STATE MEDICAL BOARDS AND

MEDICAL DISCIPLINE

A STATE-BY-STATE REVIEW 
('~~~(
~ :;

oYi 
;!t'.I3G 
OFFICE OF INSPECTOR GENERAL 
OFFICE OF EVALUATION AND INSPECTIONS 
AUGUST 1990  STATE MEDICAL BOARDS AND

MEDICAL DISCIPLINE

A STATE BY STATE REVIEW 
RICHARD P. KUSSEROW 
INSPECTOR GENERAL 
OEI-01-89-00562  AUGUST 1990
 INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1INTRODUCTION

In April 1990, we issued a draft report entitled "State Medical Boards and Medical 
Discipline." The report was a follow-up to one we issued in June 1986. It was 
prepared as a result of a study requested by Congressman Ron Wyden, Chairman of 
the Subcommittee on Regulation, Business Opportunities and Energy of the 
Committee on Small Business of the United States House of Representatives. 
The report served as the focus for a Congressional hearing convened by Chairman 
Wyden on June 8, 1990. During that hearing, Inspector General Richard P. 
Kusserow elaborated on the report's central theme: that although there has been 
some improvement in the boards' capabilties in recent years, they stil reflect serious 
shortcomings in their identification, review, and disposition of cases. 
In the report we identified a number of actions that the Federal Government could 
take to help State governments to address the identified shortcomings. For instance, 
to help the State boards obtain better information on cases involving the provision of

inadequate medical care, we called for the Health Care Financing Administration 
within the U.S. Department of Health and Human Servces to propose legislation 
mandating that the Medicare-funded Peer Review Organizations (PROs) share case 
information with the medical boards when the first sanction notice is sent to a 
physician. We found that without such a mandate, the PROs are unlikely to share 
much case information. 
At the same time, we recognized that if the capabilty and performance of the State 
boards are to improve significantly, the major actions must be taken by the States 
themselves. Toward this end, we offered some general recommendations to State 
governments and to the National Governors' Association, Council of State.

Governments, the National Conference of State Legislatures, and the Federation of 
State Medical Boards. 
Our purpose in presenting this brief follow-up report is to help individual State 
governments, the State government associations, and others gain a better 
comparative understanding of some key characteristics that bear on State board 
performance in carryng out disciplinary responsibilties. Such an understanding, we 
believe, can help clarify the extent and tye of actions which should be taken by 
State governments. 
We organize the report in terms of the three major components of the disciplinary 
sphere: (1) the identification of cases, (2) the review of cases, and (3) the 
disposition of cases. In each section we provide an introductory overvew and then 
present comparative data for all 50 States and for the District of Columbia 
(hereafter referred to as a State). In nearly all cases, the data are taken from the 
1  1989-90 edition of the Exchange, published by the Federation of State Medical 
Boards. 
More extensive State-by-State information is available in the Exchange. In this 
report, we have attempted to highlight those items that are particularly relevant to 
the boards' conduct of their disciplinary responsibilties and to the findings and 
recommendations of our April 1990 draft report. 
2
 IDENTIFICATION OF CASES

In our April 1990 report (hereafter referred to as the prior report) we indicated that 
the PROs, the State Medicaid agencies, and the Medicare carrers were referrng few 
cases to the State medical boards. We expressed particular concern about the lack 
of referral activity between the PROs and State medical boards and called for 
legislation mandating that the PROs share case information with the boards at the 
time they send the first sanction notice to a physician. 
Yet, because of actions taken by the States, we found that the overall number of 
referrals or complaints being received by the State boards was increasing, often 
significantly. Through mandatory reporting laws, immunity protections, and license 
reregistration requirements, the States have greatly facilitated the identification of 
physicians who may warrant disciplinary action. Tables 1, 2, and 3 indicate the scope 
of these actions among the 51 States. 
The mandatory reporting and immunity protection laws are the most pervasive. The 
former apply in 50 of the States, with mandatory reporting by hospitals (45 States) 
and by liabilty insurance carriers (33 States) being the most common. The immunity 
protections are extended to reporting sources in 47 of the States, protections to 
board members being most prominent (44 States) and those to individuals or 
organizations voluntarily reporting in good faith being the least prominent (31 
States). 
3
 TABLE 1 
MADATORY REPORTING LAWS, BY REPORTING SOURCE, 1989 
STATE  AL  CRT  HSP  OHE  LIAR  SMS  PRO 
TOT AL 31  19  45  29  33  25  9 
KEY: AL=A II Licensees; CRT=Courts; HSP=Hospi ta L s; OHE=Other Hea L th Care Provi der Ent i ties; 
LIAB=Liability Insurance Carriers; SMS=State Medical/Osteopathic Societies; PRO=Professional

