Why Bad Doctors Seldom Have to Take Their Medicine

The Medical Board of California, although pledged to protect consumers through proper licensing of physicians and to vigorously enforce the Medical Practice Act, rarely punishes physicians it finds grossly negligent, incompetent or unethical. Although patient lives are at stake, the medical board, comprised mostly of physicians, almost never punishes serious and illegal wrongdoing nor prevents a licensed physician from earning a day’s pay, even when federal and state laws are violated. It is no wonder that California ranks 33rd in the nation in disciplining grossly negligent and incompetent doctors.

A quick read of any edition of Action Report, the board’s quarterly publication, provides ample evidence that all of us are at risk for receiving incompetent health care. Each issue lists scores of physicians who have been found guilty of medical malfeasance and the action or discipline taken by the board in each case. The most severe action, actually revoking or suspending a physician’s license, is a rarity. The board’s action in a particular case almost always is to postpone revoking a license or suspending a guilty physician. Instead, a probation is assigned, a period during which the erring physician remains under limited scrutiny by the board. In short, the penalty for medical malpractice is generally no penalty.

During 1994-1995, the Medical Board received 11,465 complaints--8,002 for negligence and incompetence. It investigated 2,041 complaints, but took action against only 353 physicians. The board revoked 65 physician licenses, suspended and set probation for 34, set probation for 141 doctors and issued 25 letters of reprimand. Overall, less than 1% of physicians charged with medical misconduct lost their licenses or were actually suspended.

To better understand the reticence of the medical board to discipline errant physicians, consider these recent, and typical, cases. One Southern California physician, guilty of gross negligence and repeated acts of incompetence for excessively prescribing narcotics, received only probation, permitting him to continue his practice uninterrupted. Another found guilty of repeated acts of clearly excessive use of diagnostic procedures--for which thousands of dollars were charged--received only probation.

Not all physicians go unpunished entirely. One found guilty of gross negligence and incompetence for excessive prescribing--without an examination and no medical indication--was actually suspended for 60 days.

Only fatal or felonious acts by physicians consistently result in real discipline.

Currently, local medical associations lack any authority to discipline physicians. The Orange County Medical Assn. has a recorded telephone message referring all complaints against local physicians to the State Medical Board, the sole agency in California empowered to discipline physicians. Any action taken, however, occurs nearly a year after a complaint is filed.

President Clinton ordered that “one strike and you’re out” be applied to any person committing a violent or drug-related crime in public housing. And a May 30 Times editorial referring to the “lax punishment” meted out when LAPD officials police themselves, advocated “tough discipline for officers who break the rules. A slap on the wrist is no longer acceptable.”

To protect the public from incompetent and grossly negligent physicians, the Medical Board should apply the one-strike rule to medical malfeasance.

A police officer caught under the influence of drugs while on duty would not be on patrol the following day. But a doctor convicted of this charge--while on duty in an emergency room--received only the standard probationary slap.

Until medicine in California has an inspector general or the medical board functions more then merely as an old-boy network, public health remains unnecessarily at risk.