State officials plan to scrutinize the records of every patient treated by Dr. Arthur B. Boyd Jr., the Maryland Shock Trauma Center surgeon who was dismissed Tuesday after the hospital found that he had been operating on critically injured patients without a license to practice medicine.
One former Shock Trauma surgeon estimated that Dr. Boyd could have treated as many as 1,800 patients over the past two years, while in advanced training in trauma medicine at the Baltimore hospital and at Prince George's Hospital Center in Cheverly.
A spokesman for Shock Trauma said the figure sounded "way too high" but declined to provide an estimate.
State regulators say they plan to probe how Shock Trauma and its parent, the University of Maryland Medical System, permitted Dr. Boyd to work for so long without proof that he held a required credential.
"Before this physician ever put his hands on a patient, the hospital should have checked with the Board of Physician Quality Assurance to verify that he was licensed to practice medicine in the state of Maryland," said Carol Benner, chief of the Licensing and Certification Administration of the state Department of Health and Mental Hygiene.
"It's rather astonishing that a lapse like this could occur," she said. "Hopefully, we'll find this is an isolated incident."
A spokesman for Attorney General Joseph J. Curran Jr. said yesterday that the office is considering launching an investigation of the surgeon's actions.
Practicing medicine without a license in Maryland is a misdemeanor, and violators can be fined up to $5,000 and sentenced to up to five years in prison.
Joel Lee, vice president of communications for the University of Maryland Medical System, this week called Dr. Boyd a "capable" surgeon.
"We checked with his clinical manager and found that there was nothing in the record that would have indicated problems with his surgical practice," he said.
A spokeswoman for the Prince George's Hospital Center said she was not aware of any complaints about Dr. Boyd's skills as a physician.
No malpractice complaints have been filed against Dr. Boyd with the state Health Claims Arbitration Office.
Dr. Boyd, 48, whose permanent address is in Shaker Heights, Ohio, did not respond to a message left at his home yesterday. Reached by phone Monday, he refused to answer questions about his work in Maryland.
The spokesman for Shock Trauma said the hospital is cooperating with regulators.
"They are doing exactly what they should do, and we're supporting them," said Mr. Lee. "And we're doing the same sort of shadow analysis, because we need to know everything that they need to know as well."
State officials said Dr. Boyd did not apply for a state license, as required, within 30 days of starting work at Shock Trauma in July 1993. And, they said, they have not been able to find any evidence that he has ever held a license from any state or the District of Columbia, based on an inquiry to the Federation of State Medical Boards in Texas.
Maryland officials also said Dr. Boyd failed a multistate medical licensing examination, called the FLEX exam, 15 times and was turned down for licenses by authorities in Ohio, Connecticut, Alaska and California.
Records show that in 1987, the State Medical Board of Ohio barred Dr. Boyd from ever applying for a license in that state, based in part on his 1985 conviction in Michigan for attempting to bribe a public employee.
News accounts said Dr. Boyd offered $20,000 cash for an advance copy of test materials.
His Ohio license troubles won him a listing in "6,892 Questionable Doctors," a consumer reference published in 1990 by Ralph Nader's Public Citizen Health Research Group.
Charles Cichon, chief compliance analyst with Maryland's Board Physician Quality Assurance, said he could not discuss the particulars of any investigation.
But the board signaled its intention to investigate Dr. Boyd yesterday when it issued a cease-and-desist order barring him from working as a physician here.
"Part of our normal investigation into any matter like this would be interviewing anybody involved with a physician and the subpoena of any files that would be appropriate or pertain to the physician," he said.
Shock Trauma officials said Dr. Boyd claimed to have an out-of-state medical license when he applied for the fellowship program in 1993. He needed a license to get the credentials that were required by law to allow him to practice medicine here.
The officials said he was repeatedly asked to produce that license but failed to do so. On Tuesday, Shock Trauma administrators said they gave him one last chance.
He pledged to have his lawyer respond by 1:30 p.m., they said, but the call never came. So they fired him from the $50,000-a-year post.
From July 1993 to July 1994, Dr. Boyd worked and trained at Shock Trauma, hospital officials said. From July 1994 until his dismissal, he was assigned to work in the trauma center at the Prince George's Hospital Center in Cheverly, under an agreement between the two institutions.
"The contractual arrangement that we had called for them to assign trauma fellows to our trauma center, and part of the requirement for that was that they be licensed," said Lisa Shiller, a spokeswoman for the Prince George's Hospital Center. "We assumed that he was licensed. We did not conduct an independent check of his credentials."
One former Shock Trauma surgeon said, though, that a physician's repeated failure to pass a medical licensing test is troubling.
"If you've got somebody who can't pass a very basic exam, which is an assessment of someone's fundamental knowledge of medicine, you've got to assume that there are some gaps in that person's ability to take care of patients," said the surgeon, who spoke on condition that his name not be used.
Hospital credentials procedures, required by state law, are supposed to prevent institutions from hiring or granting privileges to unlicensed health-care workers or those with flawed histories.