The board that oversees medical mistakes in New Jersey threw out
93 percent of complaints filed against physicians last year.
That board fielded 1,017 complaints against some of New Jersey’s approximately 33,000 licensed doctors. This resulted in 24 license revocations or voluntary surrenders and 45 temporary license suspensions, considered the most serious sanctions against physicians.
In almost half of the disciplinary actions, the New Jersey board, which is dominated by doctors, followed the lead of out-of-state medical boards that investigated negligent, criminal or incompetent doctors. Those boards shared their findings with New Jersey, which simply duplicated the boards’ findings and took similar action.
Public Citizen, a Washington nonprofit oversight group, says New Jersey’s Board of Medical Examiners is not being diligent enough in taking action against incompetent or negligent practitioners. The board is composed of 14 doctors, one nurse, three members of the public and an accountant.
“Something is wrong in New Jersey,” said Dr. Sidney M. Wolfe, who serves as the group’s director of health research. Wolfe authored a report for Public Citizen in April about doctor discipline.
“They wouldn’t be consistently ranking as low as they do,” he said. “There are other states around the same size that consistently discipline more doctors.”
The group compared the number of board disciplinary actions with the number of doctors in each state and concluded that New Jersey placed comparatively few serious sanctions on doctors. New Jersey ranked 40th among the 50 states and the District of Columbia in a report released in April. This was a slight change from last year’s ranking of 41st.
Alaska’s board was most restrictive, with nearly eight serious disciplinary actions per 1,000 doctors. Minnesota imposed the fewest comparative penalties with just one action per 1,000 doctors. New Jersey sanctioned two doctors for every 1,000 licenses, a rate that has remained the same for the past three years.
The president of New Jersey’s medical board, Dr. Paul C. Mendelowitz, declined to answer questions about its apparent low rate of doctor discipline. The complaints are not public records.
Public Citizen found that most medical boards in the United States had weak oversight of doctors.
“We are not saying the best states shouldn’t be doing even better. But if New Jersey was doing as good a job as Kentucky, they’d have two or three times more actions,” Wolfe said.
Wolfe’s example, Kentucky, has consistently ranked in the top three nationwide in doctor discipline since 2003, sanctioning six of every 1,000 licensed physicians last year.
Of the 110 board actions taken against New Jersey doctors in 2009, 54 were prompted by criminal charges filed against doctors or investigations and disciplinary actions taken by out-of-state medical boards where those doctors also were licensed.
“The cases that require the least amount of work are where there are the most actions,” Public Citizen’s Wolfe said.
“Most labor-intensive actions are allegations of substandard practice of medicine. The board has an easier job than if they had to start from scratch. You have to dig,” he said.
Public Citizen reports that better boards have adequate funding and staffing to launch proactive investigations rather than relying on complaints or other states to identify problem doctors. They use various sources, including Medicare and Medicaid sanctions, malpractice claims and hospital databases that show where each doctor’s medical privileges were revoked or suspended.
Ohio, for example, a state comparable in population to New Jersey, ranked fourth in doctor discipline. Ohio took 58 serious disciplinary actions against the state’s 39,125 licensed doctors, according to the report. The Ohio State Medical Board has an annual budget of $8.6 million and 87 full-time staff, including 21 investigators.
New Jersey’s Board of Medical Examiners has an $11.3 million annual budget and a backlog of about 85 open investigations — the equivalent of a month’s complaints.
“We have an additional 80 inquiries that our enforcement bureau is monitoring for the board,” said Jeff Lamm, spokesman for the state Attorney General’s Office.
The board has 47 full-time paid staff but no dedicated investigators. Instead, it draws from a central pool of employees within the state enforcement bureau who handle all professional licensing boards in New Jersey, including chiropractors, nurses and dentists, Lamm said.
Ohio board spokeswoman Joan Wehrle said Ohio’s board is independent from other agencies. As a result, it does not have to share resources and its budget is earmarked directly from license fees. This gives Ohio’s board independence to pursue its mission of ferreting out bad doctors.
“They’re really proactive in setting policies,” Wehrle said. “We have the legal authority to establish rules. Our rules have the force and effect of law. So we have a real voice and a real say in how health care is practiced in this state. Not all states have that authority,” she said.
Many medical mistakes are revealed only in courtrooms through medical malpractice cases.
“I’ve seen a lot of doctors who were required to have some kind of refresher course or license restrictions,” said David Fried, a Chatham lawyer.
