Are healthcare professionals worthy trustees of patient safety in spite their biases and self-interests?
In Britain they don't think so (see Reform).
To investigate the question in the USA, the disciplinary actions of the Ohio State Medical Board are analyzed on this page. This is public information that, as far as we can determine, never has been
analyzed in this way, which in itself is an important comment on healthcare professionals as worthy
trustees of patient safety (as is this other information about the state medical board of Ohio).
Are healthcare professionals fair and impartial governors of
patient safety? Or do their biases toward their own community thwart justice and
safety for patients?
The board receives about 3000 complaints per year, roughly half from patients. As an example, I have analyzed their results for the year 2001. (I am duplicating the work for two additional years and so far have found the same results). In 2001 it appears that not one single complaint filed by a patient resulted in justice or discipline. In that year there were a mere of 143 disciplinary actions (a
percentage that is normal for them), but most were the equivalent of secretarial actions, responses to actions taken elsewhere. These numbers are public record and
can be gotten from the Ohio State Medical Board.
Of the 143 total disciplinary actions:
35 were "Out-of-State," which means the board responded to someone else's
investigation
36 were responses to criminal convictions - again, someone else's investigation
2 resulted from Department of Defense investigations
So the first 73, or slightly more than half, have nothing to do with complaints filed by patients in Ohio or investigations conducted by Ohio State Medical Board
investigators.
Of the 70 cases remaining:
48 cases were impairment issues. These typically result from a physician voluntarily entering a recovery program or sometimes getting too many DUIs (both
of which create paperwork/trails). Having these result from complaints filed by
patients and/or investigations conducted by the board would be unlikely.
Of the 22 cases remaining:
8 were continuing education compliance issues (paperwork)
2 were automatic suspensions resulting from failures to pay child support
(paperwork)
1 was a massage school whose problem was noted as "school app issue" which
sounds like more paper work.
As you can see what results in discipline is not complaints filed by patients. Healthcare workers are free to do
many things to patients, even sexual abuse and intentional injury, without
having to worry about patients being able to get the state medical board to pay
attention. And there is nowhere else for patients to take these complaints unless it's one of the rare cases in which a lawyer
sees cash (contrary to popular belief, it is rare for legitimate grievances to result in suits).
Of the 11 remaining disciplinary actions:
6 involved prescribing issues, sometimes with
additional charges
1 was fraud in obtaining license
1 was unlicensed practice
1 simply was listed as fraud
1 combined impairment, criminal actions and licensing issues
1 was a voluntary surrender of license after minimal standards of care issue(s)
It's unlikely that even any of these last 11 resulted from complaints filed by patients. The
odds of a patient's complaint resulting in justice effectively are zero.
Things for which no one is disciplined include sexual abuse,
rape, assault and the myriad other evils in which humans indulge when normal inhibitions (like consequences) are removed from their environments.
Diagnostic
evidence is extremely difficult to obtain (see
wall of
silence) and regarded with no esteem by the board when it is obtained (as is covered in more detail elsewhere on this site). The testimony of the
patient carries no weight either.
No patient can be expected to understand how
this works and to know how to find a paper trail even if one exits.
How many patients complained about Dr. James Burt without the Ohio State Medical Board
doing anything? Mutilating hundreds of unsuspecting patients does not leave a
paper trail. Who would create one? Not the nurses (see
survey). Not the hospital. Certainly not the doctor himself. If patient testimony were considered evidence, on the numbers alone the Burt case supplied more than enough. If diagnostic evidence ever were regarded as being substantial or probative, all the injuries sustained by these women would have meant something to the Ohio State
Medical Board.
When the Ohio State Medical Board finally revoked Dr. James Burt's license it was in response to an
investigation done by a news team (who considered patient testimony and diagnostic evidence to be
probative).
Four years after Burt had been exposed, the Ohio State
Medical Board still was claiming to be investigating the medical personnel who
failed, and/or refused, to report him. No one ever was disciplined as far as can
be determined. Failing to report is not what gets disciplined in medicine. Could
Arthur Richard Schramm, who co-authored
a paper with Burt, not have known what was going
on? Could Schramm have been guilty himself? The paper they co-authored made such
outrageous claims that anyone who read it would have to have serious doubts
about Schramm's fitness as a medical practitioner too. But that is not what the Ohio State Medical Board does. That
is not what most other state medical boards do either. They may have asked some questions
of the medical personnel who did not report Burt, but they did not discipline
anyone for failing to report him. They did not even find a reason to wonder
about Arthur Richard Schramm. Schramm did not get disciplined until twenty years
later, and then only because a stepson with access to Schramm's files made a
case to the State Medical Board that even they could not ignore. But they did
not do the investigation. Someone else did.