Revi ew Organi zat ions 
SOURCE:  Federation of State Medical Boards, Exchanqe, 1989-1990. 
4  TABLE 2 
IMMUNITY PROTECTION LAWS,

BY INDIVIDUALS/ORGANIZATIONS COVERED, 1989

STATE  8M  BS  RBL  AGF 
TOTAL  44  38  37
 31

KEY: BM=Board Memrs; BS=Board Staff; RBL=Individuals/Organizations Required 
by Law to Protect; AGF=Any Individual/Organization Reporting in Good Faith

SOURCE: Federation of State Medical Boards, Exchanqe, 1989-90.

5
 TABLE 3 
LICENSE REGISTRATION REQUIREMENTS,

BY TYPE OF INFORMTION REQUIRED, 1989 
STATE  OLB  HSP  PS  DAA  DEA  PMI  LSJ  FC 
.. 
TOTAL  37  33  29  30  29  24  29 36 
KEY: OLB=Other Licensing Boards' information: disciplinary actions/sanctions taken, voluntary

surrenders; HSP=Hospitals' information: discipl inary actions/sanctions taken, voluntary

resignations from staff; PS=Professional Societies' information: discipl inary actions/sanctions 
taken, membership withdrawals; DAA=Personal Drug/Alcohol Abuse/Addictions; DEA=Loss or

restriction of Drug Enforcement Administration registration; PMI=Physical/Mental Illness

potentially affecting safe practice; LSJ= Liability awards, Settlemnts, or Judgments against

appl i cant; FC=Convi ction of Felony Charges against appl icant or appl icant i s entry of gui L ty or 
nolo contendere pleas to felony charges

SOURCE:  Federation of State Medical Boards, Exchanqe, 1989-1990 
6  REVIEW OF CASES

One of the central messages of our prior report is that the State boards have not 
been granted the resources necessary to keep up with their expanded caseloads and 
to conduct careful reviews of complex cases involving the quality of medical care 
delivered. As a result, case backlogs have remained as a serious problem, with 
investigators often having active caseloads of 50-60 or more. 
Tables 4, 5, and 6 offer some useful background on the resource shortfall of the 
boards. Table 4 indicates that in 33 of the States, the license renewal fee, which 
serves as the major source of revenue for the boards, is less than $100 a year. Table 
5 further reveals that in 22 of the States, the income obtained from such fees is not 
necessarily dedicated or otherwse reserved for board use. As we noted in our prior 
report, many States use the income obtained from license renewal fees for purposes 
unrelated to the workings of their medical boards.

Table 6, which addresses only those boards that function independently of a central 
agency, indicates that the investigatory resources of the boards are quite modest. 
Among the 38 boards listed, 29 have fewer than 5 full-time investigators. Moreover, 
our prior work suggested that very few of these investigators have clinical training in 
the health care field. 
In recent years, State governments have granted their State medical boards with 
increased authorities to sanction physicians. Table 7 indicates that in all 51 States, 
the boards now have the authority to revoke or suspend a physician's license or to 
impose some kid of limitation on a physician's practice; that in 49 States, they can 
put a physician on probation; that in 45 States, they can impose an emergency 
suspension (although the restrictions tyically associated with such suspensions result 
in their being used very rarely). 
Yet, as tables 7, 8, and 9 reveal, major limitations remain. Thirt-three States stil

cannot impose a fine on a licensee (table 7); at least 22 (2 are not available) stil 
cannot require a physician to take an examination concerning his or her medical skill, 
even though it has reason to believe such an examination is necessary (table 8); and 
33 stil do not have the authority to discipline a licensee already disciplined in

