Medical

Apparently it’s no secret among doctors that if you’ve been disciplined in other states for repeated accusations of negligence, Texas is the place to set up shop.

In the first place, the Texas Medical Board doesn’t check the complaint history of doctors applying for licenses. In the second place, Texas lawmakers have made it so difficult to sue doctors for malpractice that many, many valid cases never make it to court.

The result is Texas is the go-to destination for doctors fleeing disciplinary actions in other states.

Take the case of neurosurgeon Stefan Konasiewicz. He left Minnesota and moved his practice to Corpus Christi in 1997, leaving behind him nine medical malpractice lawsuits and a public reprimand by the Minnesota Board of Medical Practice. Some of the lawsuits involved patient deaths.

Konasiewicz is currently on trial back in Minnesota on one of the malpractice suits.  A story in the Duluth News Tribune first disclosed his flight to Texas and the fact that the Texas Medical Board is still allowing him to practice despite a pile of evidence that he is unqualified.

TMB spokesperson Leigh Hopper said the board is supposed to review a doctor’s malpractice and disciplinary action record when it renews a doctor’s license every two years, but that the board relies on a doctor self-disclosing these actions, according to the newspaper story.

“If the doctor doesn’t want to tell us and is not truthful when he renews his license, then we’re not going to find out about it, either,” she said.

This, despite the fact that all state medical boards have full access to the National Practitioner Data Bank, which lists malpractice cases and disciplinary actions taken against doctors.  Hopper said that because the Data Bank charges for queries, it would cost the state of Texas too much — she estimated $160,000 a year — to check on every doctor licensed in the state.

That’s $160,000 to protect every man, woman and child in Texas –nearly 25 million people –against doctors who have been repeatedly sued for negligence in other states. In 2008, the TMB’s operating budget was $9.4 million.

The Texas Legislature has made it clear that protecting doctors against patients is much more important than protecting patients against doctors. In 2003, lawmakers passed laws that make it almost impossible for most patients to bring a lawsuit against a dangerous physician.

The combination of poor medical board oversight and harsh anti-consumer laws make Texas a sweet deal for bad doctors. And a bitter reality for the rest of us.

Amid all the Republican political talk about the need to make it even harder for people to sue over medical malpractice, there has come a major study that concludes hospital mistakes are occurring 10 times more often than originally believed – and that was already a lot.

As published in this month’s issue of Health Affairs, the study says one out of three people admitted to a hospital is the victim of a preventable medical error. These could range from a bed sore that could lead to an infection, to an object left in the body after surgery.

The entire issue of this well-respected magazine is dedicated to patient safety. After reading it, all I can think of is the country’s urgent need for medical reform.

The researchers looked at 795 patient admissions at a hospital known for its attention to patient safety. Using a new way of measuring hospital adverse events, called the Global Trigger Tool, the group found 354 “adverse events” in the records. The findings were 10 times higher for the Global Trigger Tool, which was developed by the Institute, than for the methods usually used by hospitals to measure adverse events, the research pointed out. The obvious conclusion is that hospitals have been substantially underestimating the frequency of mistakes.

Already, the latest estimate of deaths in hospitals each year from preventable medical errors is as high as 187,000. The injury estimate is around 6.1 million. The Institute of Medicine first reported on the sad state of patient safety in the U.S. in a 1999 ground breaking report. The medical community made loud promises of taking action to lower patient risk in hospitals.

“Without doubt, we’ve seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow,” said Health Affairs Editor-in-Chief Susan Dentzer in the magazine’s issue.  “It’s clear that we still have a great deal of work to do in order to achieve a health care system that is consistently high-quality—that is, safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.”

A separate study published in the magazine’s April issue looked at the cost of these errors. An analysis of insurance claims by Colorado researchers estimated the cost of preventable medical errors that harm patients to be $17.1 billion in 2008 dollars.  According to the study, 10 types of errors accounted for more than two-thirds of the total cost, with the most common ones being pressure ulcers, postoperative infections, and persistent back pain following back surgery.  The researchers recommended that these three types of errors be put at the head of the list for improvement.

A third study published in the magazine looked at cost a different way.  A study by the National Center for Policy Analysis found that the social cost to adverse events – or what people would be willing to pay to avoid the risk of death or injury caused by medical error – is from $393 billion to $958 billion. (Or from 18 percent to 45 percent of total US health care spending in 2006.)

