Three years after their teenage son, Michael, died from taking a prescription painkiller, George and Alicia Osgood are still waiting for the outcome of a state investigation into his death.
The couple wants the Maryland Board of Physicians to discipline the doctor who prescribed the strongest dose on the market of the drug, OxyContin, to treat the 19-year-old's sore throat.
"I can't believe that the Board of Physicians is not doing anything about it," said George Osgood, a civil engineer who lives in Upper Marlboro. "It never seems to get resolved."
At least 400 complaints, some accusing doctors of mistakes that gravely injured patients, are backed up at the medical board, state records show. As the General Assembly considers two bills that would continue the board as the licensing agent for more than 25,000 physicians, there are conflicting views on how best to clear the backlog.
The medical board wants to limit the role of administrative law judges and streamline a process in which physicians determine whether a fellow doctor has failed to meet standards of care -- proposals opposed by the state medical society.
It is unclear, however, whether lawmakers will decide to make any changes in the system, or leave it until next year when they must renew the board or let it expire.
A House bill would extend the board for six years and require it to come up with a plan to reduce the backlog within two years. A Senate version extends the board for two years and demands a strategy to speed up the process by July 1.
The board says it has a plan to speed things up, but needs to hire and train more investigators to handle about 1,100 complaints it receives every year. The board disciplines doctors for 40 types of infractions, including incompetence and sex or drug offenses.
"Trying to turn this ship is going to take time," the board's executive director, C. Irving Pinder Jr., told lawmakers in Annapolis last week. "We're on the right track. We've made a good-faith effort."
The effectiveness of the effort is difficult to assess. A series published in The Sun in December reported that the time spent to resolve disciplinary cases has lengthened to more than four years -- far longer than the 18 months envisioned when lawmakers created the board in 2003.
The conduct of individual cases is hidden under state law, which makes complaints about doctors confidential. The law also prohibits the medical board from discussing a complaint.
The Osgood case offers a rare look inside the secretive system. The family gave The Sun access to records of a malpractice suit and their complaint to the board against Bowie internist Carl J. Slavin -- the doctor they blame for their son's death.
Slavin denied the allegations in the lawsuit. He could not be reached for comment despite numerous attempts by phone and visits to two offices. Calls to the lawyer who represented Slavin in the lawsuit were not returned.
The doctor treated Michael Osgood during Christmas break from Iowa State University, which the teen attended on an academic scholarship. By Jan. 6, 2003, he couldn't swallow and had a fever and other signs of flu, records show. Slavin has testified that Osgood was crying from throat pain but rejected a number of painkillers, saying he couldn't swallow.
Slavin prescribed 80 milligrams of OxyContin every 12 hours. "Because of the severity of pain he was having, I felt that that was [the] dose that he was going to need," Slavin testified in a January 2004 deposition. He said he had the patient's mother fill the prescription and bring it to the office, where he watched as the teen took the first dose.
Two days later, after Alicia Osgood couldn't rouse her son, he was airlifted in a coma to Georgetown University Hospital. He died Jan. 12, 2003, from accidental "oxycodone intoxication" after the third dose, according to the District of Columbia medical examiner's office.
Seventeen of the 20 pills remained, records show.
Slavin said he was "devastated and cried for like three days" after hearing of the teen's death, according to his deposition, in which he defended his care.
The board was notified three times of Osgood's death, but when its review began cannot be determined from available records.
Dr. Charles A. Read, a lung specialist who treated Osgood at Georgetown University Hospital, told The Sun that he filed a written complaint shortly after the patient was admitted.
"I reported my concerns," said Read, adding that OxyContin "seemed like a strange prescription to give to a kid." He said that more than three years later, he hasn't heard from the board.
In September 2003, a state agency that initially processes all malpractice claims sent the medical board a copy of the one the family had filed the month before, records show. In May 2004, a month before they settled the suit, the Osgoods filed a complaint with the medical board arguing that it was "blatantly wrong" for Slavin to prescribe the potent OxyContin.
"It is difficult to kill a healthy 19 year old. Dr. Slavin did so by ignoring all of the standards and information for prescribing OxyContin, including the known risk of fatal respiratory depression when administered to patients not previously exposed to opioids," their complaint stated.
The Osgoods' lawsuit was settled for $950,000 in June 2004. In settling, Slavin "expressly denied" any fault or liability.
That month, lawyers for the Osgoods complied with a subpoena from the medical board requesting records of the legal case. In October 2004, George Osgood testified before a state commission on medical malpractice. Since then, he has been told repeatedly by medical board staffers that the matter is stuck in peer review.
That process has long been controversial. Until 2003, it was run by MedChi, the Maryland State Medical Association, which was criticized for taking too long to complete reviews. The 2003 law put the system out for bid, and it now is run by the Delmarva Foundation, based in Easton.
The law requires that doctors accused of poor care be reviewed by two physicians in their specialty. Should they disagree, a third reviewer can be brought in. About half the backlog is due to such cases, according to Pinder.
The board wants the Assembly to amend the law so it could use one reviewer, as many states do.
"You really don't need a peer review on a lot of those cases," said Ray W. Huff, one of five consumers on the 21-member board.
But Sen. Andrew P. Harris, a practicing physician and member of the Education, Health and Environmental Affairs Committee, said two reviewers are needed to ensure fairness.
MedChi opposes cutting the number of peer reviewers. The doctors group, which has about 7,200 members, also opposes restricting the use of administrative law judges to hear cases, according to its lobbyist, Joseph A. Schwartz III. Using judges guarantees their independence, a "critical factor when a doctor's license is on the line," he contended in prepared testimony.
Harris, a Johns Hopkins anesthesiologist, said doctors should be entitled to "due process" from an "impartial" third party.
There's little dispute that the board needs to hire investigators. In recent years, they have routinely juggled 50 or more cases at once, twice what the board considers the optimum.
Pinder argues that the starting pay of about $33,000 has been too low to attract and retain staff. The board has 10 investigators and wants to hire five more.
But in last week's hearing, Pinder could not explain to lawmakers' satisfaction why the board can't take steps to raise salaries. His lack of response on that and on a firm date to resolve the backlog seemed to exasperate Sen. Paula C. Hollinger, the Baltimore County Democrat who chairs the health committee and sponsored the Senate bill.