The prospects for major reforms of Maryland's system for disciplining doctors appear to be dimming in the wake of an aggressive lobbying effort by the state's medical society.
The society, known as MedChi, is trying to strip the most significant elements from a legislative proposal to change the system of regulating physicians, said Sen. Paula C. Hollinger.
"They're pulling out all the stops," the Baltimore County Democrat said of MedChi's lobbying efforts to thwart her bill, which aims to lessen the role that MedChi plays in regulating and disciplining Maryland doctors.
Her proposed changes include eliminating from state law a requirement that all "peer reviews" of physicians be handled by MedChi. In such reviews, doctors solicited by MedChi decide whether a physician has failed to meet accepted "standards of care" in the treatment of a patient.
Hollinger's bill would allow the state board that regulates physicians to contract with other nonprofit groups for peer-review services.
The bill also would change the standard of proof required in order to make it easier for regulators to pursue disciplinary cases against doctors.
Under existing law, regulators must prove a case by "clear and convincing evidence" - a high standard of proof. Hollinger's bill would change that to "a preponderance of the evidence," which is the same standard that applies to nurses and all other health-care professionals in Maryland.
Most other states use the "preponderance" standard to judge doctors in disciplinary cases, according to the Federation of State Medical Boards.
The proposed legislative reforms follow an Aug. 2 Sun article that exposed problems with Maryland's system of disciplining doctors. Legislative analysts issued a highly critical report two months later.
Both reports focused on the work of the 15-member Board of Physician Quality Assurance, responsible for licensing and disciplining doctors in Maryland.
Hollinger said the changes she is proposing follow recommendations made by legislative analysts.
She said she is concerned that MedChi's lobbying efforts could succeed in blocking meaningful change. "If you take 'clear and convincing evidence' and put that back in, and MedChi keeps peer review, then you tell me what has changed," she said. "Nothing. ... It's the fox guarding the henhouse."
Hollinger said MedChi and the physician quality board take the position that the system works well and there is no need for significant changes. "It seems like these few people want to keep everything in their own control," she said. "Basically, it's a message that the public be damned."
However, some other legislators said they were convinced of the merits of MedChi's arguments on key points.
Sen. Andrew P. Harris, a Baltimore County Republican who is also a doctor, said the higher "clear and convincing evidence" standard seems appropriate, given that a doctor's license and livelihood potentially are at stake.
On the House side, Del. Dan K. Morhaim, a Baltimore County Democrat and a physician, said that it could be costly to bid out the peer review process. He said there did not appear to be a problem with the quality of MedChi's peer reviews, only with their timeliness.
Stephen B. Johnson, an attorney for MedChi, acknowledged the society is doing what it can to get its message out to legislators as the bill moves through the General Assembly. "We think we've established that the system is working pretty well right now," Johnson said. "We don't want them [legislators] to make things worse by making changes that have not been completely thought through."
Senate and House committees are expected to vote on versions of the legislation this week.