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Mississippi Gets Worst Rating in Physician Oversight

Alaska Ranked Best by Public Citizen

June 6, 2007
Public Citizen today released its annual report ranking how effective state medical boards are at disciplining doctors, with Mississippi ranked worst and Alaska best.

The rankings are based on state-by-state data released by the Federation of State Medical Boards (FSMB) about the number of disciplinary actions taken against doctors in 2006, combined with data from earlier FSMB reports covering 2004 and 2005.

Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state for each year and compiled a national ranking of state boards by the average rate of serious disciplinary actions for 2004-2006 and for earlier three-year intervals. Non-serious board actions were not included.

There were 2,916 serious disciplinary actions taken by state medical boards in 2006, down 10.4 percent from the 3,255 serious actions taken in 2005. The national average disciplinary rate was 3.18 serious actions per 1,000 physicians, compared to 3.62 in 2005.

The three-year state disciplinary rates ranged from 1.41 serious actions per 1,000 physicians (Mississippi) to 7.30 actions per 1,000 physicians (Alaska), a 5.2-fold difference between the best and worst states.

The bottom 10 states – those with the lowest serious disciplinary action rates for 2004-2006 – were, starting with the lowest: Mississippi (1.41 serious actions per 1,000 physicians); South Carolina (1.45); Minnesota (1.45); South Dakota (1.52); Nevada (1.68); Wisconsin (1.78); Washington (2.06); Delaware (2.22); Maryland (2.25); and Connecticut (2.34).

Nine states have experienced at least a 10-place drop in ranking between the 2001-2003 ranking and the 2004-2006 ranking: Alabama went from 13th to 26th; Georgia from 15th to 25th; Idaho from 14th to 24th; Mississippi from 20th to 51st; Nevada from 33rd to 47th; New Jersey from 24th to 40th; North Dakota from 3rd to 19th; South Dakota from 37th to 48th; and Virginia from 30th to 41st.

“The data demonstrate a remarkable variability in the rates of serious disciplinary actions taken by state boards,” said Dr. Sidney Wolfe, director of the health research group at Public Citizen.

“As there is no reason to believe that physicians deserving of discipline are much more common in one state than another, these large differences in rates are likely due to the board’s practices themselves. There is considerable evidence that most boards are under-disciplining physicians.”

The 10 states with the highest three-year rates of serious disciplinary actions for 2004-2006 are, in order from the top down: Alaska (7.30 serious actions per 1,000 physicians); Kentucky (7.10); Wyoming (6.37); Ohio (6.01); Oklahoma (5.54); Missouri (5.43); Iowa (5.32); Colorado (5.24); Arizona (5.12); and Nebraska (4.91).

Seven of these 10 states (all but Iowa, Missouri and Nebraska) have been in the top 10 for all four of the three-year average periods in this report. Seven states have improved by at least 10 places from the 2001-3 ranking to the 2004-6 ranking. Most notable are Nebraska and Missouri, now both among the top 10 states. Nebraska improved from 28th to 10th, and Missouri went from 31st to 6th.

According to the report, boards are likely to do a better job disciplining physicians if most, if not all, of the following conditions are met:

• They have adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);

• They have adequate staffing;

• They undertake proactive investigations rather than only responding to complaints;

• They use all available and reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;

• They have excellent leadership;

• They are independent from other parts of the state government, so that the board has the ability to develop its own budgets and regulations; and

• A reasonable legal framework exists for disciplining doctors (the “preponderance of the evidence” rather than “beyond reasonable doubt” or “clear and convincing evidence” as the legal standard for discipline).

“Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner and endangering the lives and health of their patients,” Wolfe said. “State legislatures must act to increase the amount of doctor discipline and patient protection. Without adequate oversight, many medical boards will continue to perform poorly.”

In previous years, rankings were derived from American Medical Association (AMA) data on non-federal M.D.s, but the AMA now provides information only on the total number of licensed physicians without a breakdown by federal/non-federal status. In its current report, Public Citizen used the data for the total number of M.D.s in each state and recalculated previous three-year rankings to ensure that rankings from all years are as comparable as possible.

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