Yet, the researchers noted, the United States has few policies to compensate patients harmed by medical errors other than a “very imperfect tort system.” They noted fewer than 2 percent of patients harmed ever file a malpractice suit and even fewer receive any compensation. The study recommended a possible solution: that patients be offered voluntary, no-fault insurance prior to treatment or surgery and be compensated if they suffer an adverse event—regardless of the cause. In this way, providers would have economic incentives to reduce the number of such events, the researchers noted.

Unfortunately, the political rhetoric around tort reform does not tend to be influenced by facts. And the facts are, medical mistakes are epidemic and malpractice lawsuits are rare.  How many voters have to die from medical mistakes for politicians to take notice?

To know that tort reform is just another name for “insurance company windfall” and will not curb medical costs, you don’t have to look any farther than Texas.

In 2003, Texas passed the most aggressive tort reform measure in the country by placing a $250,000 cap on malpractice awards. Within four years, a study by the national consumer group Public Citizen showed:

• The cost of health care in Texas had risen to nearly double the national average
• Spending  on diagnostic testing (so called “defensive medicine”) was 53% higher than the national average
• The state’s uninsured rate continued to climb, and is now the highest in the country
• The cost of health insurance in the state more than doubled
• Growth in number of doctors per capita has slowed; and
• The number of doctors in rural areas declined

According to the study, the only improvement to the medical cost scene in Texas after 2003 was a decline in doctors’ liability insurance premiums.  But the data also showed payouts by insurers to cover medical liability payments dropped far more than doctor’s premiums, suggesting insurers simply added the savings to their own bottom lines.

The study author could find no evidence that any savings from lower doctor premiums had been passed on to patients or to taxpayers.

Those of us who live in Texas are already living with the effects of “tort reform.” Our health care insurance costs keep going up and our benefits keep going down.  Insurance companies must be drooling over the prospect of expanding this brand of “tort reform” nationwide.

Lawmakers who truly care about their constituents will take a hard look at the Texas experience and an even harder look at who really stands to gain from further limiting the rights of victims.

How bad does a doctor have to be before he gets his license revoked or limited by a state medical board? Pretty darn bad, according to a new study just out by the national consumer group Public Citizen.

More than 55% of all doctors who were sanctioned by hospitals for serious offenses between 1990 and 2009 did not receive any kind of follow-up disciplinary action by a state medical board, the study found.

In Texas, the figure was a whopping 60%, according to the study.  Of 725 doctors who had hospital privileges revoked or limited, only 338 of them received any discipline at all by the state medical board.

The study looked at the records of 10,672 physicians listed in the public-use section of the National Practitioner Data Bank who were disciplined by hospitals during that 20-year period. The data bank was established by Congress in 1986 so doctors would not be able to hide malpractice, or actions by hospitals, licensing boards or professional societies. (Although names in the databank are not open to everyone, they can be accessed by hospitals, and some medical practices and government agencies.)

Of these, 5,887 (or 55.16%) escaped any disciplinary action by state medical boards, the study found.  These included:

• 220 physicians disciplined because they were an “Immediate Threat to Health or Safety”

• 1,119 physicians disciplined because of incompetence, negligence or malpractice

• 605 physicians disciplined because of substandard care

We’re talking serious offenses. The study listed these examples:

• In Florida, a doctor had hospital privileges permanently revoked in 2002 for incompetence. He also was the subject of 10 medical malpractice reports totaling $1 million between 1992 and 2009 for, among other things, an unnecessary procedure, leaving a foreign body in a patient and misdiagnosis. Two patients died. But the Florida state medical board took no disciplinary action against the doctor.
  
  

• In Illinois, a doctor had clinical privileges permanently revoked in 1999,  and accumulated 10 medical malpractice reports between 1992 and 2006 totaling $7 million for, among other things, improperly managing cases, failing to diagnose and failing to identify fetal distress. One patient suffered a major permanent injury while another became a quadriplegic due to a brain injury. Yet the Illinois medical board did not discipline the doctor.

It’s not news that state medical boards are soft on doctors. Other studies have repeatedly confirmed this. What’s new about this study is that it shows that medical boards are also ignoring flashing red lights by hospitals.

Hospital sanctions are peer-reviewed decisions that occur only after hospital medical committees determine a serious mistake or misconduct has occurred.   They should carry serious weight with medical boards. The next crucial step for patient safety is to have medical boards revoke or limit a doctor’s license. That’s clearly not happening in a majority of cases.

Public Citizen is urging the U.S. Department of Health and Human Services to reinstitute investigations of state medical boards. Public Citizen is also notifying the worst state medical boards – Texas among them – of their findings.

Meanwhile, we can only offer this Biblical admonition to doctors on behalf of all patients: “physician, heal thyself.”