By Allen Powell Ii and Maria Tsigas
For the third consecutive year, Maryland’s medical board was ranked one of the worst in the country when it comes to seriously disciplining doctors, according to a watchdog group.
The report by Public Citizen ranked Maryland’s Board of Physician Quality Assurance 46th for its rate of serious action, such as license revocation or suspension, against doctors who had complaints filed against them in 2002.
The board took serious disciplinary action about 1.78 of every 1,000 doctors in the state, the report said.
“There is really no explanation to be found,” said Dr. Sidney Wolfe, the director of Public Citizen’s health research group. “There may be some good doctors at Hopkins and other places, but that’s true in every state.”
But the executive director of MedChi, the state’s medical society, dismissed the rankings, saying they are based on faulty data and reasoning.
“The whole ranking enterprise is Public Citizen’s annual silliness in our view,” Michael Preston said. “Ranking states on their rate of discipline doesn’t tell you much.”
He said Public Citizen’s rankings are based on the total number of physicians licensed in the state, not on the actual number practicing. State officials also note that many practicing doctors in the state are research physicians, which further skews the ranking.
“This ranking of theirs is faulty. It counts all physicians licensed in Maryland even if they are practicing out of state,” Preston said.
He said that if the state were ranked according to its disciplinary actions for substandard patient care it would rank in the top 15 states in the country, not the bottom.
The report comes as state lawmakers ponder whether to overhaul or abolish the state medical board.
“There is just no discipline going on. Everybody makes mistakes, but these are egregious, egregious mistakes,” said Sen. Paula Hollinger, D-Baltimore County, who is pushing two bills to revamp the board.
After a failed attempt last year at lowering the evidence standards for doctors to be found negligent by the board, Hollinger returned this year with multiple bills. One would lower the evidence standards and add more non- physicians to the board, while the other would simply eliminate the board.
Hollinger’s evidence bill would lower the standard from “clear and convincing evidence” to a “preponderance of evidence” — the standard used by the majority of medical boards in the country, according to the Federation of State Medical Boards.
“Consumers in Maryland are not being protected . . . this is the only board left that threw out the law and tied the board to the medical society,” she said.
Wolfe said that Maryland’s board must get permission from MedChi before it can seriously discipline doctors, which he said is like leaving the “fox guarding the chicken coop.”
“They’ve got this nefarious relationship with the state medical society which disables the board from doing what it was created to do,” Wolfe said.
Preston called that suggestion “ridiculous.”
“The only relationship between the board and the medical society is that we administer peer-review cases,” he said.
But Hollinger rejected Preston’s claim that research physicians are skewing Maryland’s ranking. There were just as many research physicians in the early 1990s when the state ranked in the 20s, she said.
In the last two years, Maryland’s medical board has taken a total of 137 actions against the nearly 17,000 practicing physicians in the state, according to the Federation of State Medical Boards. Within that same time period, Maryland’s board said it received more than 2,900 complaints against physicians.
But the Maryland Office of Legislative Audits criticized the board in a 2002 report for its lack of oversight, lax security systems and slow processing of complaints. It noted that the board has issued a license to an unqualified individual, allowed board employees unauthorized access to physicians’ personal information and taken up to four years to process some complaints.
Any of those problems could have serious consequences, the auditors said.
“Some of the things just have the potential for problems, but it (the board) did allow someone to get a fraudulent license, which is a major problem for physicians,” said Gerald Martz, the director of fiscal compliance audits for the audit office.
The legislature must take some action this year on the board, which is set to expire on June 30. If it is allowed to lapse, Maryland would be the only state in the country without a board that licenses physicians.
“Before we take that incredible step, we have to answer the question, `Is the system broken?'” said Sen. Andrew Harris, R-Baltimore County. “I don’t know if we can make the justification for doing away with the board completely.”