another State without conducting a new hearing (table 9). The latter limitation 
results in considerable duplication of work by the boards and in less investigatory 
time being available to handle other referrals or complaints. 
We do not have State-by-State data that address other factors that we have found 
inhibit the boards' capacity to review cases expeditiously and effectively. Such factors 
include (1) the fragmented, multi-tiered process often characterizing a State's efforts 
in investigating and preparing cases, conducting hearings, and imposing disciplinary 
7
 actions, and (2) the "clear and convincing" standard of proof upon which most boards 
must base their disciplinary actions. 
8
 TABLE 4

ANUAL LICENSE RENEWAL FEES, 1988

STATE  FEE 
SOURCE: American Medical Association, U.S. Medical Licensure Statistics

and Current Licensure Reauirements, 1989.

9  TABLE 5

LICENSURE-RELATED REVENUES DEDICATED OR

OTHERWISE RESERVED FOR BOARD USE, 1989

AK X

YES NO
FUDS DED I CATED/RESERVE
STATE 
AR X

lw::m:::::m:/:::::://::::::m:/::/::::m:m:::::m:::::::/t::::::::t:?X:::::::::::tt//t::::::/:::::::mm:m:m:m:::m:i:
.....................................................,..,..........................................

DE X

~t:m:m:m:::m:m:r::m:::m:m:::m:::::::::::::::m:::::m:r::m:::::::m::::::::::m::t::m:m:r::m:r::m:::m:::::r::::::::::::::::m::::::::::m
!rmr:::::::::::::::::r::::::::::1::::1:r::::m:::::::::::::::::::r?r::?:::';:::::::MatJltM:tll~::::::: 
HI X

t.t:rm::::::::::::::::':::::::::::::r::::m::::::::::m::::::::::::::::::1:::::::::::::::::::::::::::'::::::::1:'::::::::::::::,:::,'::rr:::r::::r:::::iK
~rm::'::::::::::::m:m:::1::::::m::::::::::::m:::::::::::::::::::::rm::::11::::::::::::~1::::::::::::r:::rr::::rr::::::::::::::::::::r:::l 
IILA  X
 X

Mi:m:::::::m:::::::::r::r::m:ri:m:::::m:::m:::::::::m:r::::rr::r::::::::m:':':::':::m:::::r::m:::::::::m:::':::::m:m:::::r:::::::::t
nt::::::1:r:::1::::::::::::111:::r::m:rr:::::1:::::r:::::::1::1:Xr::r:1::::::::::::1:::::::::::m1:::::::::::m:::r:1:
i"r:r::::::::::::::::::::r:r:::::::::::::::::::::r:'::::::::::::::::::::::::::r:::::::::::1::r:r::r:::::::::::::::r::::::1:::r::::::r::::::K
~~:::::::1::::::r::r::1:::r:::::::::r:::::r:::r::::::::::1r::::::::/:r:::~:::r::::::::::::1:::::::r::::::::::::::r:::::::r:::::::r:: 
MN . X 
~..f.:.::.:.:.::.1.1..:.r:.:.:.::.:.:.1.:.:.::.:.:.::.:.:.::.:.r.:.::.:.:.::.:.:.::.1.:.?.:.'.::.:.:.m..1.:.:.:m..m...r:.:.:.::.:.:.~.:.:.::.:.:.::.r.:.:.::.:.:.:/.:.:.:r.:.:.::.:.r.:.::.:.:.::.r.:./.::.:.:./1..::.r.:.

