Great Falls Tribune Article

August 23, 2005
Section: Your Health
Page: 3-4YH

DOCTOR DISCIPLINE
Richard Ecke
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.

PHOTO CAPTION

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 impossible."

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 Washington, D.C.

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 Bischoff's fate.

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 doctors.

Reforms urged

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 pro-doctor groups.

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 said.

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 performs nationwide.

"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.

Views clash

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 doctors.

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 the list.

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 said.

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.

Future

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 Bismarck, N.D.

"It's never a happy ending," Willner said. "All of these guys have post traumatic stress syndrome."

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 accepted.

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: www. discoveringmontana.com/dli/bsd/license/license.asp

· Public Citizen: www.publiccitizen.org and www.questionabledoctors.org

· North Dakota controversy: www.briangale.com

DOCTOR DISCIPLINE Richard Ecke Staff, Great Falls Tribune