A patient is examined by his doctor in California. (Mel Melcon / Los Angeles…)
California's medical board failed to discipline 710 troubled doctors even as they were disciplined by hospitals, surgical centers and other healthcare organizations in the state, according to a report released Tuesday.
The report by Washington, D.C.-based nonprofit Public Citizen was based on an analysis of doctors' records in the National Practitioner Data Bank from 1990 to 2009. The Department of Health & Human Services uses the data bank to track doctors' discipline, medical malpractice payments and other actions. The data released to Public Citizen did not name the doctors or their workplaces.
Of the doctors who escaped state discipline in California, 35% had racked up more than one disciplinary action from another entity, according to the report.
"If the hospital or HMO has taken action, why hasn't the board?" asked Dr. Sidney Wolfe, director of Public Citizen's health research group. "That's something that as a physician or a patient I would be worried about. Hospitals rarely discipline doctors. When they do, it's usually for very serious infractions."
Jennifer Simoes, a Medical Board spokeswoman, said officials have reviewed the report but more analysis is needed.
"We believe more data needs to be obtained, but like many state agencies, we have a 20% vacancy rate and we're trying to focus on our core functions," she said, noting that board officials had been contacted by Public Citizen about investigating the report's findings. "We told them we would do it when we had the resources." She said a state hiring freeze contributed to other deficiencies noted in the report.
At least 102 of the doctors who escaped discipline in California had their privileges to practice at a given facility suspended, limited or revoked after peer reviews, according to the report.
The report described some California cases without identifying the doctors involved, including:
*A surgeon who was disciplined three times in 2007 and 2008 had eight malpractice payments from 1991 to 2008 totaling $2 million, including a misdiagnosis and failure to perform a procedure.
*A doctor who was disciplined six times from 2005 to 2009 had his privileges suspended for providing substandard care and was considered "unable to practice safely." He had his privileges suspended in 2009 for posing an immediate threat to health or safety.
*A doctor who faced discipline in 1991 subsequently had 15 medical malpractice payouts totaling about $1.9 million between 1993 and 2009, including two cases involving an object left behind after surgery and a separate case in which a patient suffered significant permanent injury.
California's Medical Board has done a less thorough and timely job of disciplining doctors than other states', according to the report. California's board ranked 35th in the nation for the rate at which it disciplined doctors, down from 27th five years ago, according to Public Citizen.
It took board investigators more than 400 days on average to complete an investigation, according to the board's most recent annual report. State law mandates that the board take no more than 180 days.
"The board at one time was one of the better ones in the country. They've slipped down and down," Wolfe said.
Wolfe sent a letter Tuesday urging Gov. Jerry Brown to investigate the findings and adopt an independent monitor's recommendations from six years ago to fill staff vacancies and transfer board investigators to the attorney general's office, where they could work with prosecutors.
A spokeswoman for Brown's office said the governor planned to review the report.
The Medical Board is funded by doctor licensing fees, with a proposed budget of $55 million this year. Brown wants to borrow $9 million from the board this year to help fill the state budget gap.
"It won't contribute to the backlog because, in the event we did see an effect, we'd repay it," Brown spokeswoman Elizabeth Ashford said.
Gov. Arnold Schwarzenegger borrowed $6 million from the board in 2008 to balance the budget, a move the California Medical Assn. unsuccessfully sued to overturn. The money was never repaid, Simoes said.