Prescription for Improvement

A controversial report on the California Board of Medical Quality Assurance, the state agency responsible for disciplining doctors, has at least served to attract attention to the need for better enforcement. For three years, the board has been denied the funds it needs to do a better job.

The new report is the work of Robert C. Fellmeth of the Center for Public Interest Law at the University of San Diego and, to our way of thinking, it falls short of the kind of objective outside analysis that would make a major contribution to solving the problem posed by bad doctors. The center’s standing also is clouded by the fact that it is engaged in litigation against BMQA on behalf of some Vietnam-trained physicians who were denied licenses to practice in the state.

But the report coincides with completion of an internal board study that confirms some of the shortcomings of present operations and sets forth an 18% staff expansion program that can, with prompt legislative action, be put in place by July 1. That would be a step in the right direction.

Leaders of the California Medical Assn., representing most of the state’s physicians, have announced full support for bolstering the board’s staff to eliminate the backlog of investigations that now is delaying appropriate discipline. That support will be helpful as the staff-increase proposal makes its way through the Department of Consumer Affairs and the Department of Finance which, in the past, have killed staff increase requests. This is not a tax issue. The board is funded by fees paid by doctors. If the staff increase is approved, the fees will rise from $255 to $370 every other year. That would still be substantially less than some of the other professional fees in the state.

Under current law, the process of disciplining unprofessional physicians and surgeons is a slow one, averaging two to three years from initial investigation to final appeal. The board seeks quick action, according to its staff, on so-called Category I cases involving a direct risk of patient harm as contrasted with cases that might involve financial fraud or false claims. As the staff is expanded and the backlog of disciplinary cases eliminated, there will be a need for the Legislature to look beyond the adequacy of funding and determine if the law itself is adequate to protect patients. Doctors themselves, in the meantime, can make a significant contribution by doing a better job of peer review, a process now often crippled by their reluctance to blow the whistle on incompetent colleagues.