~~:r:1:::r:::::::::1:::r::::::r::::::::::m:::::r:::::::::::::::::::::::::1:r:::::::::1:m:r::::::r::r::r::::m::::::1:::::::::::::r:::~ 
H,::::::rr:::::::::r1::::m::::::::::::::::::::::::::::::::::::::::::r::::::r::::r:::::1::::::::1::r::::::::1:::::r:::::1:::::::::::::::ri!
NNEH  X
 X

~lrrr:::::::::r:::::::::::::::::::::::::::::::::r::':::::::::::::::::::::::r::::::::::!:::::::::::::::::::::::::::::::::::::::::::::1::::::::::::::1:::::~ 
~i1::::1:m:r::r::::::::::r:1::::::::1:::::::m:r::::::::::tt:1::::::1:t::::m:m~~t::::~;v.M:M~t~r::::::
NM X

~ll::::::::t:1:::::::::::::t:::::::::1::::1:::::::::'1:'1:t:::1:':m::1::1::*:::m::1:m:m::::11:m:m::11:::::::::::m:::::r
NC X

ij~'r1:::::r::::::::::::::::::::::::r:::::::::::r::::1::/::::::::::::r::1::::::::::r::::1/::::::::1:::r:r::::::::::r::::t::rr:
ijtrmm/rr::::::1r::/:::r::::::::::::::::r::::::rr:::::imr:::::::r:::::::::r:::::::::::t:::::::::r:r:::::::::::rr:1rK
~~::rm1/::::::1:::::rr:::r::::1::::11:::::::rr:::::r:::::::::::::I::::::::::1:r::::::::::::::r::::::::r::::r,::::r:::::~: 
~~/::1:::::::::::r::::::::::::r:::r:::::::::m::1::::r:::1::::::::::1::::~::r:r:::::/rr:::::::::::::1::::::::/:::::r::::::: 
~~::::r:::::::::::::::::::::::::m:::'::::r:::::::::::::::::::::::::::::1:::::::::::::::r:r:~:::r::rm::r:::::::::::::::::::::::::::::::r:::::::::::, 
TnX  XX
 

~~r:r:::::::::::::/:::::::::::::r::::::::::::::m::::::::::::::::::::::::::::::::::::::::::::::::rrr:::::r:::r:::::::r:::r::::::r::::::r::::~ 
!itt:1:::::::::::::::::t:::::::::1::::::::::1:::::::::rr::t::::rt::::::r:::1:::::::t:1:::::t:::::11:t:11::1::::1::tk
WA X

Qf:::::::r::::::m::::::1:::::::m:t::::::::t::t::::t::::::::::::::t:1:::::t:::::1:::m::::1:::::::::::::::::t::::::::::r::::::::::::::::::::::
vM:mt:::::::r:::::::::::::::::::1::::::r1::/1:::::::::::r::::::::::::::::::::(r::::::::::1:::::rm::mm::r::::::::::::::r::::::::::r
W::::::::::::::::::::::1::::::::::rtr:r:/::::::1::::::::::/::::::/::::::::::::/x:r::::1:::::::::::::m::r::::::::::r::::::::::11:::::: 
Qtr:11::r:,::::r::::/mr::::rm/:/:::::::::::rmm:::1::::::::::i::r::::/::::::::,::::::::::::::::rr::?':::::r::::j 
TOTAL  27  22 
SOURCE:  Federation of State Medical Boards, Exchanqe, 1989-90 
10
 TABLE 6 
NUMBER OF FULL TIME INVESTIGATIVE STAFF,

INDEPENDENT STATE MEDICAL BOARDS, 1989

STATE  , FT INVESTIGATIVE STAFF 
~~:::::::::::::::::::::::::::::::::::::::::::r::::::::::::::r::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::r::::::rr::r::::::::::r::::::::1 
~;.::::m:m::::::::::::::::::::::::/:::::::::::m:::::::::m::::::::::tm:::::::::::/::::::::::::::::::::::::::::r:::::::::::::::::::::::::::::::::::::::::::i 
~~:::::::::::::m:m:::::::::::::::::r::r::::::::::::r::m::r::::r:::::::/::/:::::::::/::::m::m::::::::::::::::::m:::::trr:::::::r/m:::::m::::::::::ml1 
~:::::::r:::::::/:m::::::::::::::::::::/::::r::::::::::::::::r:::::::::::m:::::::::r:::::::::r::::::::::::r:::::r::::r:::::::::::::::::::::::::::::::::::::::::::~ 
~~:::r::r::::::::::::::::::::::::::::::://:::::::::::::::::::::::::::::::/:::::::::::::::::::::::::::::::::::::::r:m::::::::::::::::::::::::::::::::::::::::::::::::::::::::r:~ 
ME 0

