State regulators say their investigation of a Maryland physician who has been sued 18 times for malpractice uncovered no problems that would warrant taking any disciplinary action against the doctor.
The target of the review was Dr. Ghevont W. Wartanian, an obstetrician/gynecologist who practices at Harbor Hospital in Baltimore. He was profiled in an article in The Sun in August that examined weaknesses in Maryland's system for regulating doctors.
The article revealed how Wartanian had never faced disciplinary action or restrictions on his practice, despite 18 lawsuits over the past two decades - nine of which led to total combined payments of more than $2 million.
The state decision comes as the General Assembly is considering bills to change the way that Maryland regulates doctors, particularly by reducing the strong role played by the state medical society in assessing whether disciplinary actions are warranted.
Wartanian said yesterday that he was not surprised by regulators' decision to close the case without taking action against him.
"I didn't have any doubts about the outcome," said Wartanian, who maintains that he practices good medicine. "Anybody with medical judgment will never, ever put a finger on me. ... I know my charts are clean. Anyone looking at them will see how much I care about my patients."
The review of Wartanian's medical practices was prompted by a complaint filed in June 2000 by Daniel M. Clements, a Baltimore malpractice lawyer. He noted the string of malpractice suits against Wartanian, including one that led to a $1.5 million jury verdict against Wartanian.
In his complaint to the Maryland Board of Physician Quality Assurance, the state board that is responsible for licensing and disciplining physicians, Clements called for a thorough investigation of Wartanian.
Clements was notified in a Feb. 20 letter signed by the board's chairman, Dr. Samir R. Neimat, that the investigation had been completed and that no action was found to be warranted.
Neimat noted that the board, by state law, must refer any "standard of care" complaint to the state's medical society, known as MedChi, for review. MedChi then solicits two physician volunteers who do "peer reviews" in such cases, which involve questions of a doctor's professional competence.
Neimat wrote Clements that the board "relies on the work and advice of the physicians who review these cases. Based on their report of the review, the board decided to close the [Wartanian] case without formal action."
Clements said the board's failure to act in Wartanian's case illustrates a need to change the state's regulatory system to better protect the public.
"One of the flaws in the regulatory system is the total dependence on the state medical society, which seems to have little interest in disciplining their own members," Clements said.
The General Assembly is considering legislative proposals that, among other things, would limit MedChi's role in the disciplinary process.
Sen. Paula C. Hollinger, sponsor of the Senate version of the legislation, said she found the cases involving Wartanian, as outlined in The Sun's article Aug. 2, disturbing.
Hollinger, a Baltimore County Democrat, questioned the board's failure to act.
"It just looks egregious that nothing has been done," she said, "The bottom line is, if this is not a case for discipline, then what is?"
C. Irving Pinder Jr., executive director of the physician quality board, said he and other regulatory officials are not permitted by state law to talk about investigations of doctors unless they lead to some formal disciplinary action.
T. Michael Preston, MedChi's executive director, said he did not know the specifics of what regulators examined in investigating Wartanian.
However, he said, the number and results of malpractice cases filed against a physician are not good indicators of his or her level of professional competence.
"A case may have been settled for any number of reasons, and OB/GYN is a high-risk practice," Preston said.
Preston also defended MedChi's handling of peer reviews for the physician quality board. Such peer reviews can be of an individual incident or a practice review that involves looking at several cases a doctor has handled.
Peer reviewers "call them as they see them," Preston said, and often find that doctors have not met standards of care.
About half of the broader practice reviews result in a finding that standards of care were not met, he said. In the rest, reviewers found the doctors were not at fault or stopped short of a finding.
"The evidence suggests that it is a fair and accurate process," Preston said of the MedChi review process.