State Society Takes Action to Address Concerns with Physician Licensing Investigations and Prosecutions
Overview
The Pennsylvania Medical Society has concerns about physician licensing investigations and prosecutions problems that could slow the resolution of cases where remedial measures are needed. The Medical Society is also concerned that the punitive, adversarial process won’t foster a culture in which the physician licensing boards can play an effective role in improving quality of patient care. The Society has developed a number of proposals that it is working to have the Rendell administration adopt.
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What has happened thus far?
The physician licensing boards have increased their scrutiny of the quality of care provided by physicians, largely as the result of licensing reforms adopted in Act 13. Physicians now must self-report certain events to their licensing board, including when they receive notice of a complaint against them in a medical liability action.
Since the Mcare self-reporting requirement went into effect on March 19, 2002, physicians have self-reported about 8,600 medical liability complaints. Prosecutors within the state’s Bureau of Professional and Occupational Affairs (BPOA) oversee the investigations of these complaints and determine whether to file charges against the physician.
As of mid-January 2006, about 5,300 cases have been closed without any charges being filed, and about 3,300 reviews are still pending. To the best of the Society's knowledge, prosecutors have filed charges for substandard care in only about 17 cases. However, the number of those prosecutions may increase in the future as more cases work their way through the system.
The physician licensing boards make the ultimate decision as to whether to impose discipline or other corrective action on the physician after the physician has been provided the opportunity for a hearing. Most of the substandard care prosecutions are in the early stages and have not yet reached the licensing board for decision.
In the only case to date in which a full hearing was held, the physician was exonerated. A few cases have been settled with corrective action by consent agreement.
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Problems with the process
The Medical Society has supported strengthening the ability of physician licensing boards to oversee the quality of physician care.
Although the overwhelming majority of physicians provide quality care, there are physicians who have clinical deficiencies or engage in other behaviors that require corrective action. Moreover, plaintiffs' attorneys can divert attention from needed medical liability reform measures by blaming the crisis on the physician licensing boards’ lax and ineffective corrective action process.
However, the Society has serious concerns with the value of the Mcare Act licensing reforms, especially the self-reporting requirement. The Society also has some questions and concerns regarding the current prosecution policies, practices, and procedures.
The Society’s concerns include the following:
- The triage process—Although there have been relatively few quality-of-care prosecutions to date, respected defense counsel are reporting signs of problems. The prosecutors reportedly are filing charges of questionable merit and seeking disciplinary measures, such as fines, in cases that only warrant remedial action.
- Prosecution procedures—Not only are some procedures unfair, but they can also lead to incorrect determinations. The qualifications of the prosecution experts are of particular concern.
- Policies regarding remedial corrective action—These policies could result in corrective action to address a minor clinical deficiency but lead to serious collateral consequences. It is particularly concerning that there is no remedial track to impose corrective action without any admissions or findings of a violation. This is a significant problem. Admissions and findings of substandard care could potentially jeopardize a physician’s defense of a related medical liability action.
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Medical Society's action steps
At its January 2006 meeting, the Society's Board of Trustees approved a series of actions aimed at changing the physician licensing corrective action process as mandated by Act 13.
The State Society will:
- Seek physician licensing board modifications of existing criteria for prosecuting cases so that the focus is not on single acts of negligence but on doctors who consistently fail to meet acceptable standards of care
- Seek physician licensing board action that creates an independent medical review committee and requires that all substandard care prosecution be authorized by that committee
- Seek a requirement that all medical experts used by the prosecutors and the defense meet Act 13 requirements
- Support change in Department of State policy to permit a consent agreement without admission of violation by the physician
- For more information, see our investigations and prosecutions resource page. It features information on our publication, Physician Licensing Investigations and Prosecutions: A Guide for Pennsylvania Physicians.
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Last Updated: 9/21/2007