WASHINGTON -- Maryland's system of rooting out incompetent or immoral doctors ranked among the 10 most lenient in the nation for the sixth year in a row last year despite modest improvements, a national patient advocacy group said yesterday.
In a volume called "9,749 Questionable Doctors," the Public Citizen Health Research Group said Maryland's physician discipline system is only marginally better since it was overhauled in 1988 and still suffers from a cozy relationship with the state's medical establishment.
"I don't think very many states that have a close pipeline between the state medical society and the medical discipline board are doing a very good job," Dr. Sidney Wolfe, the group's director, said yesterday at a news briefing.
The organization reported that last year, Maryland's Board of Physician Quality Assurance took 24 "serious actions" against doctors -- up from 16 the year before. The improvement raised Maryland's ranking among the states from 47th to 43rd in terms of the percentage of doctors disciplined.
Dr. Wolfe said most states are failing to adequately punish bad doctors. Disciplinary actions, he said, represent just "a drop in the bucket" when compared with the estimated 150,000 to 300,000 Americans who are killed in hospitals by medical negligence or malpractice.
"What is in this book is just a fraction of what is wrong," Dr. Wolfe said. Serious actions were defined as instances in which medical discipline boards suspended or revoked a doctor's license or placed the doctor on probation. Typically, such actions are taken against doctors who have abused drugs, sexually abused patients, overprescribed drugs, prescribed the wrong drugs or shown they are incompetent.
Last year, the state issued stiff sanctions against doctors at about one-sixth the pace of Missouri, which ranked first in Public Citizen's review. Maryland took serious actions against 1.48 out of every 1,000 doctors -- compared with a rate of 9.30 per 1,000 doctors in Missouri.
But Michael Compton, executive director of Maryland's quality assurance board, said the results show that Maryland's system of disciplining doctors is beginning to make a difference only three years after it was revamped. The system will continue to improve in the years to come, he added.
"Our board has progressed," Mr. Compton said. ". . . I'd predict we will come up four or five [rankings] the next time around."
He also said the watchdog group compares "apples and oranges"when it tries to rank states whose medical boards are bound by different laws and charged with different responsibilities.
Pennsylvania law, for instance, requires doctors to surrender their licenses any time they lose their medical malpractice insurance; Maryland law does not.
"It doesn't give a really clean picture," Mr. Compton said. "It's counting scalps."
In 1988, the Maryland legislature overhauled the state's medical discipline system in the face of a scathing report by the Washington Post, which found that a weak and understaffed Commission on Medical Discipline had allowed convicted rapists and incompetent doctors to continue practicing for months because of huge backlogs.
The old law placed much of the power to discipline doctors in the hands of the Medical and Chirurgical Faculty of Maryland, the state medical society. Investigations were done by physician volunteers, who were ill-trained in investigative work and were charged with evaluating serious allegations against their peers.
The new law created a more independent Board of Physician Quality Assurance, providing professional investigators, prosecutors and law judges. It also gave the governor the power to appoint all of the board's 15 members -- including the 11 physician members, taking that power away from the medical society.
But in its most stinging criticism, Public Citizen said the medical society still keeps "too-close ties" with the quality assurance board. Under the new law, the society submits a list of candidates from which the governor chooses 10 of the 11 physician members. The medical society also provides consultants to review alleged violations of medical standards of care.
The consultants, in turn, judge whether they think standards of care have been violated. But they do not decide the accused physician's fate.
"I don't see how there can be any conflict of interest when you have a mechanism that provides for this type of review," said Carmine Valente, the medical society's deputy executive director. Physicians, he said, are not permitted to consult on a case if they know or have any financial ties to the accused physician.
Public Citizen called on the Maryland legislature to sever all ties between the medical society and the board and increase the board's funding so that it can hire more staff and reduce backlogs.
It also called on the board to publish all its disciplinary actions in a newsletter and to use its power more frequently to suspend doctors pending a hearing when they pose a serious threat to the public safety.