:~:!::::::::::::::::::::::r::::r::::r:::::::llMtrfl.9.l~m::tMwmlimeeI.Mlik:MI~ 
~~::::::r::::::::::::::::::::::rrrrr:::::::::::::::::::::::::::r::::::::::::::::::::::::::::::r::::::::::::::rrrm:/:rr:::::::::::::::::::::::::::::::::::::::::::::::~ 
tM:::::::::::::r::::r::::::::::::::::::::::::::::::::r::::::::r::::::::::::::::::::r::::::rr::::::::::::::::::::r:::::::::J:::r:::::::J:rrr:::::t
~~:::::::r::::::::rr:J::::::J:::::::::::::::::::r::r:J:rr::::::::::::::::::::::::::::tt::::::::::::::::::::t::::::::::t::::t::::::::::t:::::::::::::~

~~/::::::::::/:::::r:::::::::::r::rt::t:::::::::::::::r::r:/::::::::r::::::::::::::::::::/::r::/::r:::::::::::::::r::t::::::tm::::::::::::::::::m!

. .....................................................,...................,................................................-................................................................,............................


.M....i:....:.:.:.:.;.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.z.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.;.;.:.:.:.:.;.;.;.;.:.:.:.:.:.;.;.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.;.:.:.:.:.:.;.:.;.;.z.:.:.:.:.:.;.z.:.:.;.;.:.:.:.:.:.:.:.:.:.u..... 
.NV:::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::\: 
~!=r:::::::::::::::::::::::::::::::::rr::::::rr::::r:::::::::::/::::::::/::::::::t::/:::::::::::::::::::::::rr::::::::r::::r::::::::::::::m:::::::::~

M&:t::::::::::::::::::::t::::t::::::::t::::::::::::::::::::::t::::::tt::::::::::::::::::::::::::::::::::::t::::::::::::::::::::::::::t::::::::::tt::::::t:::4

~...........................................................................................................b

SC 4

~~:::r::::::::::::r:::::::::::::rrr:::::::::::::::::::::::::::::::::::::::::::::r/:::::::::::::::::::::::::::::::::::m::::::::::::::::::::::::::::/::::::::::::::::::r::::::::::/,:~ 
~~m:::::::::::::::::::rrr::r:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::rm:rm::::::::::/:::::::rr::::::::::::::::::::::::::::::::::::::::::::::::::::::r~ 
~N::tt::::::::::::t::::::t::::tt::::::::::::::::::::::::::::::::::::::::::::::t::::::::::::::::::::tt::::::::::::::::::::::::::::::::::::::::::::::::::::::::::Ji
Mt:::::::::::::::::tt::::t::::::::t::::::::::::::::::::t::::::::::t::::::::::::::::::::::::::::::::tt::::::::tt:::::::::::::::::::::::::::::::::::::::::41

TX NOT AVA  I LABLE

!::::::::::::::::::::r::::rr:::::::t::::::::::::::::::::::::::::::::::::::::::/:::::::::::::::/:::::::::::::::mr:r::r:::::::::m::::::::r::::t::::::::::~ 
~t::::::::::::::::::::::::::::::::::::::::S.lAtf::::fRIIlpsr:l#.RaoW::AA~IRl&::AteR-~

MED I AN

KEY: Independent=Board exercises all licensing and disciplinary

powers, though som clerical services may be provided by a central

agency. 
SOURCE: Federation of State Medical Boards, Exchanqe, 1989-90. 
11  TABLE 7 
ALLOWABLE ACTIONS OR SANCTIONS, 1989

STATE  REV  ssu  sus  PRO  LL  STP  FN  PRR  PBR  LDC  LC 
TOTAL  51  45  51  49  51  41  28 30  45 36  32 
KEY: REC=Revocat i on of License; SSUS=Sumry Suspens i on of License; SUS=Suspens i on of License; 
PRO=Probation; LL=License Limitation or Restriction; STP=Stipulations or Consent Agreemnts;

FN=Collection of Fine; PRR=Private Reprimand; PBR=Publ ic Reprimand; LDC=Letter/Decree of Censure;

LC=Letter of Concern

SOURCE: Federation of State Medical Boards, Exchanqe, 1989-90. 
12  TABLE 8 
TYPES OF EXAINATIONS BOARDS

MAY REQUIRE OF LICENSEES, 1989

NE I CAL  NE I CAL 
STATE  PHYSICAL  MENTAL  IC~LEDGE  SKI LL 
TOT AL  43  44  32  27

SOURCE: Federation of State Medical Boards, Exchanqe, 1989-90.