The Rest Of The Complaints
But
what about all the rest of the complaints? Out of roughly 3000 complaints that are filed during any year, only one or two hundred result in discipline. The rest are dismissed, often for lack of evidence. When they cannot dismiss a case for lack of evidence, they have been known to decide that they are not charged with the laws applying to
that case.
This is having it both ways. They accept cases they are not authorized to accept and then dismiss them as though they did, but when they cannot dismiss them, they then decide that they were not charged by law to handle them, and then they dismiss them on that basis. So they never have to find anyone guilty,
even when patients have their lives intentionally ruined by miscreants in medicine, as through sex abuse. Is sex abuse a crime or is it not? If it is, can the Ohio State Medical Board accept those cases? It does accept them. And it does dismiss them. But it is not a law enforcement agency authorized to investigate and prosecute crimes.
When so much evidence is presented by the patient that the board cannot dismiss
a case on the basis of lack of evidence, they then dismiss it on the basis on
which they should have turned it over to the police in the first place. By not
doing that, they protect miscreants in medicine by causes the cases to become so
old they cannot be pursued by anyone.
All of this suggests that healthcare professionals are not
fair, impartial and motivated in matters requiring them to discipline their own
colleagues. It suggests that the well being of patients is not their highest
priority.
What's frivolous is the way claims are treated
The Ohio State Medical Board is regarded as one of the best
boards in the country. It is considered to be a model for the others. And yet
the odds of its arriving at justice in response to the complaints of patients
effectively are zero.
Although the board members work hard for little compensation and make difficult decisions,
they share the perspective of the people they are supposed to discipline, not
the perspective of the patients who need to be protected. All indications are
that it is run by and for healthcare professionals with an investigative arm set
up to placate, if not defeat, patients while claiming to do the opposite. I had
written extensively about that here, providing information to support that
conclusion, but because of the nature of jurisprudence in this country, had to
remove it. And I'm not even allowed to say much about that. That fact alone
should ring alarm bells.
There are people who spend their lives learning to be
managers. They get advanced degrees in management fields. They become junior
executives and climb the management ladder learning as they go. That is not what
physicians do. The physicians who end up in charge of an organization like the
Ohio State Medical Board are not people with the tools or the time to understand
the organizational problems of the bureaucracy they lead. On the board they act
more as jurists more than managers.
Citizens think that licensing agencies exist to ensure competence and to protect citizens. Most do not. The Ohio State Medical Board is one of the best
organized and bet funded boards in the country. But it is run a group of
physicians who used it to lobby the Ohio state government to enact liability limitations to protect physicians.
They did not use it to lobby the government to enact measures that would protect
patients.
Protecting physicians appears to be its real agenda, not protecting patients. Even with 22 full-time investigators the odds of its arriving at justice in response to a patient's complaint effectively are zero. With all of its resources, it has been organized by the
constituency that it is supposed to oversee. It may be that physicians who think "frivolous" whenever they think "lawsuit" also think "frivolous" whenever they think "complaint."
One is forced to conclude that the Ohio State Medical Board thinks that
its job is to protect medicine from bad patients.
Patients in Ohio who have been the victims of violence or
abuse or neglect in healthcare settings would best be advised not to waste
energy on the Ohio State Medical Board's complaint process (and there is reason to believe that many
give up once they attempt to - something else that the board
has not studied and refused to allow to be studied when I asked to) unless they
first have gotten the problem investigated by third party and can provide undeniable paper trail
and witnesses. That would be a very rare situation.
The rock bottom foundation of patient safety is criminal law
and no one enforces it in medicine.
As a result of my work on this, the Ohio State Medical Board no longer will answer my questions. They won't respond either to email or phone calls from me. If their real concern were protecting patients, would they behave this way? I always
have been polite and
understanding with them. I just have a lot of questions. And they have problems. Because of what I know, I have a duty to try to protect patients. Because of who they are, I think they do too. I think that if they believed they had such a duty, they would not stonewall me, but would be interested in what I find. I tried to share it with
them privately. Their response was the equivalent of a slap in the face. So I published it here instead. So they stonewalled me. If they continue to, it means that I will change my approach. They will like that less. They would be better
to communicat with me, but stonewalling has worked for them for so long, that they never will
stop.
If you want to say something about any of my
sites, my phone number is on almost every page. So is my
email address. There even
are Feedback Forms where you can communicate
anonymously. I am listening. I will be sensitive to what you say.