Rx for lawmakers:

Tighten medical oversight ...

Heal thyself: The way the state disciplines errant doctors, patients may be the losers.

March 19, 2002

IN MARYLAND, doctors essentially police themselves, with the state medical society playing an unusually big role in investigating complaints and disciplining errant physicians.

State Sen. Paula C. Hollinger aptly likens this cozy relationship to "the fox guarding the henhouse." It's an apparent conflict of interest in which patients are the potential losers, and unfortunately it may well continue.

Senator Hollinger has been backing legislation to diminish the medical society's role as the watchdog of its own members and to lower the state's high standard of proof for disciplinary actions against physicians. In a critical report last fall, independent legislative analysts agreed these changes are in order. But after strong lobbying by MedChi, as the society is known, the senator's bill is stalled.

In any case, the General Assembly must act on this issue this session or next. Authority for the state physician regulatory board expires after June 2003 without new legislation.

The major point of friction involves the society's opposition to lowering the threshold of proof employed by the physicians' board in weighing disciplinary actions - changing it from finding "clear and convincing evidence" that treatment standards were not met to a "preponderance of the evidence."

The Maryland board now uses the tougher standard. But about two-thirds of all states do not. And when it comes to holding other health professionals - such as nurses - accountable, Maryland uses the lower standard.

The outcome, legislative analysts found, is that the board has been taking fewer disciplinary actions against doctors, even as complaints have risen. Not surprisingly, MedChi says nothing's broken and the state ought to focus on re-educating, not punishing, doctors who make mistakes.

That's a good long-range goal. Meanwhile, legislators should reduce MedChi's role in the regulatory system and make the board use the looser standard of evidence for disciplinary actions. The need for this was first spotlighted last year by Sun reporter Greg Garland's articles about a Baltimore doctor who racked up 18 malpractice lawsuits in 20 years, paying out more than $2 million - without any state disciplinary actions.

If nothing's changed, we can look forward to more doctors with such scary track records.

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