13
 TABLE 9 
RECIPROCITY AMONG THE STATES CONCERNING

DISCIPLINARY ACTIONS TAKEN BY THE STATE BOARDS, 1989

1DA LJ2  1SD AL2J 

STATE 
AK X

ro X

Aprrrr':m:m:r::::::::mm::::::::::::::::::::r:m::::K:m::/:::::m:::::m:::::m:::::t::m:::tt::::::::r:x:::::tt::::::::/
~f-::::mmt::m::::/:m:::::tr::::::r::::tt::::::::::::::~:::::::::::::m:t::m:r::m::::/::::rr::::r::::::::::?m:m:::::rrm:m 
DE X

tM:m:m:m:m:m:tr::::t:'::::::::::::t::tm:?r::x:::::::::::::::::::::::t::::m:::::t::m:::m:m:::::m:::::::::::::::::::::::m:t::::t:
HI X

tFt:m:::m:m:mL::::::::::::::: ::m:m:::::::X::::::r::r::::::
:::::::::::::::::::::::/:::::::::t::::::':::::::::::::::::::::::::::::::::::::::::W::::::::::m:::t:::::
IL X

~t:::::::::::::::::::tt:::r:tt:::::rr:::::::t::::t::::::::t:::::'t::::::::::::::t:::::::::r:t::::::::::::::::t:::::::X:::::::::::::::::t::::
lr-::::::rr::::::r::':::::::r:::t::::t::t:r:t::t:::X:t'::::::r:::::::::t:::r:::t:r:::::::::::::::rt:r:r:::::::::::::::rrm
:J.l1irr::mItt:::::t::m:::::::::::::::::::::::::m:::::::::::::::::::rr::::m::,:::::i:::m:::rr:::::::::/::::::::::::::::::::t::::::::::::r:l
:K~:~::::::::::rY::::::::::::::::: :::::m::::::::X':::t::::::::::::
:::/:::::::~::::::::::tt::::~::::::::::::::::::::::::::::::::::::::::::::m:::tI:::::::::::::::::::::: 
:::r::::::t::::m:::::t::r:::/::::::t:::::::::t::::t:::::/I:t:::::::::::::'::::m:::t::::t:t::t::m::/mX:I:::::::::::m:::::::
!:rt:,::::m:::m:::::t::::::::::m:::::::r:::::::::::::::::::::::~::mmr:r::t::::::r:::::m:::::::rr::::::::::::::::::::::::rr::r::m:r:: 
!~m:m:m:::::r::m:r::::::::::r::::::::::::::rr::::::r::m:::::':m:::::r::::::::r::t::m:::m:::t::::::::r::::::::::::::~t:::::::::::::::::::~ 
MNOE  X XX 

!~::m:::::::::::::r:::::t:::::::::::::::::::::::::m:::::::::::::::::::::::~:::/:::::::::::::::/:::::::::::ttr::m:m:::t::::::::X::t::::::::::::::::::: 
~~::rr::'::':r::::::::mt:r:::::::::::::r:r:::::::::::r:r:,:::::::::r:r:::x:r:::::::::::::rtr:r:::::::::r::::::::::r::r:r::::::
NH X

~t::t:r:::::::r::r::::::::::::::::::':t::r:::'::::::t:::::::x::t:mrr::t:::::::r:::::::::::::::tr::::::::::::::rrrt::r:r::::r
NM X

N!ti:m:::::t::::::::::::::m:::::::::::::::::::::r:::':/::::t::m:::::::::m:::t::::::::::::r::::::::::r::::::m:rr::::::::r:::::::::m:::::::::m:~
NJ::i:::::::r::::::::::m:t::::::::::::::::::::::::::::::::rrmt:::::::::::::::::::m::X:::::::::::m:::::::rr::::::::::::r::::::::::r::rrr:::::::
ijXj::t'::::::::::::t::rtr::r:::'r::t:t:r::::::::::::::::::::::::r:rtmr::::::::r:rtt::'::::::::::::::::::::::::t::::::t:::::::tK 
~....................................................~........................................

