Why isn’t California disciplining its dangerous doctors?

Until he was banned in California from operating in 1967, Dr. Walter Freeman performed over 3,500 "ice pick lobotomies" through his patients' eye sockets.

You’d like to think that the doctor trusted to make treatment decisions for you or your family members would be in big trouble if he/she were found guilty of practice violations like “delivering substandard care, wrongly diagnosing surgical patients, improperly leaving surgical equipment in a patient, alcohol/substance abuse, or physical illness/impairment”.  But such is not the case, according to the non-profit watchdogs over at Public Citizen, who claim that the state of California has become delinquent in disciplining 710 physicians with documented records like this.

In fact, 102 of these California doctors have been designated by peer reviewers as an “immediate threat to health or safety” of patients – yet are still allowed to practice medicine in the state.  One question: are their patients aware of this?

Here’s the report: 

WASHINGTON, D.C. – The state of California has become delinquent in disciplining doctors with documented poor records, the non-profit watchdog Public Citizen said in a letter sent today to California Gov. Jerry Brown, urging him to take the necessary steps to correct the dangerous shortcomings of the state medical board.

California’s state medical board has failed to take disciplinary action against 710 physicians in the state, all of whom were disciplined for wrongdoing between September 1990 and the end of 2009 by California hospitals, health maintenance organizations, ambulatory surgical centers and other health care organizations. What’s more, 102 of those doctors were designated by peer reviewers as an “immediate threat to health or safety” of patients.

Some of the other violations include:

  • delivering substandard care
  • wrongly diagnosing surgical patients
  • improperly leaving surgical equipment in a patient
  • alcohol or other substance abuse
  • physical illness or impairment

Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group, explained:

“Unless the California Medical Board significantly improves its record of failing to discipline those California physicians previously found by their hospitals or other places they practice to present an immediate threat to health or safety, tens of thousands of California patients are at risk of being injured or killed by these doctors.”

In Public Citizen’s annual ranking of state medical boards, California used to place among the top half of states when it came to disciplining doctors. But since 2006, the rate at which doctors were disciplined has consistently dropped. In Public Citizen’s 2011 analysis, California ranked 35th in the nation, 41st in 2010.

In fact, had the state board acted against faulty physicians at the rate it had in 1997, when it ranked 18th in the country for rate of serious disciplinary actions, 164 more physicians would have been seriously disciplined in 2010 than were disciplined.

The 710 doctors represent about half of the doctors disciplined by California health care organizations in the time period Public Citizen studied. A full 35 percent of the 710 were repeat offenders.

To obtain the information sent to Gov. Brown, Public Citizen analyzed 19 years of data from the National Practitioner Data Bank, which tracks:

  • state disciplinary actions
  • medical malpractice payments
  • clinical privilege actions taken against physicians.

Here’s their state-by-state analysis of doctors disciplined by hospitals and other health care organizations – but never disciplined by state medical boards.

Nationally, 220 physicians were designated by peer reviewers as an “immediate threat to health or safety” of patients – California physicians comprising nearly half of them.

For all of these physicians, hospitals or other health care entities have already suspended, limited or revoked their clinical privileges.

Public Citizen sent a letter on March 14, 2011, to California’s medical board asking it to work with the Health Resources and Services Administration of the U.S. Department of Health and Human Services to identify the faulty physicians.

The medical board responded in April, noting that understaffing and lack of resources may affect its ability to follow up on the 710 physicians that Public Citizen identified as having escaped punishment.

California’s poor performance in disciplining bad doctors is not new. A 2005 report by the California Medical Board Enforcement Program Monitor analyzed the state medical board’s performance; nearly six years later, some of the most significant recommendations from the report have yet to be implemented, Dr. Wolfe said.

These suggestions, which Public Citizen endorses, include transferring medical board investigators to the California Department of Justice, where they could work more seamlessly with prosecutors of the Health Quality Enforcement Section, and raising licensing fees to increase the medical board’s budget. (Although fees were raised, there has been no commensurate increase in board enforcement staff.)

© 2011 Public Citizen

And by the way, it’s not just California physicians who are getting off scott-free. California’s Board of Registered Nursing has failed to act against nurses whose misconduct had already been thoroughly documented and sanctioned by others. Los Angeles Times investigative reporters identified more than 120 nurses who have been suspended or fired by employers, disciplined by another California licensing board, or restricted from practice by other states – yet have blemish-free records with the California nursing board. Find out more at:  When Caregivers Harm: Problem Nurses Stay on the Job as Patients Suffer from the Pulitzer Prize-winning journalists at ProPublica.

This news report made me wonder how health care professionals here in my own province of British Columbia are disciplined by their governing agencies. Here are news releases about recent disciplinary actions towards doctors, listed online at the B.C. College of Physicians and Surgeons.  Such news releases are sent out to the media by the B.C.  College.  Offenses listed are mostly for “unprofessional conduct” ranging from knowingly prescribing drugs not for an individual patient’s use to sexual touching of an under-age patient.

And disciplined nurses here in B.C. are similarly named by their College of Registered Nurses of British Columbia.  The Complaints & Concerns section of their website includes, for example, lists of nurses by name on their Criminal Record Review Non-Compliance and Discipline Committee Orders pages.

