Doctor discipline

March 18, 2003

A YEAR AGO, this page backed state Sen. Paula C. Hollinger's efforts to improve the state board that investigates complaints against Maryland's doctors and disciplines them. The Baltimore County Democrat's bill to wrest control of this oversight from the state medical society got very little traction in last year's legislative session.

To her credit, Senator Hollinger isn't giving up, and this year - because the physician board expires in June if there's no renewing legislation - her bill has more of a tailwind. But given the considerable financial clout of the state medical society, known as MedChi, changing the doctor disciplinary system remains an uphill battle.

That's a shame, because the problem hasn't changed: Maryland essentially allows its doctors to police themselves - and that's led to a doctor-friendly process of investigating and acting on complaints against physicians.

MedChi members hold most seats on the state Board of Physician Quality Assurance. When the board gets complaints about substandard care, it turns the investigations over to MedChi, which hires two specialists to conduct a peer review. Both reviewers must agree for cases to lead to formal charges and hearings.

And here's the rub: In those hearings, the board must find "clear and convincing evidence" of unacceptable care before it can impose disciplinary actions - the highest threshold of evidence, and one that many believe leads to too many cases of poor care going unaddressed.

Senator Hollinger's bill would lower the required burden of proof to "the preponderance of evidence," a test used by medical boards in two-thirds of the states and for other medical professions in Maryland. It also would increase the size of the board, adding more consumer representatives and limiting MedChi's role. And it would allow the board to contract with nonprofits other than MedChi to investigate complaints.

The clock is ticking with MedChi and Senator Hollinger at loggerheads over the evidentiary threshold. MedChi says the problem is more education, not discipline. But the senator says she'd rather let the board die and give its other functions to the state health secretary than retain the "clear and convincing" standard.

At this juncture, public interest is best served by her position - by forming a stronger, more independent board - and other legislators should stand with her in the face of medical society lobbying for the status quo.

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