Renewed commitment at Md.'s physicians board

The Md. Board of Physicians has worked to overhaul itself amid controversy and criticism.

Gov. Larry Hogan's Heroin and Opioid Emergency Task Force recently issued its final report, a section of which highlighted the Maryland Board of Physicians' mandate of continuing education related to proper opioid prescribing. The task force recommended that other health occupation boards in the state prescribe similar educational initiatives for their licensees. This recognition is especially important to the Board of Physicians because our position is that doctors do play a central role — both good and bad — in the statewide overdose epidemic. The board stood its ground and promulgated this new regulation of mandatory continuing education for the sake of public health, and we did so over the objections of physician interests.

Controversy and criticism are not new at the board. In June of last year, during the same week that Gov. Martin O'Malley appointed me as chair, a disturbing event illuminated the shortcomings of the board and the need for transformational change. That day, local police arrested a Maryland physician for alleged sexual misconduct against several patients. To the board's dismay, we soon discovered that the accused physician had a previous felony rape conviction in the state of Florida and had lied about his criminal history when he applied for licensure in Maryland in 1996. Had the board been aware of this physician's criminal history, his application for licensure would have been denied.

How had this physician received a license without investigation? Today a simple Internet search could identify the accused physician's criminal history, yet the board's policies at the time relied on physicians to report their own histories of misconduct.

While this event was one of the board's most public failures, by no means was it the first. The month I was originally appointed to the board in 2011, the Department of Legislative Services (DLS) released a scathing audit of the board's activities. This "Sunset Review" included 46 critical findings, noting recurrent issues of backlogged cases, inconsistent sanctions and a lack of transparency. Incredibly, DLS had issued similar reports in 2001, 2003, 2005 and 2007, but this time the board was threatened with statutory dissolution. The board needed an urgent and innovative plan.

For background, the Maryland Board of Physicians is the third largest medical board in the country and regulates the licensure of more than 40,000 physicians, including those practicing at some of the nation's best teaching and research institutions like Johns Hopkins University, National Institutes of Health and University of Maryland. In addition, the board regulates nine other allied health specialties. Its functions include licensing, discipline, and policy making; but ultimately the board utilizes the police power of state to enforce the Maryland Medical Practice Act. Simply put, our mission is to protect the public health.

As a profession, physicians have a proud history of maintaining high ethical standards in the practice of medicine; as individuals, they are as susceptible to the proclivities of human desire as any person. It is the role of professional organizations and regulatory boards — such as the Maryland Board of Physicians — to elucidate and enforce the high ethical standards consistent with the tradition of medicine and demanded by caregivers and patients alike. To do so effectively requires close attention to the fair, transparent and efficient execution of our duties. It is a high bar to achieve, and in 2011 the board was missing the mark.

Following the DLS report, the board reflected on its important mission and courageously voted to engage Jay Perman, president of the University of Maryland, Baltimore, and his team of expert consultants. Here the board openly recognized the depth and breadth of its problems and proactively sought outside help.

One of the first actions we took based on these consulting reports was to double our meeting schedule. Second, we divided the board into two panels, thereby redoubling our throughput of disciplinary cases and enhancing due-process rights for licensees. We also facilitated quicker resolution of charges, encouraged more settlement conferences and offered a pre-charging consent order for early disposition of certain cases. We increased transparency through the board's website and newsletter, codified sanctioning guidelines to improve consistency of our decisions, increased usage of the national practitioner databank and the prescription drug monitoring program, clarified regulations governing mandatory hospital reporting, and trained our staff in better practices of case investigation and customer service.

Today, our backlog of cases is near zero. Cases are settling earlier in the disciplinary process, and we are issuing licenses in 10 days or less for 95 percent of completed applications. Christine Farrelly, the new executive director at the board, has made sweeping and important organizational changes, including increased accountability of staff.

And the board acted swiftly following the arrest of that Maryland physician for sexual misconduct. The former chair and I jointly requested formal investigation by the Office of the Inspector General into our licensing processes, and the board aggressively lobbied for routine use of criminal background checks. As a result, a board bill signed by Gov. Larry Hogan in April now requires background checks for all applicants for medical licensure in Maryland, effectively closing a loophole.

Changing an organizational culture, especially that of a government agency, was a tremendous challenge. To do so required the joint and sustained commitment to our mission by many stakeholders. Although there is more work to do, we now have a record of innovation and transparency to help us meet upcoming challenges. Like our mandate of continuing education for safe opioid prescribing, bold solutions will continue to be required to address vexing problems in the future.

Emerging issues one might anticipate will be the enforcement of standards for the medical use of marijuana, regulation of telemedicine and the implications of electronic medical practice across state lines. Furthermore, a recent Supreme Court decision sternly warned health occupation boards like the Board of Physicians to consider anti-trust implications that arise when regulators double as market participants (North Carolina State Board of Dental Examiners v. Federal Trade Commission). In Maryland, this ruling will impact scope of practice between various health occupation boards, the enforcement of standards of care for Naturopathic doctors, and how much if any prescriptive authority they should be allowed in our state.

Finding solutions to these sorts of questions will require an efficient, transparent, and nimble board that remains focused on its mission to protect public health. Through the tireless efforts of many stakeholders, the board, once hobbled by inefficiency, is now better prepared to handle these 21st Century challenges.

Dr. Devinder Singh is chair of the Maryland Board of Physicians and director of Plastic & Reconstructive Surgery at Anne Arundel Medical Center in Annapolis; his email is dsingh@aahs.org.

Copyright © 2017, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad
39°