt" or "clear and convincing evidence" as the legal standard for discipline).

The full report is available online.

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