Every hospital has a system for checking the credentials of each doctor who lifts a stethoscope within its walls. But at the Maryland Shock Trauma Center, it failed.
Somehow, the hospital allowed Dr. Arthur B. Boyd Jr., 48, to practice trauma surgery for two years under its supervision without ever obtaining proof that he held a medical license. State officials say he also concealed at least 15 failed attempts to pass state licensing exams, and a 1985 Michigan conviction for trying to bribe a state official for an advance copy of the exam.
A Sun review of the credentials process suggests that two factors combined to allow Dr. Boyd to treat some of the state's most critically injured patients without a license:
* Shock Trauma failed to follow its rules for verifying that doctors seeking positions have medical licenses.
* The hospital's credentials policy precluded a check with a Texas agency that would have revealed Dr. Boyd's inability to obtain a license. Instead, it used a Virginia clearinghouse that had no record of the matter.
"We screwed up," said Shock Trauma spokesman Joel Lee. The hospital's verification process "fell down because we didn't insist on licensure. It's a very straightforward problem."
Dr. Boyd was fired Tuesday. Now, an internal investigation is under way to determine exactly where the process broke down; what else, if anything, in Dr. Boyd's background was missed; who was responsible, and whether it could happen again.
"It's an analysis that we want to make carefully, and that's going to take a little bit of time," Mr. Lee said. So far, the center has assured itself that it has no other unlicensed doctors.
The Maryland health department's Licensing and Certification Administration sent four inspectors into the hospital Friday. The team -- two physicians and two nurses -- represent the state and the federal Health Care Financing Administration, said Carol Benner, state licensing administrator.
They are examining Dr. Boyd's credentials file and the records of patients he treated. No cases of faulty care have yet been reported. The review is expected to extend to the middle of next week.
Attorney general probe
The Maryland Attorney General's office is gathering facts to determine whether prosecution of Dr. Boyd is warranted.
Practicing medicine without a license is a misdemeanor in Maryland. It's also a violation of state licensing rules, and the State Board of Physician Quality Assurance can fine violators up to $50,000.
Hospitals, too, are liable. Ms. Benner said a hospital that fails to meet state requirements for verifying credentials faces fines of up to $500 for each day the violation continued, or license revocation.
"Any penalty would depend on what we would find," she said. "If this is an isolated incident, we're certainly not going to de-license the hospital."
The state set its current credential verification requirements a decade ago. Ms. Benner recalled cases where a doctor held a license, but the hospital failed to verify its existence. In a case this year, a hospital pharmacist had allowed her license to expire.
"This is a lot different," she said of Dr. Boyd's case.
Double-checking the educational and professional credentials of a physician seeking a staff position or hospital privileges is tedious and can take three to four months, officials at hospitals in Maryland and elsewhere said.
"It's a constant frustration over the amount of time and effort it takes to credential somebody in a hospital. But in the end, for reasons like these, it is important," said Dr. Alexander Kuehl. Formerly with Shock Trauma, he now teaches at Cornell University Medical College in New York.
"Licensing assures both a level of competence and moral character," he said. But "the bigger issue is that it's patently illegal to practice without a license. Literally, the individual is breaking the law every time he picks up an instrument."
Hospital officials estimate Dr. Boyd treated as many as 650 patients at Shock Trauma from 1993 to 1994. From 1994 until last week, he worked for Prince George's Hospital Center in Cheverly under a contract between the hospitals. A spokeswoman there said Dr. Boyd treated about 300 patients.
Barbara Davis, vice president for clinical quality systems at Shock Trauma, oversees the credentialing process. It applies to private and attending physicians, and to doctors in training fellowships like the trauma surgery program for which Dr. Boyd was hired.
Ms. Davis has a staff of three, plus a secretary. They process 150 new applications each year for medical staff positions.
Candidates are first interviewed by faculty at the University of Maryland School of Medicine, who review their resumes and recommend qualified people for further consideration. Next, they complete a lengthy application.
"We take every piece of information we get from that applicant and verify it through original source verification," said Ms. Davis. That means getting written confirmation from from every college, medical school, residency and other training program the applicant attended, and every hospital, clinic and private practice for which he or she worked. "We also get evaluations of their performance at other hospitals."
State and federal drug agencies are asked about any prescription irregularities, and malpractice insurance companies are asked to report any claims against the applicant where payments exceeded $500,000.
Neither Mr. Lee nor Ms. Davis would discuss whether Shock Trauma's investigation has found any other assertions by Dr. Boyd -- apart from his claim of licensure -- that don't check out.
"This is confidential information," Mr. Lee said.
But Shock Trauma failed to make at least two record checks that might have discovered Dr. Boyd's lack of qualifications.
* State regulations require that hospitals independently verify doctors' licensure, and obtain the confirmation in writing from the state licensing agencies. Mr. Lee has said Shock Trauma DTC supervisors asked Dr. Boyd for proof of his licensure. He was able to put off their inquiries repeatedly with excuses for two years, until a Sun reporter's questions last week prompted his dismissal.
"It should have been verified," Mr. Lee said. "It was not."
* By state law, all hospital credentials checks must include a query to the National Practitioners Data Bank in Virginia, a computerized clearinghouse for information on disciplinary actions taken against licensed physicians anywhere in the country.
A bribery conviction would ordinarily result in such action. But Mr. Lee said Dr. Boyd's license denial would not be recorded there because he never obtained a license.
Dr. Boyd's conviction is on file, though, with the Ohio state medical board. And a Maryland official said Ohio's subsequent refusal to grant Dr. Boyd a license is on file with the Federation of State Medical Boards in Texas.
Mr. Lee said Shock Trauma's credentials committee decided years ago that it would not consult the federation's database because it was considered "redundant."
A criminal records check might be expected to reveal Dr. Boyd's 1985 bribery conviction in Ingham County, Mich. Shock Trauma does conduct such checks on physicians today, but did not in 1993 when Dr. Boyd applied.
However, a criminal records check of Dr. Boyd probably would not have revealed his Michigan conviction.
A Michigan law enforcement official said Friday that he could not comment on Dr. Boyd. Questioned further, the official explained that under Michigan law, felons with clean records can, after five years, ask for an expungement of their criminal records. After that, the records are sealed.
If Dr. Boyd's conviction was expunged, it would explain the official's refusal to comment. But there is no way to verify that.
Questions about Dr. Boyd's credentials arose days after the hospital learned that a former nursing aide, accused of using his job to steal credit information from a critically wounded police officer, is a parolee convicted of killing his mother.