Maryland Physicians with Complaints Could Face Tougher Review

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When Maryland’s physician quality board comes up for review during the next legislative session, some are calling for tougher measures to deal with doctors who are the subject of multiple complaints.

Until 2003, state law required the state’s medical board to review doctors with three or more claims in five years. That legal requirement disappeared when the new board was created.

Regulators, who had been going beyond the requirements of the previous law by looking at every claim, had phased out that practice by 2003.

C. Irving Pinder Jr., the head of the review board, said his staff was swamped and that the routine review of claims wasn’t worth the effort.

“We concluded it wasn’t a very good barometer of bad medicine,” Pinder said.

An analysis by The (Baltimore) Sun found that while most Maryland doctors are sued for malpractice no more than once in a decade, about 120 across the state were the focus of five or more claims.

About 200 were the subject of three or more from 2000 through 2004, and over 10 years, about three dozen had seven or more, the review found.

The Board of Physicians decided in 2003 that it would investigate automatically only when doctors settle three cases for $150,000 or more each over five years. Pinder said the board also reviews any doctor who resolves a claim about care in the past five years with a payment of at least $1 million.

The Sun analysis of board data found very few of the state’s 17,000 doctors met that criteria for review.

There were 11 payouts of at least $1 million reported to the board last year. Over the past five years, four doctors now practicing in the state settled three cases, each for $150,000 or more, the analysis found.

Whether they were reviewed cannot be determined because board investigations are confidential.

“If someone is sued over and over, it should be looked at,” said Dr. Stephen Pollock, a Towson cardiologist who spoke last year at legislative hearings on malpractice insurance rates.

“There should be an immediate investigation (of each claim) to see what is going on,” said Harry L. Chase, a lawyer who directs the state alternative dispute resolution office where malpractice claims are initially filed. “Doctors can mess up a lot of people before they pull their license.”

Medical groups note nearly every medical procedure carries risk and that complications sometimes can’t be avoided. Some malpractice insurers settle lawsuits as a business decision, they note.

“A suit does not provide a good indicator of the quality of a practitioner and neither does a payout,” said T. Michael Preston, executive director of MedChi, the Maryland State Medical Society.

However, some states have more aggressive policies.

The Massachusetts Board of Registration in Medicine reviews any doctor who has paid three claims in a decade.

“We’re interested in the early detection of problems,” said Dr. Martin Crane, chairman of Massachusetts board. “We find that it is a small group (of doctors) that is fraught with problems and has to be looked at carefully.”

Three states, including Virginia, require action against doctors sued repeatedly for mistakes that cause injury.

Under a law that took effect July 1, Virginia’s medical board must “assess the competency” of doctors with three malpractice payments in a decade and develop a “plan of corrective action” or other “appropriate resolution.”

Regulators in Nevada and Pennsylvania investigate every claim, and starting this year, Georgia will investigate a doctor’s “fitness to practice” after two settlements.

Douglas Cooper, chief of investigations for the Nevada Board of Medical Examiners, said the process is time-consuming, but worthwhile because about half the reviews reveal problems that warrant further investigation.

“We are finding an increase in cases that seem to have merit,” Cooper said.