State board should stiffen
discipline of doctors


Hawaii's Board of Medical Examiners has been rated last in the country among medical boards in the discipline of physicians for malpractice.

DEFENDERS of Hawaii's medical profession say the infrequency of disciplinary action against doctors reflects the element of peer pressure within the closeness of the medical community. Ralph Nader's Public Citizen advocacy group more appropriately attributes the consistently low record of discipline to leniency by the Hawaii Board of Medical Examiners in bringing serious actions against negligent doctors. The board's record can be regarded only as dismal, and structural changes are needed to crack down on mistake-prone physicians.

Public Citizen ranked Hawaii lowest in the country last year in the number of serious disciplinary actions taken against physicians -- 1.07 per 1,000 doctors, compared with a national average of 3.56. In nine years during the past decade, Hawaii has ranked at or near the bottom in that category, raising questions about how well patients are protected from physicians who might be barred from medical practice in other states that do a better job of disciplining doctors.

Nader's organization found that 71 Hawaii doctors made malpractice payouts at least twice between 1990 and 2002, but only six had actions taken against them by the Board of Medical Examiners. Of the 19 with three or more payouts, only three had their licenses suspended or revoked.

Robert Merce, an attorney for medical malpractice plaintiffs, says half of the state's medical malpractice claims are attributable to 5 percent of the doctors. "If you got rid of 5 percent of the doctors and weeded them out, you would also get rid of roughly 50 percent of the claims," Merce says, "and if you got rid of 50 percent of the claims you wouldn't have a problem, but they won't do that."

Dr. Larry Schlesinger, chairman of the Hawaii Medical Association's Physicians' Health Committee, told the Star-Bulletin's Sally Apgar that his committee has "tight controls" over doctors and "a big stick" -- the power to take away medical licenses. Too often, though, the big stick lies dormant.

Like the National Practitioner Data Bank created by Congress in 1991 to help medical institutions track bad doctors, all the information is confidential, making it impossible for patients to learn about their doctors' disciplinary records. A patient can find from the state Regulated Industries Complaints Office, the medical board's enforcement arm, whether their doctor's license has been revoked or suspended, but not why.

Public Citizen says low (poor) records of disciplinary action by a state medical board can be improved with more adequate funding and staffing, "proactive investigations" instead of response to complaints, hospital sanctions and malpractice payouts, excellent leadership and independence from state medical societies and state government.



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