Despite massive publicity in the last decade about attempts to reduce the number of incompetent doctors in practice in the United States, state licensing boards took serious action against just 563 physicians in 1983--but victims of injury and death caused by physicians have been alleged to number from 136,000 to 310,000.
Moreover, this problem of alleged pervasive incompetency has been overshadowed as organized medical groups have induced state legislatures to focus instead on sharp hikes in medical malpractice insurance.
Debate Over Cause
As a result, a Ralph Nader group charges in a new report, the debate over malpractice problems has ignored the underlying cause of the crisis--too much poor medicine practiced by too many doctors.
Responding to the Nader analysis, however, a top official of the American Medical Assn. asserted there is no necessary link between the rates of doctor discipline and the number of people killed or injured by malpractice. And, he added, the AMA has been among those advocating more stringent disciplinary procedures for erring physicians.
Nationwide, the Nader group contends, only 1.45 of every 1,000 doctors delivering care in facilities not owned by the federal government were subjected to serious discipline in 1983. There were 389,467 non-federal doctors in 1983. "In summary, there is a tremendous and dangerous gap between the amount of malpractice . . . and the amount of doctor discipline," the Nader report, which included the estimate of malpractice victims, concluded.
The Times separately obtained comparable figures for 1984, which indicate some increase in serious disciplinary actions--but only to an average of 1.85 per 1,000 doctors.
In California, a crisis a decade ago led to work stoppages and slowdowns by physicians protesting large increases in malpractice rates.
The protest prompted legislation that greatly expanded the Board of Medical Quality Assurance--the major doctor discipline agency here--but also accorded doctors special treatment in lawsuits, limiting the amount for which they could be sued and imposing other restrictions on the right of patients to recover damages.
New York 34th in Discipline
In fact, the new Nader tabulation indicates that many states affected by the insurance crisis recorded the lowest rates of serious disciplinary actions in the country.
New York, for instance, ranked 34th among the states in the vigor of its physician discipline. Illinois ranked 36th and Massachusetts ranked 41st--revoking the license of just one of its 13,697 doctors in 1983.
The implication, argued Nader's Washington-based Health Research Group, is that premiums may be driven up not by greed by lawyers and patients or defects in the court system but because medical boards are still failing to detect and put out of business doctors whose ineptitude hikes rates for all physicians.
Medical groups, however, were quick to dispute the alleged relationship between the number of physicians who may warrant license action and the number and amount of malpractice judgments.
California's chief of medical licensing, for instance, contended that few malpractice suits produce evidence that can be used to revoke a physician's license and, conversely, that many of the worst doctors are seldom sued--possibly because they have been canceled by insurance carriers or simply don't bother to seek coverage.
Even states--led by California--that have moved most aggressively to find and put out of business the worst of their physicians still discipline far too few doctors, the Nader group charged. And despite its reputation as a vigorous pursuer of incompetent doctors, California ranks only 11th among the 50 states in serious disciplinary actions taken against its physicians in 1983, the year selected for analysis by the Nader researchers.
In this ranking, California took the three most serious types of license action--revocation, suspension or probation--against only 117 of its 50,981 physicians, according to the Nader tabulation. The number translates to 2.29 actions for each 1,000 physicians in the state.
How States Ranked
The total put California well behind such states as first-place Utah, which issued serious sanctions against 12 of its 2,306 doctors (5.2 per 1,000 physicians), and third-place Florida, which moved against 71 doctors of 17,105 (4.15 per 1,000)--revoking the licenses of 36 to lead the nation in that category. Nine states--Delaware, Vermont, Montana, Idaho, New Hampshire, Rhode Island, West Virginia, Kansas and Alabama--along with the District of Columbia took no serious actions at all.
Nevertheless, the Nader report cited Florida, Kentucky and California--three states that have beefed up their disciplinary agencies--as among the most vigorous in the country.