Nearly three years ago, the Illinois medical board received a letter urging the agency to investigate a Chicago doctor who tried and failed to intubate a 52-year-old woman after giving her anesthesia that stopped her breathing.
The letter detailed not only the medical error, which preceded the woman's death, but also the doctor's admission in a deposition that he later added dozens of entries to records of the patient's vital signs that were "inaccurate" and "not true," an unusual acknowledgment backed up by court documents. The anesthesiologist and the suburban hospital where he worked agreed to an $8 million settlement.
The Illinois Department of Financial and Professional Regulation, however, has yet to take any apparent action against the doctor, baffling the attorney who sent the letter.
"He failed in the technical job of getting her intubated and then he tried to cover it up," said Bruce Pfaff, who represented the patient's family in the lawsuit. "The (department's) failure to sanction him is unforgivable."
In 2012, the agency responsible for protecting the public from dangerous doctors disciplined fewer than 30 Illinois physicians in cases where the department cited medical errors or failures to properly diagnose a problem, according to a Tribune review of state data.
By contrast, IDFPR took disciplinary action against more than 100 physicians after medical boards in other states found the doctors had engaged in misconduct or provided improper care. The cases involve doctors who hold or have held licenses in Illinois, yet often no longer work here.
Such cases are important to address, patient advocates say, as they prevent incompetent or abusive doctors from simply relocating to another state. But federal figures show that Illinois nearly leads the nation in relying on other states' actions as the basis for disciplining doctors.
Since 2004, about half of all IDFPR actions against physicians were prompted by investigative findings in other states, according to the National Practitioner Data Bank, which compiles information provided by state medical boards. That is a higher rate than all other states except Pennsylvania.
Experts and advocates say that when so-called reciprocal actions far outpace all others, it can signal a lack of effectiveness in more difficult cases. A medical board reacting to another state's action can borrow from evidence collected elsewhere, the turnaround time is faster, and physicians are less likely to fight the discipline.
"It's a lot easier to take a reciprocal action," said David Swankin, an expert on consumer protection boards at the Citizen Advocacy Center in Washington. "You can run up the numbers. They're quicker, cheaper and you can never say they're bad."
Investigating an in-state practitioner for incompetence, substandard care or negligence demands considerably more time, he said.
"They're taking the low-hanging fruit," said Arthur Levin, director of the Center for Medical Consumers in New York. "There is much less that you need to do when another state has done the investigative work for you."
A spokeswoman for IDFPR disputed the figures released by the national data bank, an information clearinghouse overseen by the U.S. Health Resources and Services Administration, saying that inaccurately classified information had inflated the state's rate of reciprocal actions.
The department estimated that from 2004 to 2011 a third of all actions taken were reciprocal, nearly 20 percentage points lower than the data bank's rate for the same period. Even by that standard, however, only five states in the data bank had a rate that was the same or higher.
"We have consistently had problems with the classification system at the NPDB," said spokeswoman Sue Hofer. "Since we don't license by specialty, some of our disciplines are mischaracterized by the national system."
Martin Kramer, a spokesman for HRSA, said the agency is confident that the data bank numbers are correct. Some penalties included in Illinois' total count might not qualify as disciplinary actions at the federal level, HRSA officials said. If Illinois includes those in its analysis, reciprocal actions would account for a smaller share of the total.
Hofer also said the state's high rate of reciprocal actions may partially stem from its large number of medical graduates. Illinois medical schools account for about 6 percent of doctors nationwide, more than all but four other states — California, New York, Pennsylvania and Texas. After obtaining credentials in Illinois, doctors may relocate to other states, creating more potential for reciprocal actions.
"I think that's a huge part of it because we're such a hub of medical training," Hofer said.
Hofer said IDFPR's efforts to impose penalties based on out-of-state violations don't add to the workload of investigators because the department's prosecutors handle reciprocal actions. Despite cuts in staffing, she said, the agency aggressively polices bad doctors and finds ways to take swift action, even in the most complex cases.
"They get the work done," she said. "If it's a case (where) you need to be on it very quickly because the evidence might disappear, they're fully capable of making those judgments and doing triage to get to the most important cases."