Discipline against physicians by state medical boards increased in 1996.

State medical boards took 4,432 disciplinary actions against 3,880 physicians in 1996, according to the Federation of State Medical Boards. Some physicians received more than one sanction, resulting in more total actions than physicians involved. According to the federation, currently about 624,000 licensed physicians are practicing in the United States.

The disciplinary actions were divided into two types--prejudicial and non-prejudicial. Prejudicial actions, in turn, were divided into three categories:

(A) loss of licensure or loss of licensed privilege,

(B) restriction of license or licensed privilege, and

(C) other prejudicial actions. The latter category, for example, refers to board recommendations for continuing medical education or for fines for improper charting as a result of prejudicial behavior.

Last year, there were 1,607 category A violations, 1,261 category B violations, and 953 category C violations for a total of 3,821 prejudicial actions. The violations involved a variety of misconduct, including sexual misconduct, insurance fraud, incompetence, and substance abuse.

State medical boards also took 611 non-prejudicial, or administrative, actions. These actions typically were license denials based on inadequate qualifications or denials of reinstatements following disciplinary action.

The federation--responsible for promoting high standards for physician licensure and practice--serves as the primary center for collecting, maintaining, and reporting actions taken against physicians by its member boards and other governmental authorities. Federation membership is composed of the medical boards of all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands, and, in addition, includes 13 of the 16 separate U.S. osteopathic boards.

Increased activity

Federation President James West said that state medical boards have taken more disciplinary activity since 1991. He said there was a 4.5 percent increase from 1995 to 1996 in serious prejudicial actions involving revocation, suspension, or restriction of physicians' medical licenses.

Included in the federation's summary is a statistical calculation used to assess each board's disciplinary activity. Computed since 1991, this statistic--the Composite Action Index (CAI)--averages four activity ratios that measure disciplinary activity.

The 1996 CAI increased 17.4 percent from 1995. Based on the 61 licensing jurisdictions that supplied data for both years, 36 boards improved their CAIs by an average of about 64 percent in 1996, while 25 boards saw a decrease averaging 21 percent from 1995.

The federation's executive vice president, James Winn, said that the structure and funding of medical boards--which vary by state--have a direct impact on their CAI. Independent or semiautonomous boards have higher CAIs than those that are subordinate or advisory. Boards with the authority to set their own fees, control and direct the activities of their staffs, and adopt their own budgets maintain higher CAIs on average than those boards without those powers, he said.

Based on the differences in board structure, funding, staffing, and the state statutes under which each entity operates, one jurisdiction or board cannot be compared to another, he said. State board actions, which are reported to the federation, are public information and can be accessed from individual state medical boards.

Questions on data

Sidney Wolfe, a physician who is director of the Public Citizen Health Research Group, a consumer watchdog organization, said that his group's analysis of the data "raises serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians."

Wolfe added that most states have a long way to go before "they even begin to" offer serious protection of citizens from doctors who are incompetent, who sexually abuse patients, or who otherwise demonstrate serious problems that interfere with delivery of high-quality and compassionate medical care.

Unfortunately, the main federal legislative focus on medical malpractice has been to punish the victim instead of disciplining the perpetrator, he said. "Legislative efforts to limit victim compensation abound in most of the recent `Contract on America' legislation. No legislative attention is given to requiring states to significantly improve the discipline of physicians in order to prevent malpractice injuries and deaths from occurring."

Copies of the federation's report are available by calling [phone] or by writing to 400 Fuller Wiser Rd., Ste. 300, Euless, TX 76039-3855. The report is also available on the World Wide Web at http://www.fsmb.org/b_action.htm. Copies of Wolfe's analysis of the report are available by calling [phone].