He represented Atlantic City resident Lashanda Langston in a 2006 malpractice case against the doctor who delivered her baby in 2002. The baby’s arm was injured during delivery. Five years later, the child still could not raise his arm above his head, state court records show. Under a court settlement, the child will receive $275,000 in installments when he turns 18.
“I don’t get the sense that the board does very much in the way of oversight,” Fried said.
While New Jersey’s medical board ranked poorly in sanctions, Public Citizen said the board’s website was the best in the country in public openness. The site provides narrative detail about every case where sanctions are imposed. Patients can search by name for any complaints filed against their doctor and see what, if any, medical malpractice payouts he or she made over the past five years.
Doctors who face lawsuits in New Jersey are not automatically subject to medical board sanctions. In fact, the board’s website provides context about the average number of settlements a doctor is likely to incur given his or her specialty.
Even so, some of the cases revealed in court papers appear deserving of board scrutiny.
In 2006, Ocean City resident Claudia Tapia was treated at Shore Memorial Hospital in Somers Point for an abnormal mass in her left breast. The doctor performed an ultrasound-guided needle procedure. Her lawsuit filed last year in state Superior Court in Atlantic City alleges the doctor lost a guide wire in her chest and never told her about it.
Tapia had a partial mastectomy. Lab tests found no cancer. Before the surgery, the hospital took X-rays that revealed the missing wire. Still, nobody at the hospital said anything to Tapia, she said in her lawsuit. Tapia’s lawyer, Dominic C. Guerrini, declined to comment.
After the mastectomy, Tapia suffered unexplained chest pain for the next 16 months. The pain got so bad that on Feb 4, 2008, she went back to the hospital. Diagnostic tests found the missing wire. It had migrated to her heart, dangerously close to her aorta, she said in court papers. The hospital discharged Tapia and told her to follow up with a cardiac specialist, her lawsuit contends.
On Feb. 13, 2008, she went to AtlantiCare Regional Medical Center, complaining of shortness of breath and extreme pain in her chest. Surgeons conducted emergency surgery to remove the wire.
None of the doctors cited in the Tapia or Langston lawsuits was sanctioned by the New Jersey State Board of Medical Examiners. Since board investigations are not subject to public scrutiny, the public will never know whether the board even examined the court allegations.
Citing patient confidentiality, Shore Memorial Hospital declined to comment on the lawsuit, spokeswoman Courtney Spahr said.
Attorney Abbott S. Brown, a medical-malpractice lawyer, said the board does not do enough to inform the public about its role and how to file a complaint.
“I take about three cases out of 100 who call me. I often tell the other 97 that they have the recourse of filing a complaint with the state. Almost none of them are aware of that,” he said.
He suggested the board make all complaints public — not just the board’s actions. This is how the National Transportation Safety Board handles airplane accidents.
“When was the last time two planes collided over a runway? You can’t remember because it never happens. They made steps to correct it and prevent it from happening,” he said. “A little sunshine helps.”
Brown said the medical board could start by keeping closer tabs on civil lawsuits.
Malpractice cases have a higher burden of proof on patients than many other kinds of civil lawsuits in New Jersey. The patient typically has to find two other doctors, medical specialists in most cases, to sign an affidavit agreeing that the defendant doctor made unreasonable mistakes.
“There are no frivolous malpractice suits. I have to have doctors of the same specialty swear the case has merit,” Brown said. “In a state with 8.5 million people, there are less than 1,500 medical malpractice lawsuits in a single year.”
Few errors reported
Medical professionals, hospitals and clinics rarely report errors observed by other doctors, Brown said. That leaves the Board of Medical Examiners oblivious to persistent problems.
“To this day, there is a conspiracy of silence in the medical profession to protect their own. Maybe within closed doors, they’ll discuss what went wrong but they won’t open that to the public,” he said.
Since a single doctor can have dozens or even hundreds of patients, medical boards can make a big difference in the health of a community.
“The multiplying effect of allowing bad doctors to practice medicine is enormously bad for public health,” Wolfe said.
Boards, including New Jersey’s, regularly share information about discipline with other state boards. This is important because many doctors are licensed in multiple states.
“It’s a really important way of protecting the public. If a physician is in trouble in one state, they’ll seek that geographic solution and practice wherever they have privileges elsewhere. That doesn’t help anyone,” Wehrle said.
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