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Mass. doctors face fewer sanctions

Group says state may have relaxed policing

By Elizabeth Cooney
Globe Correspondent / April 6, 2010

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The number of serious disciplinary actions taken against Massachusetts doctors fell by almost half over four years, placing the state’s medical licensing agency in the bottom 10 nationally, according to a report released yesterday by a consumer group.

The Public Citizen Health Research Group said the numbers suggest that Massachusetts has relaxed its policing of problem physicians. “There are doctors practicing in Massachusetts who three, four, or five years ago might have been disciplined for doing exactly what they do now,’’ Dr. Sidney M. Wolfe, the group’s director, said in an interview. “Almost a 50 percent decrease in three years cannot be explained on the basis of suddenly the doctors in Massachusetts have gotten better.’’

But a spokesman for the Massachusetts Board of Registration in Medicine said disciplinary numbers do not tell the whole story. He said complaints to the board fell by more than a third from 2007 to 2009, and the number of malpractice payments made by Massachusetts doctors has gone down since 2001.

“Patient safety is the mantra of the whole health care system in Massachusetts and has been for a number of years,’’ spokesman Russell Aims said. “You’d expect to see some positive impact. . . . In Sid Wolfe’s opinion, there is some base level number of doctors who should be disciplined per 1,000 doctors licensed. Who’s to say what that is?’’

Wolfe’s group analyzed data compiled by the Federation of State Medical Boards, which showed that, in 2006, 100 Massachusetts doctors lost licenses, had their privileges restricted, or were placed on probation. In 2009, that number fell to 52. From 2007 through 2009, the rate of serious actions per 1,000 physicians was 1.93, giving Massachusetts the sixth-lowest rate in the country, just above Connecticut (1.8) and New Hampshire (1.65). Nationwide, serious disciplinary actions went down by 18 percent from 2004 to 2009, when the rate was 3.05 per 1,000 physicians.

In Massachusetts, the medical board investigates complaints from patients, their relatives, hospitals, doctors, the court system, news accounts, and anonymous sources. When the agency decides that a case merits disciplinary action, physicians are asked to sign a consent order, sometimes surrendering their license permanently or temporarily while they follow the board’s rulings.

A physician impaired by drug or alcohol might undergo treatment or work under special oversight before reinstatement, for example.

Physicians who don’t agree with the board’s findings can have their cases heard by the state Division of Administrative Law Appeals.

Last year the division’s head resigned after an outcry over a backlog of cases involving doctors and other professionals, as well as pension appeals from state retirees. There were 34 medical board cases pending at the end of last year, down from a high of 40 at the end of 2008.

Wolfe said a variety of factors can affect how many serious measures medical boards take. Funding and leadership are key, he said.

In Massachusetts, cases reached a high of 107 in 2002 during the tenure of Nancy Achin Sullivan as executive director. She left the board in July 2008.

“Being the head of a medical board is a very difficult but extremely important job,’’ Wolfe said. “Nancy did a good job.’’ Sullivan declined to comment on the Public Citizen report.

Sullivan was succeeded by Dr. Stancel Riley, who previously led the board’s Division of Patient Care Assessment, now called Quality and Patient Care. Board funding is stable at $8 million.

Dr. Allan Frankel, a faculty member of the Cambridge-based Institute for Healthcare Improvement and former director of patient safety at Partners HealthCare System, said the number of cases does not give enough information about medical boards. “If you tell me disciplinary actions have gone down, it doesn’t tell me that they’re not doing their job. Their role is to pressure hospital systems and health care organizations to learn and improve and to get rid of bad apples, but not to stifle what they are learning by being too punitive. Discipline is not the only mechanism for getting these systems to be better.’’