Wednesday, March 7, 2012

Physician oversight or intimidation?

The Board of Medical Practice in the state of Minnesota regulates 20,000 physicians. Most of them are employees in large healthcare companies. That means they have to undergo the credentialing process within those organizations as well as collateral organizations in addition to renewing their state license every year. There are about 800 complaints against physicians with the board of medical practice every year and the board takes serious actions based on those complaints at the rate of about 1.29 serious actions per 1000 physicians.

In Minnesota, anyone can complete a formal complaint against any physician. A specialist at the board sends a letter with the complaint to that physician's office and they have two weeks to respond to the complaint. That generally involves a specific letter to address the complaint as well as all of the associated medical records.  Frequently several physicians or clinics are part of the complaint in the process cannot go forward until all of the responses have been received by the Board.  The physician must respond literally to the complaint as written by the complainant.   The complaint is never interpreted by the Board.  The Board renders a decision based on the information it receives.
Like many states there is a move by politicians and the news media to suggest that doctors are not regulated tightly enough and they are not punished thoroughly enough in the state of Minnesota. The local press has been beating that drum for the past month.
There is now a clear case to be made that some of these complaints have little to do with medical practice and more to do with politics.  Many of us have seen it happen to our colleagues. I am familiar with several cases where a physician was accused of having a problem with other staff. The descriptions of those problems varied from being "disrespectful" to "snubbing" another staff member. Even in the case of unsubstantiated complaints there are protocols available in the Twin Cities that allow for physicians to be fired, written up, or rehabilitated based on purely subjective complaints. That is a far cry from the concerns about "disruptive physicians". It is apparent that in many settings purely subjective and essentially political complaints are being made on physicians and advanced by their administrative hierarchies.
Before anyone plays the "you're just defending physicians" card consider this. There is no physician I am aware of who would not agree with disciplining a physician who is physically abusive, verbally abusive, or otherwise out of control. There is no physician I am aware of who wants to see an incompetent physician practicing anywhere regardless of the source of their incompetency.  The people who escape criticism in the issue of physician discipline are not physicians but anyone who stands to gain from the proposition that there continue to be physicians who endanger public safety and there are widespread undetected numbers of them out there practicing.
Clearly the media has a stake in this process. The letter by Dr. Langland points out that the media in this case certainly could have done a better job investigating the major points of their contention that the medical board is failing in its public safety mandate. At a national level, Public Citizen obviously has a lot to gain by its ranking of medical boards and suggesting that ranking has a lot more meaning than it really does. Politicians at all levels get a lot of mileage out of keeping professionals accountable. That is true whether they are teachers or physicians. The irony is that politicians at all levels are clearly some of the least accountable people out there. I have also posted clear evidence that their approach to holding teachers "accountable" with an emphasis on standardized test score results is exactly the wrong approach to improving student test scores.
There are clearly a lot of people with a lot to gain in pushing this agenda and that conflict of interest is never discussed. The objective evidence is also never discussed. But I want to draw attention to a key paragraph in Dr. Langland's letter and that is the paragraph below:
"The Star Tribune also expresses concern that a majority of 74 doctors whose privileges were suspended or revoked by hospitals or clinics did not receive disciplinary action. Again, I am very familiar with these situations, most of which do not involve substandard patient care. Often they result from personality conflicts, turf battles and competitive issues. The board has correctly not let itself be drawn into these battles." (see reference 1)
This is a rather stunning revelation. It suggests that some organizations that are punishing physicians for what are essentially subjective or political complaints are also filing those complaints with the Board of Medical Practice and looking for them to be legitimized. While it is good to know that the current board has been able to see those complaints for what they are, there is no guarantee that will always be true. With the increasing influence of businesses and their agenda to control doctors, at some point in the future we may see these trivial complaints suddenly become complaints that threaten a physician's license and livelihood.
That is a heavy price to pay for the cost of doing business.

George Dawson, MD

1.  James Langland.  State Medical Board is Sound.  StarTribune March 5, 2012
2.  Star Tribune Editorial Board.  Medical Board Fails Quality Examination.  StarTribune February 25, 2012
3.  Medical Board actions against doctors, per 1,000 doctors, 2010.  StarTribune  February 6, 2012.
4.  Glenn Howatt and Richard Merryhew. State panel: Public deserves more information about physician misconduct.  StarTribune February 27, 2012.
5.  Glenn Howatt and Richard Merryhew. Doctors who err escape penalties.  StarTribune February 5, 2012.

1 comment:

  1. It's time to scrutinize the work of the medical boards. I found a detailed document describing the action against MN licensee 24506. I wrote a detailed critique of a WA Board (MQAC) action here:

    I would be happy to critique a MN case, preferably involving a psychiatrist, or at least the handling of a psychiatric case. Perhaps if the boards know they cannot operate with impunity they will shape up.