Lag widens in medical complaints

When the mother of rapper Kanye West died a day after having plastic surgery, attention shifted quickly to Dr. Jan Adams, the Los Angeles physician who performed the operation.

A Los Angeles County coroner’s report did not fault errors in the surgery itself. But in a separate matter, state officials have questioned whether Adams should be practicing medicine at all.

Last year, the Medical Board of California and the state attorney general’s office filed a formal accusation to revoke or suspend Adams’ license to practice medicine. The document filed April 10 cited Adams’ three convictions related to two incidents in which he was accused of drunk driving.

A hearing date has not been set, but in the meantime, Adams is allowed to practice medicine.

Such a lag is not unusual.

It takes an average of 934 days from the receipt of a complaint to the completion of judicial review, according to the board’s most recent annual report.

Slightly more than half of that, 488 days, is the average time spent by the Medical Board and attorney general’s office investigating a complaint and preparing a formal accusation. The rest of the time is spent waiting for the case to be resolved by an administrative law judge or settled.

The length of time it takes to resolve complaints has been increasing overall during the last decade. In the fiscal year that ended June 30, 1999, it took an average of 722 days for the process to be completed.

The Medical Board has been criticized because of the long waits, as well as other reasons. Most recently, board members came under attack for allowing doctors with alcohol and drug problems to go into a confidential state-monitored program while seeking addiction treatment.

The program allowed accused doctors to avoid the public disciplinary process, but five audits found that it was not working. The medical board voted unanimously to end the program; it will expire July 1.

The controversy has prompted state officials to pay more attention to how other boards discipline healthcare providers. At a legislative hearing last week, state Sen. Mark Ridley-Thomas (D-Los Angeles) urged that audits be performed on similar substance-abuse programs for nurses, pharmacists and other health professionals.

The length of time it takes to discipline doctors has been a controversial issue for the board for many years.

After a jury convicted a doctor in the deaths of eight newborns and a fetus in 1989, the Medical Board was publicly castigated by Los Angeles County Superior Court Judge Judith C. Chirlin, who said the case was “a testament to the abject failure” of the board. She added that the agency must “accept responsibility for at least some of the deaths” for failing to investigate the doctor properly.

Evidence had been piling up against Dr. Milos Klvana for nearly a decade, according to a Times article at the time. He was sentenced to 53 years to life in prison in 1990.

In April 2002, a report in the Orange County Register highlighted the case of an obstetrician who killed or injured infants during deliveries. Dr. Andrew Rutland continued practicing medicine for years, even though a hospital committee had flagged him as a danger in 1993.

Rutland surrendered his medical license in October 2002, but the Medical Board reinstated it in 2007, subject to a five-year probationary period.

Both news accounts were highlighted in a 2004 report by Julianne D’Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego School of Law. Fellmeth was hired by the Legislature to conduct an independent analysis of the board’s disciplinary system. The report found that “overall, the enforcement process takes too long to protect the public.”

Medical Board spokeswoman Candis Cohen said she could not comment about individual cases. But it is not unusual, according to data Cohen provided, for years to pass before a Medical Board case is resolved.

The president of the Medical Board agreed, in general, that the hearing process for physicians gets dragged out far too long.

“The system gets used for time delays,” Dr. Richard Fantozzi said.

The core issue lies in long-established rights given to medical doctors, Fellmeth said.

Once the state grants a professional license to an individual, that license is considered property, Fellmeth said. And under the eyes of the law, an individual’s property is granted specific legal protection.

“The 14th Amendment to the U.S. Constitution says that the state may not deprive a person of ‘life, liberty, or property, without due process of law,’ ” Fellmeth said. “The state must afford you some basic procedural protections before the state can take [a license] away from you.”

Ned Wigglesworth, spokesman for the California Medical Assn., said it can take time to build a credible case against an accused doctor.

In egregious cases, state officials can ask a judge to suspend a doctor’s license, Wigglesworth said.

Such suspensions can be hard to get, Cohen said. The Medical Board and attorney general’s office must convince a judge that the physician represents an imminent threat to public safety.

“Judges don’t like to easily take a property right, e.g., a medical license, without due process,” Cohen said.

Consumers can look up whether a physician is formally accused of wrongdoing or has been disciplined by going to www.mbc.ca.gov and clicking on “check your doctor,” Cohen said.

A link to “enforcement public documents,” listed just below “check your doctor,” allows anyone to read a formal accusation and details of any charges filed by the Medical Board and attorney general since 2002.

The Medical Board’s accusation, for example, describes in detail three of Adams’ alcohol-related convictions:

On May 9, 2003, Adams pleaded no contest to a charge of driving under the influence of alcohol or drugs, the accusation states.

Adams, in an interview with The Times in November, said he was asked to take a roadside sobriety test after an accident but refused. He said his attorney advised him to plead no contest, which he called a mistake.

In 2006, Adams pleaded no contest to a charge of driving with a suspended license. A jury acquitted him of drunk driving but found him guilty of driving with a blood alcohol level of 0.08% (the legal limit) or greater.

Adams has said he had one beer that evening but blew 0.09% and 0.10% on Breathalyzer tests.

He said he fought the matter in court because he had been taking medication for a pulmonary embolism suffered a year earlier and was concerned that the medication might have affected the reading.

State officials say they hope new efforts will reduce the time it takes the Medical Board and attorney general’s office to complete an investigation.

The board is imposing fines if doctors delay providing records, Fantozzi said. In addition, to improve efficiency, the board’s investigators have begun conducting joint probes with lawyers from the attorney general’s office.

The Medical Board staff has faced losses and challenges since the agency’s budget was cut in 2002.

“We have had vacancies, recruiting and retention issues with investigative positions and the additional ‘learning curve’ time for new investigators,” said Debbie Nelson, associate analyst for the board. “For those reasons, the investigation times have taken longer.”

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ron.lin@latimes.com