Disciplining of Doctors Criticized : Health: Medical board report says state evaluators of suspect physicians often are sloppy or unqualified. One board member says hiring seems to be based ‘on the buddy system.’

Many medical experts hired by the state to investigate problem doctors do such a poor job evaluating a physician’s performance that they handicap efforts to discipline even the most egregious offenders, an internal California Medical Board report has found.

The report, by the board’s new chief of enforcement, said that in too many instances the doctors the state uses as experts against other doctors are themselves not qualified for their roles. Investigating physicians are sloppy in the way they review cases, lack up-to-date medical knowledge or lack expertise in the specialty of the physician they are examining, the report said.

“We have many cases where we have . . . either lost or the case wasn’t taken to the point that it would have been taken (because of these experts),” John Lancara told the board last week.

The report is the first to question the quality of the medical expertise used by the state in its doctor disciplinary cases.

Over the years, the medical board, which licenses and polices the state’s 77,000 physicians, has been criticized repeatedly by legislators, consumer watchdog groups and prosecutors for failure to take quick and aggressive action against bad doctors.

The examination of its use of medical experts and consultants was ordered by the board’s new executive director, Dixon Arnett, who has sought to make the disciplinary system more efficient and consumer-friendly. The board voted recently, for example, to give the public greater access to disciplinary information about doctors.

Arnett said the report on the board’s use of medical experts was compiled through interviews with the officials most responsible for bringing charges against bad doctors: deputy attorneys general and the chief investigators in each of the medical board’s 12 regions.

In the disciplinary system, medical experts advise prosecutors and judges as they determine whether a suspect physician has been negligent. The state hires medical consultants in each of the board’s regions and they in turn recruit physicians from the community to serve as experts in specific cases.

“It doesn’t mean that we’ve been prosecuting docs erroneously,” Arnett said. “What it does mean is that we are probably making it tougher on ourselves to make cases--particularly the most egregious ones--and we are handicapping ourselves as far as filing additional charges are concerned.”

But Dr. Richard Ikeda, the board’s chief medical consultant, took issue with the report, insisting that most of the medical experts used by the state are among the “best and brightest” doctors in California. He said the state could not win more than 95% of its cases if their work was not generally of high quality.

Deputy Atty. Gen. Barry Ladendorf of San Diego offered the board several examples that argued otherwise.

In one instance, he said, a physician frequently used by the state to provide expertise because he wrote good reports, had not practiced medicine since 1985 and had spent his last five years writing a cookbook.

In another, two obstetrician-gynecologists used as experts in a case in which a doctor was accused of causing the deaths of newborn infants, had not delivered a baby themselves in 10 years.

“I don’t want to tell you that this is what’s happening every case, because it’s not and oftentimes . . . we get pretty decent experts in these cases and we win. . . ,” Ladendorf said. “But there is no reason for us to get a case where a doctor hasn’t delivered a baby in 10 years and that’s our best expert.”

Since its delivery to the medical board last week, the report has drawn praise from two groups that often take opposite sides on medical board issues--the California Medical Assn., the state’s largest physician organization, and the University of San Diego’s Center for Public Interest Law, a consumer watchdog group.

The board, meanwhile, voted to appoint a task force to conduct a more thorough review. “I’ve seen horrible medical expert opinions in these cases . . . and that has to improve,” said Dr. Lawrence D. Dorr, a board member from Los Angeles. “It looks to me like the experts that are getting picked to do some of these cases are being picked on the buddy system or something. . . . It’s a waste of our money and it’s a waste of our time.”