|August 23, 2005
Section: Your Health
Staff, Great Falls Tribune
State medical board keeps close watch
Consumer group rates Montana among 10 best states
for protecting its citizens
Stories and photo by RICHARD ECKE
Tribune Staff Writer
During the late 1990s, consumer group
Public Citizen rapped the Montana Board of Medical
Examiners for being too lax in regulating doctors.
Richard Willner, executive director of the
Louisiana-based Center for Peer Review Justice,
says, "The law does not require every patient to get
Mercedes Benz standard of care. It's absolutely
For the last three years, however,
Public Citizen included Montana among the 10 best,
based on the rate of doctors disciplined - 6.4
actions per 1,000 doctors from 2002 to 2004.
"Montana has a relatively good
medical board," says Dr. Sidney Wolfe, an M.D. who
directs Public Citizen's Health Research Group in
Jeannie Worsech, executive
director of the Board of Medical Examiners in
Helena, said the board and its staff want to "do the
job for Montana citizens. We're not trying to do
more or less."
Less was the case in 1998, when
complaints against doctors dropped to 75, the only
year since 1997 when complaints fell below 100,
according to Montana Department of Labor figures.
Worsech inherited a backlog of
cases when she became the board's executive director
in December 2001. "We were about 450 complaints
behind," she said.
A reorganization helped change that,
creating a state complaint unit that handles
complaints in 21 state boards and programs.
"We're currently up to date"
thanks to great work from the unit's workers, she
said. The board decided at least 40 complaints per
year from 1997 to 2004.
One of Montana's most notorious
doctors these days is Ennis physician James Stephen
Bischoff, who faces a murder charge for allegedly
giving an 85-year-old patient a lethal injection.
While out on bond, he was arrested on charges of
robbing a bank in Rexburg, Idaho. Courts will decide
Most complaints against physicians
are less bizarre, running the gamut from poor
aftercare or botched surgeries to performing
unnecessary work. Montana has 2,204 practicing
While Montana has raised the status
of its medical board, a nationwide system for
investigating doctors, dentists, osteopaths and
podiatrists has come under criticism from several
Richard Willner, president of the
Center for Peer Review Justice in the New Orleans
area, said he is appalled to see "how easy it is to
discipline a doctor," and how careers can be ruined
by one complaint. "There's no question that it's gone
too far," Willner said in an interview.
Such contentions draw an
incredulous response from others, including Public
Citizen, a group that has campaigned for tougher
treatment of poor doctors.
"It's quite the other way around,"
Wolfe said. He said a doctor typically must commit
many offenses before facing discipline by a hospital
or state medical board, and some escape even then.
Wolfe said a Corpus Christi,
Texas, doctor "admitted to having sex with 16 of his
patients and (is) still practicing." Only about 1 in 10 physicians is
disciplined for sexual offenses toward patients, he
Susan Miller, program director for
Colorado's medical board, laughed at the notion that
disciplining a doctor is easy. "It is not easy and it is not quick,"
Miller said flatly.
Opinions vary widely on how well the system
"It's a very poor system," said
Edward H. Dench Jr., an anesthesiologist in State
College, Pa. Two years ago, the onetime president of
the Pennsylvania Medical Society pushed for a law
calling for statewide review boards to handle
complaints against physicians, rather than using
local boards that might be biased.
Legislation sailed through the
Pennsylvania House, but stalled and died in the
Senate, after heavy lobbying by hospital interests,
Dench said. Dench would like to see national review
boards to ensure doctors reviewing the work of other
doctors are impartial.
A few years ago, Montana peer reviews
of doctors often were done by other Montana doctors,
but today's reviews are routinely performed by
out-of-state physicians, under contract with a
private firm, Worsech said.
Such out-of-state critiques are
more in line with what Dench favors. Even Wolfe said a state or national
approach to peer review would be fine.
Dench said groups are popping up
across the country, suggesting reforms for the
doctor discipline system.
Willner has consulted with former
Great Falls physician Jake Allen, who for much of
the 2000s battled with Benefis Healthcare and state
regulators over four cases in which he allegedly
provided substandard care. Allen eventually quit
practicing medicine to go to law school in Michigan.
Physicians often are startled to
face complaints, Willner said.
"They think that they will present
their defense and everything will be OK," Willner
said. But that's not always the case. Some of them
lose their licenses and their careers.
If physicians are turning a more
critical eye on the system, others think states
should be even tougher on doctors.
Public Citizen rates state medical
boards based upon how aggressively they regulate
Consumer groups also have pushed to
gain easier public access to complaints against
physicians. Some Internet sites post ratings of
doctors, based in part upon disciplinary actions or
lawsuits against them. Some state medical board Web
sites post details of disciplinary action on its
sites; Montana's site asks consumers to call the
board's Helena office to get details.
Wolfe said the National
Practitioner Data Bank, which lists physicians
subjected to discipline, should be available to
other doctors and the public. He said the American
Medical Association pushed to make it secret,
threatening to kill legislation that first created
Few state medical boards discipline
physicians aggressively, and even fewer hospitals
do, Wolfe said.
"In 15 years, the majority of
hospitals have never disciplined one doctor," Wolfe
Getting a balance
A few decades ago, physicians may
have been less inclined to want to see other doctors
disciplined, according to Great Falls gynecologist
Peter L. Burleigh, who served on the Montana Board
of Medical Examiners from 1988 to 1992.
"I think physicians tend to want
to protect their own," he said. However, by the 1980s, consumer
groups and activists clamored for greater oversight
of physicians. "They felt there should be more
active discipline," he said.
Burleigh said the state medical board
took its role very seriously. "The board's first obligation is
to protect the public," Burleigh noted.
Government also responded with a
Federal Health Care Quality Improvement Act of 1986,
which set up the data bank and prescribed a
disciplinary system for doctors, dentists and
podiatrists. States still would play their roles of
licensing and regulating the medical community.
Over the years, the system has
seen abuses, Willner said. He cited cases of a
hospital stripping doctors of privileges after
physicians launched a competing surgery center. A
different hospital filed a complaint against an
established physician to help the practice of
another doctor recruited to a community, he said.
"Obviously, it's not a perfect
system," said Great Falls attorney Neil Ugrin, who
represents hospitals in Montana, including Benefis
in Great Falls. But he said patients have a right to
expect they will be protected.
Willner got his start with a case
involving a North Dakota podiatrist, Brian Gale, who
was brought before the state Board of Podiatry for
discipline. The state board president, Dr. Aaron
Olson, was Gale's former employer, and the
relationship was acrimonious.
Gale finally prevailed in a bitter
10-year battle after Willner entered the fray. The
North Dakota Board of Podiatric Medical Examiners
finally dropped the case in February 2003 after both
sides were nearly bankrupt.
Gale's case attracted attention from
other podiatrists, medical doctors and the media.
Eventually, outside pressure helped push podiatry
board members out, and brought new members in.
"We got rid of every one,
including the lawyer," Willner said.
Gale continues to practice in
"It's never a happy ending,"
Willner said. "All of these guys have post traumatic
How to file a complaint
To file a complaint against a Montana
physician, visit www.medicalboard.mt.gov on the
Internet and download a complaint form, or call
(406) 841-2362. Only written complaints are
ON THE INTERNET
· Montana's Board of Medical
Examiners regulates doctors; visit www.discovering
montana.com/dli/ bsd/ license/bsd_boards/ med_board/board_page.asp
· For information on boards
overseeing health professions in Montana, visit:
· Public Citizen:
· North Dakota controversy:
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All rights reserved. Reproduced with the permission
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Record Number: grt2005082414401678