Study urges doctor reform

Legislative analysts support changes in discipline process

`Backlog of cases'

Md. medical society against proposals limiting its role

November 08, 2001|By Greg Garland | Greg Garland,SUN STAFF

Legislative analysts are recommending major changes to the way Maryland regulates and disciplines doctors -- at a time when that system is under increasing public scrutiny.

In a report to legislators made public yesterday, analysts outlined a series of proposals, including limiting the role that the state's professional medical society plays in the disciplinary process.

The report also criticizes the state's Board of Physician Quality Assurance, which oversees doctor discipline, for taking fewer disciplinary actions against doctors in recent years even as the number of complaints increases.

"The decline in disciplinary actions taken by the board ... is seen by many as a de facto sign of the board's inability to fulfill that part of its mission related to protecting the public," the report says.

Analysts say the board's disciplinary work "is perhaps its most visible and scrutinized activity. Indeed, the writing of this review has been set against the backdrop of both national and local media reports concerning medical errors and physician discipline."

The report -- written as a "sunset review," or periodic evaluation of state agencies -- comes less than two months before a General Assembly session during which key legislators in health care matters have vowed to tackle doctor regulation.

It also follows a Sun article in July that raised questions about weaknesses in the regulatory system.

The article focused on a Baltimore obstetrician-gynecologist, Dr. Ghevont W. Wartanian, who has faced 18 malpractice suits in the past two decades, nine of which led to total payments of more than $2 million. Wartanian, who says he practices sound medicine, has never faced disciplinary action or had his practice restricted, records show.

The analysts' report released yesterday says that resolving complaints against doctors is taking far too long -- often more than two years.

"The board is again accumulating a significant backlog of cases, with 503 complaints pending at the end of fiscal 2001 compared to only 99 at the end of fiscal 1998," the report says.

The number of formal actions against doctors dropped from 113 in fiscal 1998 to 69 this year, the report says.

The report recommends making several changes to state law so regulators can more easily pursue cases against doctors accused of wrongdoing or providing negligent or substandard care.

T. Michael Preston, executive director of the state's medical society -- the Medical and Chirurgical Faculty of Maryland, or MedChi -- said the group strongly opposes some of the report's recommendations, which would lessen MedChi's role in the disciplinary process.

"The concern we have with many of the recommendations is that they come at too high a cost in terms of due process and assuring that the review of complaints that are [against doctors] is fair and objective," Preston said.

MedChi plays a key role in handling allegations of substandard or negligent care. By law, the Board of Physician Quality Assurance must refer such cases to MedChi for peer review.

The society solicits two physicians to review the case. The board typically takes disciplinary action only if both reviewers agree that the physician failed to meet accepted standards of care.

The analysts' report recommends that the society use only one peer reviewer. It also suggests that state law be changed to allow the board "to competitively contract with an outside body or bodies to conduct peer review."

In a response to the report, MedChi says it strongly opposes both measures.

MedChi says requiring two peer reviewers is appropriate. "Medicine is not an exact science and specialists can disagree legitimately on what the standard of practice requires," MedChi writes in its response. "Academic studies have shown significantly increased reliability coming from the use of multiple reviewers."

MedChi also argues that it should retain its role in overseeing peer reviews, rather than allowing that responsibility to be shifted to "paid experts-for-hire." The group also says national rankings show that Maryland does a good job of handling complaints involving negligent and substandard care.

Several key legislators in health care issues have said they favor removing MedChi from handling peer reviews. They say such reviews should be done by an independent body.

Daniel M. Clements, a Baltimore malpractice lawyer who has been pushing for system reforms, said he thought many of the report's recommendations were good. "There are dramatic changes that are being proposed which would seriously alter the process," Clements said.

At its convention in September, MedChi voted to propose a different system for disciplining doctors in Maryland.

The society argues that a less punitive system not focused on sanctions will encourage more thorough reporting of medical mistakes. The MedChi proposal would protect physicians who report their errors from facing punitive action.

Depending on the error, a physician could be directed to be retrained in a certain procedure or have his or her license restricted. A physician who failed to comply would be reported to the state's disciplinary board for possible sanctions.

The MedChi proposal got a generally cool reception from legislators who have been working on health care reform.

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