The State Board of Physician Quality Assurance came down hard on Dr. Merrill I. Berman after it concluded he had overbilled Blue Cross/Blue Shield. The board, in October 1989, put Berman, a Towson psychiatrist, on the equivalent of three years' probation, ordering him to undergo periodic peer review and to receive intensive drug and alcohol counseling.
Six months later, Dr. Steven C. Gumeiner came before the board on a charge that he had administered a lethal dose of an inappropriate anesthetic to a gunshot victim on the operating table at Sinai Hospital. The penalty for the fatal mistake? A letter of reprimand.
The two cases are typical of the board's approach to disciplining the state's 22,500 doctors. Physicians who make medical mistakes are less likely to be seriously punished than doctors who are caught over-prescribing drugs, bilking insurance companies, drinking or doing drugs on the job, according to a review of the board's public records by The Evening Sun.
The state board, which operates in an atmosphere of secrecy, has come under scrutiny from several sources, including the office of Gov. William Donald Schaefer, which was angered by the handling of a case involving the death of a young boy.
The legislature's Department of Fiscal Services, in a recent unrelated "miniaudit," criticized the board on several fronts, saying that its higher budgets the past two years "have not enhanced its overall performance. In fact, in some cases, the board's record shows clear evidence of decline."
The Evening Sun's review of the records shows that since its creation July 1, 1988, the board has taken public action involving 55 doctors. Only eight of those were for medical mistakes. Sixteen were for drug- or alcohol-related problems, including over-prescribing certain medications; nine involved sexual contact with patients; 10 involved fraudulent billing practices; and 12 were for a handful of other reasons, including doctors who lied on their license applications.
Also since July 1988, many doctors who made medical decisions that resulted in heavy malpractice judgments or settlements -- as documented either in court or at the state's Health Claims Arbitration Office -- were not penalized by the board, according to the board's public records.
In all, board officials say only about 40 percent of their actions -- including those not made public -- involve charges of bad medicine, as opposed to drug abuse or other infractions.
Dr. Israel H. Weiner, the board chairman and a Baltimore County neurosurgeon, said the board usually is reluctant to penalize a doctor for a single medical mistake, no matter how serious. Doctors, Weiner said, are generally well-trained and competent.
"Incompetency cases are very difficult to prove," Weiner said. "It's a question so many times of opinion. Does one mistake make incompetency?"
A reprimand, he added, is a substantial penalty, one that can hurt a doctor for the rest of his or her career.
Three years ago, the General Assembly passed what it billed as a major overhaul of the now-defunct Commission on Medical Discipline and named the overhauled commission the State Board of Physician Quality Assurance. At the time, the commission suffered from overwork, and cases routinely took several years to resolve. Doctors the commission did manage to punish often received light penalties.
Some of the 1988 legislative changes were cosmetic -- renaming the board, for example -- while some were substantive, including adding a new layer of administrative oversight designed to improve the board's efficiency. The government also boosted the board's budget significantly.
While almost everybody acknowledges that the board has improved somewhat, some problems persist.
"We're not doing nearly as well as we would like," said Weiner, who gives the panel a grade of C+ or B-.
Among the problems that still exist:
* Cases still grind slowly through the disciplinary system, which involves three separate state agencies and the private state medical association. The board has a backlog of roughly 1,300 cases, including almost 200 that have been open for more than a year.
* Doctors still dominate the 15-member board, and the state medical association still has nearly complete influence over disciplining doctors accused of practicing bad medicine, a situation some critics say leads to light punishments.
* The board's office remains understaffed and under-equipped, according to board officials. If, for example, too many people are using the board's computer at the same time, the system freezes.
* Nearly all of what the board does is still kept secret from the public. Only some formal decisions are released. Other disciplinary actions are not made public at all.
* The board's philosophy of disciplining bad doctors appears not to have changed at all -- medical mistakes are less likely to be punished than problems with sex, drugs or fraud.