Three years have passed since Tiffany Troch, the 13-year-old daughter of Mark and Debbie Troch and an honor student at Perry Hall Middle School, slipped eight feet from a rope swing and landed on a tree stump. It was April 16, 1992.
The Troches drove their daughter to an emergency room. "We were on our way to GBMC [Greater Baltimore Medical Center] and we hit a bump and Tiffany yelled and we detoured to St. Joe's because it was closer," Mark Troch recalls. Tiffany, complaining of abdominal pains, walked into the emergency room at St. Joseph Medical Center at 5 o'clock. She was pronounced dead at 6:20 the next morning.
A few weeks later, The Evening Sun published a story that raised questions about Tiffany's treatment. In the story, the Troches alleged that delays in the diagnosis and treatment of their daughter's lacerated liver had caused her condition to deteriorate beyond the point from which recovery was possible. They said the two doctors who examined her had not done enough to prevent shock. The Troches were right.
A state medical arbitration panel ruled that the actions of the doctors, the hospital and the physicians' group that runs the emergency room all breached standards of care and contributed to Tiffany's death. The panel awarded the Troches $4.35 million in damages. A jury upheld the panel's findings but excused the hospital of responsibility; the damage award was reduced to $3.35 million.
The Troches pressed on. They complained about the doctors to the Maryland Board of Physician Quality Assurance, which conducted an investigation. Some months later, the Troches learned that the case had been closed, with no disciplinary action taken against the two doctors.
"They didn't even ask us any questions about what had happened," Mark Troch says. "Everything is confidential with this body. It's a 15-member board appointed by the governor. [The chairman] claims they did a thorough investigation, but they never talked to us. How can they just let them [the doctors] go? If they don't discipline someone in a case like this . . . then when will they discipline someone?"
Last year, the board disciplined 94 Maryland doctors, resulting in the most sanctions in five years. That's according to a survey conducted by the Federation of State Medical Boards. The most sanctions were given for poor standards of care (21), selling prescription drugs for profit (18) and sexual misconduct (13). Discipline ranged from license revocations to reprimands.
Nationally, medical boards disciplined 3,685 doctors in 1994, and the total number of actions against doctors has increased in each of the last three years.
Still, Dr. Sidney M. Wolfe of the Public Citizen's Health Research Group criticizes regulation of the medical profession, saying 80,000 patients die in hospitals each year because of bad care. "We have a huge pool of physicians causing some negligent deaths or injuries. But only a fraction" are disciplined, " he says.
"It is just a good-old-boy organization, they just look after one another," Mark Troch says of the Maryland board. "We want the public to know what's going on out there. I want people to question doctors."
The Troches appealed to the General Assembly this winter, and they won a small victory -- passage of a measure, sponsored by hTC Del. Alfred W. Redmer Jr., R-Baltimore County, that requires the board to interview victims or their survivors in a standard-of-care case.
The board had opposed the bill on the grounds that the interviews would be time-consuming and costly, says J. Michael Compton, its executive director. The board's complaints prompted legislators to amend the bill to require interviews only when a case proceeds from a preliminary review to a "full investigation." Right now, the board reviews trial transcripts, medical records and depositions, then decides whether to cite doctors.
Compton says the board was investigating the death of Tiffany Troch before her parents filed a complaint. "Any time something appears in the newspaper where medical negligence was alleged we do an investigation, and this case is one of those," he says.
And in this case, two doctors found to be negligent in a 13-year-old girl's death did not lose their licenses to practice medicine. They were not even reprimanded.
"The outcome of a case is not really what the board looks at," Compton says. "We've taken away the license of physicians who have never been sued. The [board] looks at a pattern. We are completely different from the civil process. Our law even says that board investigations cannot be used in civil court. One does not influence the other, and they should be separate. The outcome is not a consideration."
"The [board] looks at what happened minute by minute," Compton says. "Who talked to whom, who did what. You can see a little mistake, how each individual mistake in itself was not very serious but was compounded by other delays." The board only examines the actions of doctors, not the hospital staff or nurses, in making its determinations, he says.
"It's not as cut-and-dried as saying, 'We had a death here so someone has to be at fault because they were in a hospital.' Sometimes you have a system problem, as opposed to one person being at fault."
The Troches, meanwhile, press on. They will discuss their daughter's death and its aftermath on the nationally syndicated "Sally Jessy Raphael" late this month.