Doctor reform dealt a blow

Delegates reject change in discipline of Md. physicians

Senator decries action

House weakens language aimed at increasing sanctions

March 24, 2002|By David Nitkin | David Nitkin,SUN STAFF

State delegates rejected yesterday a major change to the way Maryland disciplines its doctors, leading a key legislator to declare that a much-discussed reform effort has perished for the year.

"It's a dead bill," said Sen. Paula C. Hollinger, a Baltimore County Democrat and a leading advocate of reform of the system for punishing doctors. "There's no sense in passing legislation that doesn't protect the public."

Hollinger is the Senate sponsor of a bill that seeks to change the way the state Board of Physician Quality Assurance investigates and disciplines physicians accused of harming patients.

Few Maryland doctors are disciplined, critics say, because the standard of proof is too high, and because the panel that conducts reviews is dominated by medical professionals who might be reluctant to act against their colleagues.

Under current law, the peer review hearing - a component of the state board's function - is the sole province of the Maryland State Medical Society, or MedChi, which some say wields disproportionate influence on behalf of its members.

Legislative reform proposals follow a Sun article in August that raised questions about weaknesses in the regulatory system. The story detailed the case of a frequently sued Baltimore doctor who has never faced disciplinary action.

Additionally, a report from legislative analysts released last fall described the current system as inefficient and ineffective, noting that the number of disciplinary actions against doctors has fallen in recent years as the number of complaints has increased.

Yesterday, the House of Delegates considered its version of the reform bill that would, in part, have changed the standard for a discipline case from "clear and convincing evidence" to a "preponderance of evidence" - a less strict requirement that could have led to more frequent sanctions against doctors.

Doctors say the latter standard is too loose and is typically used in civil cases. In lay terms, they say, "preponderance of evidence" means that a jury is 51 percent certain of guilt, compared with "clear and convincing" evidence, which requires 70 percent certainty.

Del. John S. Arnick, a Baltimore County Democrat, sponsored an amendment to keep the "clear and convincing" language unchanged in state law, and it passed 70-53.

The amendment weakening the bill was approved after heavy lobbying by MedChi, one of the state's most active political contributors. Its political action committee has given more than $123,000 to state lawmakers and other candidates for office during the current four-year election cycle, according to the Maryland elections board.

The medical society argued that because doctors' licenses are difficult to obtain, they should be equally hard to take away.

The Hollinger bill remains in committee. But the senator said the House action "guts the bill," because it removes the most significant component of the reform effort. Her bill, too, would be subject to the same lobbying, she said, and was not worth passing in such an altered state.

"I would say the public should be very concerned about this," Hollinger said, because it appears likely that the physician review system will remain largely unchanged and allow problem doctors to continue practicing."

Yesterday's House vote was a victory for the state medical society, which was distributing fliers in the morning urging delegates to vote with Arnick.

"MedChi was all over the House office building," said Del. John Adams Hurson, a Montgomery County Democrat and the House sponsor of the legislation.

Arnick rejected the notion that his amendment killed the bill's chances for the year. "If that's what [Hollinger] wants to do, fine," he said. "The bill does a lot of other good things."

The House bill - which, with the Arnick amendment, is expected to pass in the full House tomorrow - would add more consumers to the physician review board and would allow the panel to contract with someone other than MedChi for peer review evaluations.

Arnick said it was unfair for doctors to risk losing their licenses based on the lower standard of proof.

Hurson said that despite the amendment, which he opposed, other components of the House bill have merit.

Under state law, the physician review board is scheduled to "sunset," or cease operating, on June 30, 2003. The bills sponsored by Hurson and Hollinger would reauthorize the board for five years, with some changes.

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