Florida’s medical boards have taken no action against more than 90 percent of the doctors who lost hospital privileges over the past 20 years, new data show.
Most of the time, state health officials learned about the hospitals’ disciplinary actions and investigated, but the medical boards’ screening panels decided not to pursue charges, according to a letter sent Sept. 14 letter to a consumer group from the chief of the Division of Medical Quality Assurance.
So, under Florida law, the cases remained secret. Members of the public who check the Department of Health's consumer web site would never know that a doctor had lost hospital privileges.
This raises the question: Is the public at risk? Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, says yes.
"When a hospital does something (to a doctor's privileges), it's usually very serious and only after the hospital has done everything it can to avoid it," he said. "That's why it's surprising and unacceptable that Florida hasn't done a better job of disciplining its doctors."
But Florida Hospital Association Vice President Bill Bell said it may not be all that alarming. For example, he said, they could be kicked off staff for failing to show up for meetings, serve rotations in the emergency department, or maintaining their malpractice insurance.
"Physicians can be disciplined and removed from a hospital staff for administrative reasons that have no impact on patient care," Bell said.
Florida DOH's Division of Medical Quality Assurance developed the data over the summer in response to a series of questions from Dr. Wolfe's group. Lucy Gee, the MQA chief, disclosed the results to Dr. Wolfe in a Sept. 14 letter.
The letter was sent to members of the Board of Medicine in September. (Correction: An earlier version of this article incorrectly stated that the letter was not made public. The board discussed the letter briefly during a public meeting in October).
Findings from the research
The National Practitioners Data Bank, operated by the Health Resources and Services Administration, is the repository that states, hospitals, insurers and others check before issuing licenses or credentials. Federal law requires that they report serious disciplinary action against physicians to prevent a negligent, abusive or addicted doctor from becoming a serious health threat.
In March, Public Citizen’s Health Research Group reported that there was a disconnect: Doctors who were showing up in the data bank were not showing up in medical-board actions. Wolfe asked the states to request information from the data bank on actions against physicians taken by hospitals over the last 20 years. They defined serious as either revocation of hospital privileges or a suspension of a year or more.
One object of the exercise was to see whether hospitals were complying with the law on reporting; another was to find out what was happening after states got the reports.
In her letter, Gee disclosed that hospitals had failed to report to DOH 77 physicians who lost privileges. She thanked Wolfe for instigating the study that turned up those missing cases, and said 15 of them are still under investigation.
But her letter revealed something more surprising: DOH knew about most of the loss-of-credentials cases, yet medical boards took no action. (Florida has two: the Board of Medicine and the much-smaller Board of Osteopathic Medicine).
Gee said DOH received reports on 296 of the cases and opened files on all of them. Of those:
--61 were not investigated because they were not “legally sufficient.” Gee cited the law, saying that to be legally sufficient, a complaint has to contain “facts that show that a violation of (state law or rules) has occurred.”
It is not clear why a case serious enough to lead to loss of hospital privileges would not meet the legal sufficiency standard. Gee provided no details.
--The DOH staff investigated and presented 235 cases to a medical-board committee for screening. These committees are called “probable cause panels” because they decide whether there is sufficient evidence to believe there was a violation of the Medical Practice Act.
The panels usually consist of two doctors and one “consumer” member, all of whom serve on the board or were members in the past.
--Only 19 of the cases, or 8 percent, were deemed to have “probable cause.” In those cases, an administrative complaint was filed, at which point they became public.
--The other 92 percent of the cases, involving 216 physicians, never became public. Gee said 49 of those physicians received a “letter of guidance,” which is “non-public.”
--Some kind of disciplinary action, such as a fine or probation, was taken in the cases of 14 physicians, or 6 percent. No details were contained in the letter.
Letter mentioned at hearing
The letter from Florida came up when Wolfe testified on Thursday before a board that sets policy for the National Practitioners Data Bank.
The public is not given access to information in the data bank, but until recently, some data were available, with the names of the doctors stripped off. The physicians were identified only by numbers.
After a reporter in another state matched some of the information from the public-use data with court records and other public documents and published a story, the surgeon he wrote about complained. A federal official responded by taking down the public-use data.
A number of media groups complained, including the Association of Health Care Journalists. (Disclosure: This reporter, as well as two members of the board for Health News Florida, are members of that association.)
Wolfe appeared before the panel that sets policy for the data bank on Thursday to urge restoring the public-use records. He said they enable his group to monitor how well state medical boards do their jobs of protecting the public from physicians who are impaired, incompetent or negligent.
Each year Wolfe's group releases a report that rates state medical boards on how well they protect the public. Florida always ranks near the bottom.
During his testimony, Wolfe mentioned that Florida had written a letter saying: “We appreciate Public Citizen offering us the opportunity to research the data to provide an analysis and response …We look forward to continued cooperation … on data sharing.”
--Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Carol Gentry, Editor, at 727-410-3266 or by e-mail.
