Efficacy of state medical board is questioned

The state Medical Examining Board ranked 37th in the nation in the annual rate of serious disciplinary actions the board took against physicians accused of wrongdoing from 2017 to 2019, according to a Public Citizen report issued earlier this year.

Connecticut’s board averaged about 13 serious disciplinary actions per year in 2017, 2018 and 2019, according to Public Citizen. The rankings were based on the number of serious disciplinary actions taken by states per 1,000 physicians.

Connecticut’s rate was 0.65 per 1,000 physicians — Kentuckyhad the highest rate of serious disciplinary actions at 2.29 per 1,000 physicians, the report said. Public Citizen defines a “serious disciplinary action” as one that has a clear effect on a physician’s ability to practice.

The medical boards, which oversee the discipline of physicians in all 50 states and the District of Columbia, largely are unfunded or underfunded, are not adequately staffed, are reactive to complaints rather than initiating proactive investigations, and have little oversight by state officials or legislators, the report said.

“They are not doing what they are mandated to do,” said Dr. Sidney Wolfe, founder and senior adviser of the Public Citizen’s Health Research Group and one of the authors of the report. “So, what is happening is they are leaving tens of thousands of patients exposed to doctors who shouldn’t be practicing.”

Complaints filed against physicians in Connecticut can take months and sometimes years to investigate and adjudicate.

In one recent case, a psychiatrist was allowed to practice while a 2018 complaint was investigated and discipline negotiated on allegations that he had failed to monitor a patient on Lithium and failed to keep the patient’s records during the period under review. His case was settled in June with a $10,000 fine and 18 months’ probation.

Attorney Kathryn Emmett, chairwoman of the Connecticut board, said the Public Citizen report doesn’t reveal the whole picture. Emmett said she couldn’t speak for the entire board but noted that comparing states by the number of disciplines issued wasn’t the best way to assess their effectiveness.

“I think that the idea that the greatest number of serious disciplines can be used is faulty,” Emmett said. “I don’t think it shows whether the board is accomplishing its goal of protecting the public.”

But at least two public members of the board share the national advocacy group’s concerns. Jean Rexford, who has been a board member for more than a decade and founded the Connecticut Center for Patient Safety, told the board during its May meeting that she wanted to look at whether it was doing enough to address the safety of the public.

“I think the legislation that chartered us was many, many years ago,” Rexford said. “Is it time to take a look at that and bring it up to 2021? Do we need to have better consideration of transparency?

“I’ve been feeling incredibly powerless on Zoom [where the meetings are now conducted], but also powerless in our role in protecting the public,” Rexford said before suggesting that a committee of board members examine “how we could keep current and do a better job.”

Rexford’s comments prompted the creation of a working group, which met in private for the first time on Sept. 28. The state Department of Public Health contends the meetings are administrative and not open to the public. The Connecticut Health Investigative Team has filed a complaint with the state’s Freedom of Information Commission on the denial of access to the working group meetings.

Med Board’s Composition and Role

The med board’s composition — which includes physicians, attorneys and public members — and its duties are laid out in a decades-old law that periodically has been updated. The board has no funding and no staff of its own.

Any fines collected from disciplined physicians go into state coffers. All staff members are DPH employees who also deal with complaints against other professions. The board has no independent investigatory or policy-making powers, according to the statute.

The DPH’s Practitioner Licensing and Investigations Section reviews complaints filed against physicians. The same investigators deal with complaints filed against dozens of other professions, including nurses, hair and nail salons, and veterinarians.

There are 18 full-time investigators within the unit who work on 1,200 to 1,500 complaints per year, said Section Chief Christian Andresen. There also is a hearing process for physicians who contest the charges.

The agency receives about 450 complaints about physicians each year that result in an average of 43 disciplines per year, DPH officials said.

The DPH hires medical consultants to determine whether a physician facing a complaint has met the standard of care or has participated in activities that could be harmful to patients, Andresen said.

The range of complaints that come before the medical examining board includes physicians practicing while under the influence of alcohol or drugs, physicians failing to diagnose serious illness accurately, physicians practicing with a serious mental illness, or physicians prescribing to patients without adequate oversight or controls.

Michele Jacklin, a public member of the med board, said the board is “impotent and toothless” compared to medical boards in other states.

“Other states routinely issue fines as high as $50,000,” Jacklin said. “In Connecticut, often the penalties are $1,000 to $5,000, which is a slap on the wrist for a physician.”

State statute limits the fines for physician discipline to $25,000.

“The discipline is negotiated by DPH

attorneys and then