Legislation Would Speed Doctor Discipline in Missouri
By Jeremy Kohler
St. Louis Post-Dispatch (MO)
March 1, 2011
Missouri regulators would have more authority to suspend dangerous doctors, and patients would be able to better research physicians, if bills filed in the state Legislature become law.
At a 60-minute hearing to introduce legislation in the Senate on Monday, the agency that licenses and regulates doctors — the Board of Registration for the Healing Arts — said it supported the effort to reform the state’s lax, secretive system of physician discipline.
A news organization testified in favor of greater transparency.
A doctors’ group chafed at one key provision of the bill that would give the board the ability to issue fines.
Last year, a Post-Dispatch investigation into patient safety in Missouri showed that the healing arts board is one of the nation’s weakest and least transparent.
The series inspired Sen. Kevin Engler, R-Farmington, to sponsor a bill that would give the board more power — and give patients more information. Engler, chairman of the Senate committee that oversees the agency that handles licensing of doctors, said he was frustrated by the board’s inaction and said the stories detailed “how this happens over and over and over, and this industry has a difficult time policing the bad players.”
The bill would make it easier for the board to discipline doctors who are habitual substance abusers, sex offenders or who have a case of serious medical negligence.
Tina Steinman, the board’s executive director, helped Engler craft the bill. She said it would “provide us with additional tools to expedite disciplinary processes when necessary.”
The discipline process moves too slowly as problem doctors are allowed to continue practicing for years without conditions, Engler said.
The board often tries to settle cases rather than prosecute doctors in the state’s administrative hearing commission, where cases can drag on for years.
“We have to do something to bring about quicker actions from this board,” Engler said. “These are people that have got life and death decisions … (and) we’re bragging about how we get these things done in two years.”
Under the bill, the administrative hearing commission would have to issue its decisions within 120 days.
In cases where the board thinks a doctor poses an immediate threat to public safety, the board would be able to suspend the doctor’s license without first having to prove the case. The doctor could then appeal the board’s decision.
Patients also could learn more about their doctors’ qualifications and backgrounds under the new bill. Currently, only the doctor’s address, licensure date and disciplinary history are available. The bill would allow the board to release information on a doctor’s medical school, specialty credentials and disciplinary record in other states.
It’s information that the board already has and that consumers ask for regularly, Steinman said.
Doug Crews, executive director of the Missouri Press Association, testified in support of the bill’s increased transparency and said opening records was good public policy.
The legislation follows a Post-Dispatch investigation that found that doctors who provide substandard care often continue to practice without public action by regulators.
Instead, the healing arts board increasingly relies on nonpublic “letters of concern” to doctors, which are not considered discipline. Their use has grown from 20 letters a year in 1986 to 910 in 2006.
The Post-Dispatch also showed that most information about doctors — even where they went to medical school — is kept confidential.
Letters of concern would remain confidential under the new bill. But Engler said he hoped the number of letters would shrink if the board gained disciplinary power.
Some other provisions of the bill were more controversial.
Under the new law, doctors could face monetary penalties for infractions. Almost every other state collects fines from doctors who violate rules of practice. In Missouri, the fines could reach $5,000 for each infraction up to a maximum of $25,000.
Fining doctors would be “overreaching,” said Audrey Hanson McIntosh, attorney for the Missouri Association of Osteopathic Physicians and Surgeons.
“We are not here to protect bad doctors, but we also want to temper that with the rights of those doctors who already have licenses,” she said.
McIntosh also opposed making it easier for the board to suspend doctors. The doctor should have a hearing “in front of a fair and impartial body versus the board itself.”
Sen. Jay Wasson, R-Nixa, vice chairman of the committee, then suggested that the decisions should rest with the board.
Engler said he would meet with the board this week to tweak some language in the bill before it is moved out of the committee. A similar bill is also working through the state House of Representatives.
