Calif. Ranked 37th in Disciplining Doctors : Medicine: Consumer group urges reforms to attack incompetence and negligence.

California ranks 37th in the nation in disciplining doctors for incompetence and abusive behavior, according to a report released Tuesday by Public Citizen, a consumer advocacy group that has long criticized state medical boards for being too soft on negligent physicians.

Although California edged up from 38th place in 1990 and new state laws have given boards more disciplinary power, the report calls for further improvements in a system that once was a model for the nation.

California reported 230 disciplinary actions against physicians in 1991, an average of 2.94 actions per 1,000 doctors. The national average is 5.19 actions per 1,000 doctors. A basic premise of the study--and one with which the American Medical Assn. concurs--is that the higher the number of disciplinary actions, the better the job the state board is doing.

Alaska led the 50 states in disciplinary action for the year, followed by Oklahoma, Iowa, Georgia, Kentucky and Mississippi. The report condemned Rhode Island and South Dakota for taking no serious actions at all against physicians. It also listed New York, Massachusetts, Pennsylvania and Maine as having poor disciplinary records.

“People who live in states with better boards are protected from the kinds of doctors who are injuring or killing people in states with the worst boards,” said Dr. Sidney M. Wolfe, director of Public Citizen’s Health Research Group.

The report offered several recommendations for improving the quality of the nation’s medical care. It called for increased funding and staffing of state medical boards and congressional action requiring state boards and other medical organizations to share information about disciplinary measures. It also recommended that the National Practitioner Data Bank, which collects information on “questionable” doctors, be opened to the public.

Several actions were recommended specifically for California, a state that Wolfe said had been a pioneer in the 1970s in developing a system to oversee medical practitioners.

It suggested that the state amend legislation so disciplinary actions cannot be delayed automatically when a doctor appeals, adopt looser standards of evidence rules in disciplinary cases and create a panel that can review the dismissal of a complaint.

As its standard of proof in disciplinary matters, the Medical Board of California uses the tougher-to-meet “clear and convincing evidence” standard, instead of the less stringent “preponderance of the evidence” standard used in many other states.

The California board is also restricted from holding informal hearings and is not empowered to impose fines. Representatives of the state board were not available for comment Tuesday.

The report said that 3,034 disciplinary actions were taken by state medical boards during the year. But it termed them “a pittance compared to the 150,000 to 300,000 Americans who are injured or killed each year in hospitals alone as a result of medical negligence.”

Wolfe cited several recent studies estimating the number of injuries or deaths that have occurred in hospitals as a result of negligence. The most recent, in 1990, was a survey of New York hospitals by Harvard University researchers. Extrapolating from their findings locally, they estimated that 80,000 deaths occur nationwide each year as a result of negligence.

Although the total number of “serious” disciplinary actions had increased from 1990, the report said, much of the increase was probably attributable to a change in the way the Federation of State Medical Boards classifies such actions.

Disciplinary action was taken against doctors most often for improperly prescribing drugs, giving substandard care, abusing drugs or alcohol and failing to comply with a state board order or professional rule. Sexual abuse of patients represented only 2% of all disciplinary actions, the report said.