Michael Amon

N.Y.’s dr. discipline system often relies on others

Posted in Newsday by michaelamon on November 25, 2009


BY MICHAEL AMON
June 17, 2008 p. A6

As lawmakers consider overhauling the state’s doctor discipline system, records show that New York – more than any other state – relies on medical investigations conducted elsewhere to punish physicians.

What’s more, among the 10 states with the most doctors, New York ranks ninth for punishing physicians through its own investigations, sanctioning 2.10 doctors per 1,000 in 2007. Florida, by contrast, disciplined 5.91 doctors per 1,000.

Of the 311 disciplinary actions taken by the New York Board for Professional Medical Conduct in 2007, 173, or 56 percent, did not stem from in-state probes but from “reciprocal actions” – sanctions taken against doctors punished first by other states. Called “piggybacking” by reform groups, these actions require minimal investigation and are rarely challenged by physicians.

“It becomes an issue of productivity,” said Arthur Levin, director of the Center for Medical Consumers in Manhattan. “When we want to look at how proactive New York is, all we know is that they’re very good at finding the bad doctors in other states but not necessarily here.”

Numbers may hinder effort

New York actually punished more doctors than any state but Illinois last year, but those figures include the piggybacked investigations. Patient advocates say the statistics make New York’s physician discipline board look deceptively aggressive and could hurt efforts to change the system, including Gov. David A. Paterson’s proposal now being considered by the legislature.

Claudia Hutton, a state Department of Health spokeswoman, said New York punishes fewer doctors on its own because under state law, investigators must prove at least two instances of negligence or wrongdoing – not one as in many other states. She also said staffing levels were stagnant at the Office of Professional Medical Conduct, which investigates cases for the Board for Professional Medical Conduct.

“We do the best we can with our staffing levels,” Hutton said, noting that OPMC received funding to hire 15 more investigators this year, bringing the total to 84. “I think you will see different numbers over the next few years.”

Hutton added that it’s important for the state to pursue actions against doctors sanctioned elsewhere. “We don’t want that physician returning here to practice,” Hutton said.

Paterson’s plan

Paterson’s bill would encourage more local probes by allowing the Office of Professional Medical Conduct to use malpractice histories to initiate cases. It also would make public the names of doctors charged with wrongdoing and make it easier to go after doctors who refuse to turn over records for probes. The law was proposed following criticism that OPMC and the Department of Health were too lenient with Dr. Harvey Finkelstein, the Long Island doctor accused of reusing syringes.

The proposal’s chances are unclear, legislative aides and advocates say. Legislative leaders and the governor’s representatives today will try to hammer out an agreement.

Taking a closer look

“When New York is touted as the state with the highest numbers, it makes it harder to make the case for reform,” said Blair Horner, legislative director of the New York Public Interest Research Group. “You have to look at the numbers a little harder.”

New York is not alone in pursuing out-of-state cases. Since 2003, when Dallas-based trade group the Federation of State Medical Boards began alerting states to sanctions of doctors with multiple licenses, reciprocal actions have risen 37 percent. The actions are universally praised for preventing bad doctors from jumping from state to state.

“You can’t be against reciprocal actions, they’re a good thing,” said David Swankin, president of the Citizens Advocacy Center in Washington, D.C. “The question is – what are they doing besides reciprocals?”

New York has long piggybacked on the work of other state’s doctor-disciplinary systems. Since 2004, 61 percent of its sanctions have been initiated in other states. From 1990 to 2006, New York, along with Pennsylvania and Hawaii, were the only states to punish more out-of-state doctors than in-state ones, according to the National Practitioners Data Bank.

One explanation: New York’s medical schools train about 15 percent of the nation’s doctors. They often keep a medical license here but practice – and get disciplined – somewhere else.

When a New York-licensed doctor is sanctioned elsewhere, the state moves quickly to restrict their practice here, Hutton said. Three full-time OPMC staff members and one part-timer are assigned to handle reciprocal actions.

Out-of-state probes easier

Disciplinary cases from other states are easier to process, Hutton said. They don’t have to be reinvestigated by New York staff. Instead, the out-of-state action is reviewed to ensure that it constituted misconduct under New York law. The doctor can challenge the findings, but most do not, Hutton said.

As for punishing fewer doctors than other big states, one reason may be that New York places hundreds of physicians with substance abuse problems into a monitoring system that is the nation’s most extensive. The roughly 1,400 doctors now in the system are required to get treatment and to allow doctors chosen by the state to track their progress, Hutton said. In other states, many of those doctors would have been disciplined.

“New York has a more progressive model, and frankly I believe in the long run it provides for better care for more patients,” said Dr. Michael Rosenberg, president of the Medical Society of the State of New York.

Staffing levels an issue

Finally, Hutton blamed staffing levels, saying the number of investigators had remained flat at around 69 for several years, even as complaints surged from 6,275 in 2003 to more than 7,300 in 2005 – second only to Florida. Each complaint, she said, must be investigated, taking an average of 230 days.

Even without the staff increase this year, though, New York had the second-largest investigative team in the country, behind only California.

Other states appear more productive with smaller staffs. The State Medical Board of Ohio regulates 40,000 doctors – half as many as New York. But with 21 investigators, it disciplined 160 physicians in locally generated cases last year, compared with 138 in New York. North Carolina, with 10 investigators, disciplined 129 doctors on its own initiative last year, while cutting in half the number of reciprocal actions it took from 83 in 2006 to 41.

North Carolina Medical Board spokeswoman Jean Fisher Brinkley said questions had been raised about whether reciprocal actions “were the best use of resources.” With more locally generated cases, she said, “the relevance to people in our state was greater.”

BEHIND NEW YORK’S DOCTOR DISCIPLINE SYSTEM

Much more than other states with a lot of doctors, New York issues sanctions that stem from other states’ investigations – cases known as “reciprocal” or piggyback actions.

Critics say it exaggerates the state’s doctor discipline statistics and hurts chances for toughening the system.

State says it pursues reciprocal actions to keep bad doctors from returning to New York.

State generates fewer in-state doctor-discipline cases than other states. One reason: New York must prove two bad acts by doctors here before punishment kicks in – many other states require just one.

THE PROCESS

The New York physician discipline process can begin several ways.

The Office of Professional Medical Conduct can file charges when it learns that a doctor has been disciplined in another state or convicted of a crime. The charges are reviewed to ensure that they constitute misconduct under the state’s Public Health Law.

Then doctors are offered a settlement agreement but have the right to a hearing before the Board of Professional Medical Conduct. Most waive the hearing and settle, officials said.

Doctors can also be investigated when a complaint is filed by a member of the public. Each complaint is checked by one of 84 investigators.

Most of the more than 7,000 complaints filed each year are dismissed but they can lead to formal charges. After being charged, doctors are offered a chance to settle, or plead guilty. They also have the right to a hearing before a three-member panel made up of two doctors and a non-doctor. The burden of proof is preponderance of the evidence.

Advertisements

One Response

Subscribe to comments with RSS.

  1. Jehan Mir said, on July 13, 2011 at 6:19 pm

    On or about June 2008, Claudia Hutton, Director Public Affairs ,N.Y. Department of Health in a press release declared that out of state disciplined physiciians can contest the findings of the other State, if they claim findings of the other State were not supported by evidence or facts.

    You briefly refer to it in the last part. Is there any way I can get that press release even though I searched the State of N.Y. Department of Health web site and did not find anything on the subject though you do refer to it partially Where did you get that information. I will greatly appreciate your help. Thanks

    Jehan Mir,MD


Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: