Scorned several years ago by Ralph Nader's Public Citizen for having the nation's lowest medical disciplinary response, Hawaii now ranks 10th by the consumer advocacy group. The state's doctors defended the low ranking at the time, but the state's medical regulatory arms deserve credit for the turnaround.

Public Citizen's Health Research Group ranked Hawaii last in the country in 2002 for the low rate of disciplinary actions against doctors. The organization's director blamed the state's Board of Medical Examiners for neglecting to ensure that doctors meet high standards of competency.

Public Citizen reported that Hawaii's rate of serious actions against doctors was 1.07 per 1,000 doctors. Fewer than 6 percent of the state's doctors had been responsible for 57.8 percent of malpractice payments. The Hawaii Medical Association blithely maintained that the disciplinary rate was low because “;we do an outstanding job policing ourselves.”;

The advocacy group's report cited a 2001 case on the Big Island of a surgeon implanting the shaft of screwdriver into a patient, killing him and resulting eventually in a $5.6 million jury award to the man's family. The surgeon had been credentialed to practice medicine in Hawaii after being suspended from practice in Oklahoma and Texas.

The Nader report “;was really embarrassing,”; said Constance Cabral, the Hawaii board's executive officer, citing concerns from doctors about “;other physicians practicing who shouldn't be.”;

Cabral said the board and the Regulated Industries Complaints Office, both in the state Department of Commerce and Consumer Affairs, adopted several initiatives that increased disciplinary actions and increased protection for Hawaii's patients. As a result, Hawaii's rate of taking serious actions against doctors increased to 4.03 per 1,000 doctors, the sharpest rise of all states.

The disciplinary actions include professional or unethical misconduct, incompetence, negligence, improper or unnecessary surgery. They also involve welfare fraud, out-of-court settlements, failure to report another board's action and drug abuse.

Jo Ann Uchida, complaint and enforcement officer in the regulatory office, said her agency sent staffers to national training, where they got “;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.”;

Government officials naturally defend their agencies when under attack in national rankings. In this case, the two Hawaii agencies took the criticism seriously, sought improvement and achieved success.