The state Board of Physicians has a serious backlog of complaints and a growing timeline for resolving it, according to a newly released legislative audit of the agency charged with protecting the public from bad doctors.
It also isn't keeping complete records and its actions lack transparency, sometimes in violation of open meetings laws, the review says.
The review comes ahead of the General Assembly session in January, when lawmakers are to consider reauthorizing the medical board, which expires under a "sunset" provision. It also comes six years after auditors first outlined similar problems with the board and nine years after the board was remade to address lax protection of consumers.
"The board faces significant challenges moving forward," the review reads. "Also, based on past performance, [the Department of Legislative Services] has significant concerns about whether the recommendations, especially those contained in legislation, will be complied with by [the medical board]. The board failed to implement key recommendations and requirements of previous sunset evaluations and sunset legislation."
The 21-member board includes 13 doctors and five consumer members. For fiscal 2012, it has an appropriation of $8.6 million and 68 staff, who are responsible for licensing and overseeing 43,000 medical professionals.
During fiscal 2011, it handled almost 1,730 complaints, including 739 that continued from the previous year.
By the year's end, it closed almost 900, leaving more than 800 pending. It took 164 formal actions, more than in previous years, the review noted. Some recent high-profile actions include revoking the license of Mark G. Midei, a Towson cardiologist accused of placing unnecessary stents, and suspending the license of Mark R. Geier, a Rockville doctor accused of mistreating children with autism. Both have appealed the decisions.
Complaints come to the board from the public, as well as from boards in other states and other providers. The majority involve allegations that doctors did not meet the standard of care or that their actions were unprofessional or immoral. There are various steps the board can take, including suspension and revocation of medical licenses.
Auditors offered 46 recommendations, including asking the board to report on progress in 2014 and withholding funds until the board writes sanctioning guidelines to ensure an even application, something first recommended before the last review.
Other recommendations have to do with improving record-keeping, notifying the public of hearings and disciplinary action and developing a system for ongoing cases that allege sexual misconduct.
Board Deputy Director John Papavasiliou said, "We're still in our response phase of the process and will not be able to fully comment at this time."
In a written response to the audit, board officials agreed fully or partially with fewer than half of the findings. They told lawmakers six years ago during hearings that pay for investigators was too low to attract enough staff.
The board falls under the state Department of Health and Mental Hygiene, but operates independently. Dr. Joshua M. Sharfstein, department secretary, said the review was not about trying to "micromanage specific decisions; rather it's about asking whether the board is headed in the right direction."
He said he found the review "very concerning. It's critical that the board work better for both patients and doctors."
Sharfstein said the sunset review is a regular opportunity for the administration and the legislature to assess the board's efficacy and rechart its course if need be. He is recommending that the board bring in an external expert who can guide a thorough review of procedures.
Consumer advocates expressed frustration that past reviews have not led to more changes.
"While healthcare consumers welcome the [legislative services] review of state Board of Physicians, the deficiencies cited in the sunset review are nothing new. And, unfortunately, they are typical of state licensing boards across the country where lack of accountability and transparency are common," said Michael Bennett, president of the Coalition For Patients' Rights.
"The public has at least as much right to know that they are in safe medical hands as they are when shopping at Wegmans for pine nuts or bean sprouts that may be contaminated with salmonella."
In a recent national ranking by the advocacy group Public Citizen, Maryland was 38th among states for disciplining doctors in 2008-2010 with 2.55 disciplinary actions per 1,000 physicians.
The national rate was closer to three per 1,000 physicians, according to the analysis from the group, which recommended ensuring adequate staff and funding and independence from government and medical societies, engaging proactively in investigations rather than responding only to complaints by using data from hospitals and malpractice payouts.
Dr. Sidney Wolfe, director of Public Citizen's health research group, said Maryland has been in bottom third of the rankings for 15 years and the sunset report should be a "wake-up call" to the board and the legislature.
He said some states have become more effective in disciplining doctors by reconstituting their boards or hiring more staff. Many have developed websites that are useful to consumers looking for information on their doctors, including sanctions and malpractice awards — or provided a reliable accounting that there are none.
"It's encouraging this group did a report that has touched on a number of areas consistent with the poor performance of the board we've witnessed for a long time," he said. "Most doctors in … Maryland, and all states, are practicing very good medicine. But there is a certain subset that offers substandard care, and if you happen to live in Maryland you may be in greater jeopardy of visiting one that should have been disciplined but hasn't been."