If you’re a patient, check out your local professional regulatory body to see if your own health care professional is on such a list.

See also: What Doctors Should Do – But Don’t – When Their Colleagues Are “Significantly Impaired or Incompetent to Practice Medicine”

7 thoughts on “Why isn’t California disciplining its dangerous doctors?

  1. California is not alone. I do not think anyone has figured out the answer to this. As a doctor, it concerns me that there are “loose cannons” out there. Equally I am concerned that every time more regulations are passed, it makes my life harder without actually impacting on the problem.

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    • Hi Dr. Joe,
      It’s not just the loose cannons that concern me. Every occupation, not just medicine, has its fair share. It’s more the fact that regulatory agencies that should be policing these “cannons” are somehow unable or unwilling to.
      Cheers,
      C.

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      • Unable I think. They are more than willing to regulate but the regulations rarely catch the bad doctors but do make lots of paperwork for the good ones.
        Joe 🙂

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  2. I predict that California’s bureaucratic excuses for NOT getting rid of these dangerous doctors would somehow evaporate with just one single interview on 60 Minutes….

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    • You may be right, Bemused. Funny how we can overcome “understaffing and lack of resources” in a heartbeat once embarrassed bureaucrats are sufficiently outed.
      Cheers,
      C.

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  3. Dear Public Citizen:

    I am responding to Public Citizen’s August 9, 2011 press release “California Is Delinquent in Disciplining Dangerous Doctors” and to Dr. Sidney Wolfe’s August 9, 2011 letter to Governor Jerry Brown regarding the press release.

    Re the Public Citizen press release, August 9, 2011:

    I hope Public Citizen does not expect Governor Jerry Brown to respond to Dr. Wolfe’s important letter in a way that is favorable to California’s healthcare consumers.

    As you must know, Governor Brown is notorious for not being tough on dangerous California healthcare professionals and providers, such as nursing homes and nurses that commit elder abuse against vulnerable, sick patients in these facilities. But please don’t take my word for it. You can read the details at Christina Jewett’s March 9, 2010 “Fewer Elder Abuse Prosecutions under Jerry Brown” and her August 21, 2010 “Prosecutions of Elder Abuse Cases Decline under Jerry Brown” at California Watch.

    I also hope that Public Citizen does not expect the Medical Board investigators to “work more seamlessly” with California Department of Justice (DOJ) investigators and prosecutors.

    The major budget cuts, understaffing, and lack of resources that are also plaguing the the California DOJ are resulting in far fewer investigations and prosecutions of dangerous healthcare professionals.

    Please note that a senior California DOJ BMFEA special agent has said the following:

    * There is a plan to lay off about 200 agents across the board.

    * Older, more senior agents from the Bureau of Narcotics Enforcement (BNE) or Bureau of Investigations and Intelligence (BII) would bump out agents in the more specialized units, such as Medi-Cal Fraud and Elder Abuse, even though they have no skills or experience in that field.

    * There is no money for investigators.

    * There is full funding for everyone one else in the AG’s office.

    * The plan is very selective and punitive retribution against investigators.

    * The plan is to dismantle investigators only.

    * No one will be left to work elder abuse.

    * Attorney General Harris is going along with the plan to dismantle the BMFEA and does not realize the consequences of having no state DOJ investigators.

    * There is absolute chaos within DOJ, including the Bureau of Medi-Cal Fraud and Elder Abuse.

    * No one is really working any cases.

    * All are worried about losing jobs on short notice.

    * Even those with 12+ years of seniority may lose jobs to be replaced by more senior agents with no specialized skills in healthcare fraud or elder abuse.

    Thanks for taking the time to read my email about this very important topic. This is especially vital if you are a healthcare consumer or a vulnerable elder or dependent adult in a nursing home in California.

    These are scary, dangerous times in California.

    Regards,

    Scared California healthcare consumer

    (Ed. note: All anonymous comments are subject to ruthless editing for space).

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  4. Why isn’t California disciplining their dangerous doctors? Same reason the Texas Medical Board isn’t disciplining theirs.

    In Texas, doctors can injure or kill their patients without accountability ever since Governor Rick Perry signed the 2003 Tort Reform Act. Tort Reform strangled the 7th Amendment and allowed it to die a slow unceremonious death.

    If you want to view the collateral damage left behind Tort Reform inflicted by negligent reckless doctors, Google: Cleveland Mark Mitchell Dec 12 1950 – April 26 2008 – Youtube.

    If you want to view the face of Dr Javier Andrade who dropped the ball by failing to provide the basic standard of care to my husband in a Galveston, Texas emergency room and who died shortly thereafter, watch: Why did you drop the ball Dr Andrade?

    He is free to practice medicine at a New York Bariatric Group because the Texas Medical Board failed to police after their own and allowed countless of doctors to injure or kill Texans without accountability.

    Are we sacrificing fundamental constitutional liberties secured in the Bill of Rights to protect a few bad doctors like Dr Javier Andrade with Tort Reform? Yes we are.

    Thank you for your time,

    Cilla Mitchell

    A Texas nurse and vet

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