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State should keep working to improve doctor discipline

Ranking of serious actions shows more needs to be done

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South Carolina's showing in a national ranking of how frequently doctors are disciplined was a poor one.

South Carolina is among the 10 worst states in protecting patients from dangerous doctors, according to a nonprofit consumer group's annual ranking of state medical boards.

The Public Citizen's Health Research Group based its rankings on the number of serious actions taken against doctors between 2003 and 2005 as reported to the Federation of State Medical Boards.

Serious actions were defined as license revocations, suspensions, and probation or other restrictions on practice.

The rates ranged from a low of 1.62 serious actions per 1,000 doctors for Mississippi to 9.08 per 1,000 doctors for Kentucky. South Carolina's rate was 2.06 per 1,000 doctors.

Georgia's rate was 3.99 per 1,000 doctors, and North Carolina's rate was 3.45 per 1,000 doctors.

South Carolina has ranked in the bottom 15 for at least five of the past three-year periods.

We need to do better, and we agree with this statement from Dr. Sidney Wolfe, director of Public Citizens, as reported in The Greenville News: "There is not a shred of evidence that the quality of doctors overall is any different in any state."

Wolfe also says that the group averaged actions taken over three years to account for the impact a few actions would have on a state with a small number of doctors. According to the group's report, South Carolina had 11,053 physicians in 2004. That compares with top-ranked Kentucky's 10,814 physicians.

The report also states that Kentucky took 72 serious actions against physicians in 2005, compared with 15 taken by South Carolina in 2005.

There has been some improvement in how the board handles complaints against doctors. Last year, the legislature passed a measure that requires the state Board of Medical Examiners to release information on misconduct complaints soon after the board conducts a preliminary investigation to determine whether there is substance to a complaint against a doctor.

Details about the allegations become public 10 days after the doctor responds to the complaint, and from that point on "all subsequent records and proceedings relating to the misconduct allegations must be open to the public."

The state Supreme Court also ruled in a case brought by this newspaper that administrative law judges must give a reason before sealing records or closing hearings in cases involving physician discipline. The ruling also made it clear that the Administrative Law Court is a public body and must act accordingly.

Dr. Gerald A. Wilson, president off the South Carolina Medical Association, touts the way the state medical board handles complaints, but he also says the medical board's nine members are stretched thin.

The health advocacy group addresses this concern in its list of conditions it says would help a board do a better job off disciplining doctors. They are:

• Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes).

• Adequate staffing.

• Proactive investigations rather than only responding to complaints.

• Using all available reliable data from other sources, such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts.

• Excellent leadership.

• Independence from state medical societies and other parts of the state government.

• A reasonable legal framework for disciplining doctors (the "preponderance of the evidence" rather than "beyond reasonable doubt" or "clear and convincing evidence" as the legal standard for discipline).

South Carolina officials should look at this list and determine where we fall short, and then set about doing even more to improve the process.

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