As Maryland legislators begin hearings this week on reforms to the state's system for disciplining doctors, they are confronting a problem that has bedeviled other states throughout the nation for years: What is the most effective way to protect patients from medical errors that cause serious injury or death?
The debate pits the state's medical society -- MedChi, which now plays a major role in the state regulatory process -- against those who want to make it easier to pursue cases against doctors accused of wrongdoing or of providing negligent or substandard care.
Legislators are considering ways to foster a more vigilant, aggressive disciplinary board that will hold doctors accountable when they make mistakes that cause harm. But MedChi contends that such a punitive system discourages reporting errors that need to be dealt with in a more methodical way.
The legislative review is the first intensive scrutiny of the physician disciplinary system since it underwent a major restructuring in 1988, and the stakes are high -- for the more than 10,000 practicing physicians in Maryland, and for the hundreds of thousands of patients they treat. At issue, say critics of the present system, is whether Maryland's doctors will be allowed to continue essentially policing themselves.
Dale L. Austin, who heads a national association of medical regulatory boards, says most states throughout the nation are struggling with the same issues. "I think everybody wants to minimize errors and improve their system," Austin said. "There isn't a simple answer."
Maryland policy-makers will begin their search for the answers Tuesday, as the House Environmental Matters Committee considers proposals for major changes to Maryland's current system for disciplining doctors.
The review was prompted by a Sun article published in August that exposed problems with the system and by a critical report issued by legislative analysts last month. Both reports focused on the work of the 15-member Board of Physician Quality Assurance, responsible for licensing and disciplining doctors in Maryland.
Del. John Adams Hurson, the House majority leader and chairman of the committee overseeing the physician quality board, says legislative changes in the board's operations clearly are warranted. "The current system is not working well, and we need to fix it," said Hurson, a Montgomery County Democrat.
In response to rising legislative interest in trying to change the way the board operates, MedChi tried to get out in front of the debate with its proposal -- for a shift to a nonpunitive system. But that is likely to be a tough sell for legislators.
"The effort of the medical profession to deflect this review by talking about the industrywide problem [of medical errors] is not going to succeed," Hurson said. "They need to tackle the specific suggestions that have been made and deal with them."
Sen. Paula C. Hollinger voiced similar views. The Baltimore County Democrat is chairwoman of a Senate subcommittee that will hold a hearing Dec. 11 on proposals to change the workings of the physician quality board. "There need to be some very dramatic changes," she said. "Our job is to be there to protect the public."
Complaints have increased
Legislative analysts describe the current system as inefficient and ineffective, noting that the number of disciplinary actions against doctors has fallen in recent years -- even as the number of complaints has increased.
Their report was made after a Sun article in August that focused on the case of a Baltimore physician who has never faced disciplinary action or a restriction of his practice despite 18 malpractice suits during the past two decades -- half of which led to payments that total more than $2 million.
In their report, the analysts propose changing state law so regulators can more easily pursue cases against doctors accused of wrongdoing or providing negligent or substandard care. The analysts also recommend limiting the role that MedChi plays in the disciplinary process.
Dr. Samir R. Neimat, chairman of the physician quality board, says that he thinks it does a good job overall and that major changes are not needed. "I don't think that the system is broken," Neimat said. "Of course, there is always room for improvement."
But the proposed legislative reforms were lauded by Dr. Cheryl E. Winchell, a former member who served on the physician quality board for nine years. She says one of the most important steps policy-makers can take is to end MedChi's involvement in the disciplinary process, which she considers a conflict of interest.
"MedChi doesn't want the board to do a good job," Winchell said. "Having a trade society involved in the process has not worked well. The proof is in the numbers."
`A better product'