Most states are not doing a good job of protecting patients from bad doctors, but Hawaii is one of the best, a national nonprofit consumer advocacy organization reports.

Hawaii's national ranking for “;doctor discipline”; has jumped from 51st to 10th since 2001-2003, says Public Citizen.

It is one of five states with the most improvement and one of the top 10 with the highest disciplinary rates to protect health care consumers.

“;Before that it was really embarrassing,”; said Constance Cabral, executive officer of the Board of Medical Examiners, citing concerns from doctors about “;other physicians practicing who shouldn't be.”;

Since then the board and the Regulated Industries Complaints Office, both in the state Department of Commerce and Consumer Protection, adopted a number of initiatives that increased disciplinary actions and enhanced protection for Hawaii's health care consumers, she said.

The highest number of disciplinary actions since 2003 was 31 in 2008. There were 14 in 2003 and 29 last year.

The 2009 disciplinary actions involved professional misconduct, unethical conduct, competency issues, negligence, improper or unnecessary surgery, a felony conviction relating to welfare fraud, violation of a prior settlement agreement, failure to report another board's action, a conviction relating to a controlled substance and incompetence.

The average rate of disciplinary actions in the top five states was 5.45 per 1,000 physicians, Public Citizen said.

Hawaii has about 8,077 licensed medical personnel, including 3,882 on the mainland and 76 in foreign countries.

The medical board is charged with protecting the public from “;dishonest, fraudulent or unskilled practitioners ... through legislative, executive and adjudicatory functions,”; Cabral explained.

The Regulated Industries Complaints Office, the board's enforcement arm, arbitrates, investigates and prosecutes licensing violation complaints.

Enforcement action could include formal prosecution, which might involve an administrative hearing before a hearings officer, or a proposed settlement could be proposed to the board for consideration.

The board determines the appropriate outcome and sanctions, including revocation, suspension, fine, censure, reprimand and probation.

The initiatives placed more emphasis on training and specialization of the investigative and legal staff.

“;We started sending staff to national training,”; said Jo Ann Uchida, complaint and enforcement officer in the regulatory office. “;That really made a difference, getting an idea what other states were doing and networking with similar agencies.

“;As we get more effective, we get more people willing to come in and complain,”; Uchida said.

Other improvements included using a team approach with investigators and attorneys screening medical complaints. Certain cases also are fast-tracked.

She said her office would like to act more quickly on complaints, but medical cases often are complicated and investigators must consult with medical experts “;to make sure they are in fact aberrations.”;