Doctors urge less punitive system

Critics say it hides discipline from public

September 07, 2001|By Greg Garland | Greg Garland,SUN STAFF

Faced with a likely legislative move to toughen the way Maryland regulates its doctors, a state medical society task force is proposing that the system be restructured to make it less punitive and encourage more thorough reporting of medical errors.

The group says that creating this new system -- rather than tightening the state's current one -- would improve medical care and patient safety.

But some local lawyers and national health policy experts are reacting negatively, noting that the medical society's proposal would leave regulation of doctors largely under its own control and further shield doctors from public scrutiny.

The Medical and Chirurgical Faculty of Maryland -- or MedChi, the professional society that lobbies for doctors and plays a big role in regulating them -- plans to vote on the task force recommendation at its annual convention in Ocean City this weekend. If approved, the society would push the plan in the next legislative session this January.

The task force's report occurs after an article in The Sun last month that exposed weaknesses in the state's system for regulating doctors, which led to calls for legislative reforms.

MedChi Executive Director T. Michael Preston said the proposal follows recommendations of the National Academy of Sciences on more effective ways to reduce medical errors and protect patients. "The basic goal is to try to achieve reform of the regulatory system that is meaningful in getting at the problem of medical errors and the issue of patient safety," Preston said.

In its report, the task force says that fear of sanctions drives some physicians to try to keep information about medical errors from regulators. "Reducing the risks that patients face when they receive health services entails reducing the risks physicians face when medical errors occur," the report states.

The report adds, "The current model of seeking out the `bad doctors' and punishing them is not only unproductive in improving patient safety; it is counter-productive because it suggests falsely that physician competency is the root cause of errors, the causes of which in reality are more complex."

The task force recommends creating a new state entity -- the Quality Institute -- to receive and analyze data about medical errors.

The institute, which likely would mostly be run by doctors, would decide when and how to intervene with a particular physician. The intervention could include restrictions on the physician's practice or directing him to get additional training in certain procedures.

The institute would meet in private and its actions would be kept confidential, although it would publicly report aggregate numbers on the types of errors reported and actions taken.

Its work would be overseen by the Board of Physician Quality Assurance, the state board that is responsible for licensing and disciplining doctors.

Preston said the system also would encourage "self-reporting" -- as is the case with airline industry workers. A doctor who reported a mistake would not be subject to sanction, but could be referred for disciplinary action if he failed to report a mistake that later came to the institute's attention through other sources.

"We're convinced that this is a reasonable approach," said Dr. Thomas E. Allen, a Baltimore County psychiatrist who headed the task force.

The task force proposal is drawing criticism from some who say it seems more focused on protecting doctors than patients and would be less effective than the current system.

"You do have the issue of will this organization be motivated enough to take action when things need to be done to protect the public," said Dr. Rodney A. Hayward, professor of medicine and public health at the University of Michigan. "Also there is the issue of how can you have public scrutiny of something that's completely secret. For getting rid of bad providers, this is not the best system. There is more benefit to it in finding the problems and fixing them."

Said Daniel M. Clements, a Baltimore malpractice lawyer: "What they are proposing would make the situation worse. It takes the little bit of light that shines on the present process and turns off the light and gives them even less incentive to discipline any of their own.

"The essence of their proposal is to hide the entire medical discipline and evaluation system from the public, from public participation and from the legislature," Clements said. "Basically they are saying, `We're doctors. Trust us.'"

He said doctors have a professional obligation to report errors and "untoward events."

Another Baltimore malpractice lawyer, Philip C. Federico, offered a similar assessment. "If you have someone who repeatedly makes mistakes, they need to be disciplined," Federico said. "What they are talking about is essentially taking away the disciplinary aspects" of the current regulatory system.

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