Calls for more doctor oversight

Sun reporter

Key Maryland lawmakers are calling for tighter oversight of the state's doctors, including greater disclosure of malpractice claims histories and other information by the Board of Physicians.

"There needs to be change," said Sen. Paula C. Hollinger, chairwoman of the Education, Health and Environmental Affairs committee. "We have to figure out a way to make the board more responsive to the public need."

She and several others were reacting to a series published this week in The Sun that found that the board overlooks dozens of doctors with unusually high numbers of malpractice claims and shields the identities of doctors associated with tens of millions of dollars in payments to injured patients.

Hollinger, a Baltimore County Democrat who was instrumental in creating the board in 2003, said its operations would be scrutinized during a mandatory review.

The law expires in 2006, requiring an evaluation by lawmakers.

"I'm interested in taking a good look at the way the board operates and improving the manner in which it does," said Del. Peter A. Hammen, a Baltimore Democrat who chairs the Health and Government Operations Committee.

The Sun's series also found that Maryland's medical board conducts its proceedings largely in secret and lags behind other states, including Virginia, in posting claims information on the Internet.

"It's very disconcerting that a conservative state such as Virginia is far ahead of Maryland" in publishing doctors' malpractice histories online, said Senate President Thomas V. Mike Miller. "It's shocking to me that in Maryland, the same information is not available to people who need to make life-and-death medical choices."

Miller said the newspaper exposed significant weaknesses in the monitoring system, including a backlog that stretches to more than four years of disciplinary cases for quality of care.

The board has to "eliminate the backlog," he said. "If you have a physician with a history of bad treatment, of obtaining bad results and practicing bad medicine, then action needs to be taken forthwith."

Miller said the lengthy disciplinary process may indicate the board "needs more resources" and that the backlog and other issues could be the subject of reform proposals that he expects his colleagues to introduce in the coming session. Few details have emerged.

The General Assembly created the Board of Physicians to replace a previous panel amid concern that the state was doing a poor job disciplining doctors. The board's 21 members, five of them consumers, were appointed in September 2003 by Gov. Robert L. Ehrlich Jr.

Don Hogan, an aide to the governor on the subject, said the office would review the series findings "to see if there's any issues that should be examined."

Series findings In the series, The Sun said an investigation had found that the board rarely examines a group of doctors across the state who have multiple malpractice claims. While about 17,000 doctors practice in Maryland, most aren't sued very often. About 120 doctors, from a variety of medical specialties, had five or more malpractice claims against them over the past decade.

Most of those doctors don't draw any scrutiny from the board, the newspaper found, because it automatically reviews only those doctors with three malpractice settlements of $150,000 each over five years or those who settle a case for $1 million or more.

'Costing everybody' W. Ray Huff, a former Democratic state delegate who was appointed to the Board of Physicians six weeks ago, said reforms are needed to ensure quality medicine and to keep malpractice premiums and medical costs down.

"We should look at the malpractice claims because if they're paying a lot out, it's costing everybody," said Huff, a consumer member.

He said that in setting a policy on when to investigate a doctor, it might be wiser to focus not on arbitrary numbers or a dollar limit but on the nature of the complaints.

T. Michael Preston, executive director of MedChi, the State Medical Society - which represents about 6,500 doctors in the state - said malpractice claims may not be a valid indicator of a physician's performance.

"We think it is unfortunate there's such a focus on malpractice claims. We don't feel it is a useful tool" for judging doctors, he said. Yet Preston said he didn't oppose setting parameters for examining doctors, so long as it is done fairly.

Preston said the series "creates an opportunity" for the society, which represents about 6,500 doctors, to build support for creating a system to help patients judge how well doctors do in treating patients as compared with their peers. The system would be based on physician "report cards." He declined to elaborate on the concept.

Huff and two other board members had differing opinions on whether the public should be allowed to attend doctors' disciplinary hearings. A recent report by legislative auditors recommended opening them.

Huff suggested that the hearings could be opened after an initial closed-door session to determine whether there's any merit to the complaint brought against the doctor. "I don't want to hurt the reputation of a doctor if he hasn't done anything wrong, but I think the public has a right to know what's going on," he said.

Samuel K. Himmelrich Sr., a consumer member of the board, believes it would be wrong to open disciplinary hearings to the public because it could tarnish reputations of doctors who were targeted by frivolous complaints.

"There are a tremendous number of complaints that once investigated, there's little validity to a lot of them," he said.

Dr. Moises Z. Fraiman, a retired surgeon who has served on the board or its predecessor for seven years, said he has no problem with opening disciplinary hearings. He is proud of the board's work and would welcome public scrutiny.

"As far as I'm concerned we know we are doing the right thing," he said. "There's nothing that we have to hide."

fred.schulte@baltsun.comSun reporters Joanna Daemmrich and Dennis O'Brien contributed to this article.

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