Study Hits Lag in Doctor Disciplining : Health: Draft report says medical boards suffer from serious problems. It also criticizes slowness of action against physicians in botched cases.

The number of medical cases botched by doctors “far exceeds the number of disciplinary actions actually imposed” by state medical boards, according to a draft federal government report.

The study, which was obtained by The Times in advance of its official release later this month, acknowledged that the boards have made “significant progress” in improving their capacity to discipline physicians. But it said they still suffer from a litany of problems, including serious case backlogs, staff shortages and a lack of meaningful data to assess their performance.

The report by the Office of Inspector General of the U.S. Department of Health and Human Services also criticizes California’s “fragmented” disciplinary process, in which responsibility for physician discipline is shared by several state agencies.

In a series of articles published last month, The Times documented significant shortcomings of California’s doctor disciplinary system, such as hundreds of uninvestigated patient complaints and long delays in concluding cases. Officials of the Medical Board of California have acknowledged many specific deficiencies but maintain that their overall performance is good.

The Times found that blame for the problems is shared by the medical board, which licenses and disciplines physicians, the state attorney general’s office, whose lawyers try disciplinary cases against physicians, and the state Office of Administrative Hearings, whose judges hear the cases.

California ranked 42nd among the states in the number of serious disciplinary actions per 1,000 licensed physicians in 1987, the most recent year for which complete data is available.

The inspector general’s report pointed out that while most state medical boards “decry assessments of their performance based strictly on the number of disciplinary actions they take, the reality is that, with rare exceptions, there is little else available upon which to base meaningful assessments.”

The report added: “Even when all appropriate caveats are taken into account, the (number of botched cases and other physician misconduct warranting discipline) far exceeds the number of disciplinary actions actually imposed by the boards.”

The draft report recommends more funding and investigators for state medical boards as well as increased sharing of information between state and federal agencies.

It also calls on the federal government to help state medical boards develop better performance indicators, such as standardized measures of case processing time, the results of investigations, and the number of investigators per 1,000 licensed physicians.

As part of the study, federal officials visited medical boards in the four states with the largest numbers of physicians--California, Texas, Pennsylvania and New York.

The federal investigators concluded that while medical boards “are much better equipped to carry out their disciplinary responsibilities than they were 25, 10, or even 5 years ago,” further improvement is needed.

Among the specific findings:

* Large backlogs of uninvestigated complaints remain a serious problem for many medical boards. In addition, typical medical board investigators may have caseloads of 50 to 60 or more.

* Even when states have been successful in reducing backlogs, “the gains are not necessarily enduring ones.” For example, in California “the number of cases not yet assigned to an investigator rose substantially during the last six months of 1989, after dropping even more substantially between mid-1988 and mid-1989.”

* An increase in reported disciplinary actions by all state medical boards is only “of modest significance.” This is because some reports involve multiple actions against the same physician and others reflect the reinstatement of licenses.

* Quality-of-care cases, which are often of great public concern, account for only 5% to 10% of disciplinary actions. The great majority of disciplinary actions involve the improper use of alcohol or drugs, such as inappropriate prescribing, unlawful distribution or self-abuse.

* California has “relied particularly heavily” on private “nondisciplinary” actions against physicians, such as warning letters, educational conferences and a special program for physicians with drug, alcohol and emotional problems. At the other extreme, the report found that some states, such as Texas, “have discontinued the use of such private approaches,” citing “public suspicions of boards being too understanding or lenient toward physicians.”

* The Medicare-funded peer review organizations regularly review quality-of-care cases involving the elderly and disabled. But they rarely refer cases to state medical boards, even when serious quality-of-care problems are found. Officials of peer review organizations cite “insufficient” authority to share case information, the report said. “None of us wants to become a landmark case,” one official was quoted as saying.

Two physicians who had seen advance copies of the report had conflicting reactions.

Dr. James Winn, executive vice president of the Federation of State Medical Boards in Ft. Worth, Tex., said the report was “fair” and “followed what our recommendations are.”

But the inspector general’s recommendations were criticized as “weak” by Dr. Sidney Wolfe of the Public Citizen Health Research Group in Washington, who is a frequent critic of state medical boards.

Wolfe said the inspector general should have recommended federal funding for the boards tied to requirements on the states, such as full public disclosure of all final disciplinary actions and a minimum number of investigators per 1,000 licensed physicians.

“Most of the states have chosen to do as little as possible and have made the whole disciplinary process a farce,” Wolfe said. “It is time for a much stronger federal role.”