Physician discipline plan draws criticism

But bill's sponsor says major change is unlikely

February 21, 2002|By Greg Garland | Greg Garland,SUN STAFF

A legislative proposal to change the way Maryland disciplines doctors drew criticism yesterday from doctors, the state board that regulates physicians and a leading reform proponent.

All called for major amendments, some of which the bill's sponsor, Sen. Paula C. Hollinger, said would serve to "gut" the legislation. However, she said she is confident that major portions of the bill will survive as it winds its way through the legislative process.

"There is room for change here, but no substantial change," said Hollinger. "My feeling is that any changes that are made would be to improve the legislation, as opposed to changing the intent."

The legislation -- the subject of a three-hour debate yesterday before the state Senate's Education, Health and Environmental Affairs Committee -- generally would make it easier to discipline physicians who harm patients. It also would limit the key role that the state's professional medical society, known as MedChi, plays in the disciplinary process.

Physician discipline in Maryland is handled through the 15-member Board of Physician Quality Assurance. Its members include 12 doctors, two consumer representatives and a hospital administrator.

Among other changes, Hollinger's bill would eliminate a requirement in state law that puts MedChi in charge of "peer reviews" of any physicians whose practices are called into question. The society solicits two physicians to do such reviews and, generally, both must agree that the physician has breached accepted standards of care before the board pursues disciplinary action.

Hollinger's bill would allow the board to contract with other entities to conduct such peer reviews, although some legislators at the hearing expressed concerns about the costs of such a change.

The bill also would require posting on the Internet of malpractice settlements and judgments against doctors of more than $150,000, as well as details of disciplinary actions taken by hospitals.

The legislative reform proposal follows a Sun article in August that raised questions about weaknesses in the regulatory system. The story detailed the case of an often-sued Baltimore doctor who has never faced disciplinary action.

Legislative analysts later issued a critical report that recommended a major overhaul of the system to make it more effective.

Those and other major changes drew opposition from the state medical society and the physician quality board. "We are happy with the present [peer review system]," board chairman Samir Niemat told the legislative panel. "MedChi has done a professional job and has been fair to physicians and complainants."

Hollinger, noting the legislative analysts' call for major changes in the system, expressed frustration at the board's opposition to all of the bill's major provisions.

"Our job is to protect the consuming public, and many of us felt we could do a better job," she said. "To come in and say, `Forget the report, we know what is best for us' ... that's why we have licensing boards, so that you know somebody is trying to protect you."

The bill also got mixed reviews from Daniel Clements, a Baltimore malpractice lawyer who has called for reforms of the disciplinary system. He said he strongly supports taking MedChi out of the peer review process but opposes other elements of the bill, such as adding six more physician members to the physician quality board.

He said doctors don't want to have to take disciplinary actions against colleagues, regardless of how bad they might practice medicine or how many patients they might harm. "The mindset is there is no such thing as a doctor who can't be rehabilitated," Clements said. "To add six more doctors is bad. What about consumers?"

Clements noted that the House version of legislation to reform doctor discipline would add five more consumer members to the physician quality board. A hearing on the House version is set for 1 p.m. today. The Senate committee's chairman referred the Senate version of the bill back to a subcommittee for further work.

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