................................,...........,...............................,-........................

~~::::r::::::::::::::::::::::::::::::::r:tt:rr:t:::::::::::X:::t:::::::::r:::::t:::r:'::::::::r:::::::tt::::::t~::::::::::r::r:t:: 
w X

~~:::::t::t::::t::::::::::::tt:m:m::::::::::::::::::::::::::::::::t::::::::::::::::::::~tt:::::::::::::::::::::::::::::::::::::::::;::::::r:t:r::::::: 
 X

~~:::t::::::::::::::::tt::/:::::r::::::::::::::::::::::::::::::::X:::::i:::::rm:rmm:::tt::::::::::::::::::::::::::::r~rrr:::::t::~ 
~ X

t-~*r::::rrr:tt:::t:t:::::::::::::::::t::tr::::::r:tt::::::tt::'r::::r:::::t:::tt::::::::::::::ri::::t:rrr::::::
t~::::trr::::::tr::::::::::::::t:::::::t::::mt:t::::::::t:r:::::::::t::tt:::::::::::::::::::t:tt:tt::::x::r:ttt::t:
gW:::::::::::m::::'::::m:m::::::t::::::t::::::::::::::::::::::::::::X:::::::::t:::r::::::::::rrr::m:::::::::::::::::::::x::::rrr:::::r
~,:::r::::::::m::::::::mr:::::::/m::r::::::::::::::::::m:::::::::::w:::::::r::::tt:::r:::t:m::::::/:r::::::rx:::::t:::::::::::::t 
~/t:::rr::rr::::::::://::::'r::::::::::::::r::::::r~:::::tt::t:r::r::rr:t:m:::::::::::::::::rxr::::::::::::::?:: 
arf::::r:::t:m:r::r:m:::://:::rrr::r::::r::r::::r::::rr::::m::::::m:::::r:::::::::::m:t/:rrr::::::r::::::l 
TOT AL  18  12  23  7 
SOURCE:  Federation of State Medical Boards, Exchanqe, 1989-90. 
KEY: DALJ (1-2)=Any discipl inary action taken by another licensing juris or SDALJ 
(1-2)=Specific discipl inary action of another juris. Grounds for original action

must be val id grounds in both juris (1=new hearing required; 2=new hearing not

requi red)

14  DISPOSITION OF CASES

Each State medical board informs the Federation of State Medical Boards (FSMB) 
of formal actions it has taken against physicians. These State-by-State submissions

provide the basis for the data in tables 10 and 11.

These data, as we noted in our prior report, can be somewhat misleading. This is 
because in addition to initial adverse actions they also include any subsequent 
modifications to those actions. Thus, if a board put an individual physician on

probation, subsequently modified the probation, and at a later point terminated it, 
that physician would account for three board actions to the FSMB. 
Nevertheless, the FSMB data provide a reasonable indicator of the extent to which 
State boards are disciplining physicians. In this regard, tables 10 and 11 indicate that 
from 1985 to 1987 (the latest year for which validated data are available), there were 
widespread variations in the rate of actions taken by the State boards. Clearly, some 
State boards were much more inclined to discipline physicians than were others. 
It is important to add that in cases where there is some basis for concern, but not 
enough to warrant disciplinary action, many State boards take private, nondisciplinary 
actions that are not reported to FSMB. These might include referrals to impaired 
physician programs as well as various kinds of educational interventions intended to 
address deficiencies in a physician's practice skills. 
15
 TABLE 10

SERIOUS DISCIPLINARY ACTIONS PER 1,000 LICENSEES, 1985-1987

STATE  ACT I OMS PER 1.000 LICENSEES 
AK 10.03

MW::::::::m:m:::::::::i::::::m:::::::/i:::::/m:::::::m:::::I::::::::::::::::I::::::::::::t::::::::::::II:*~~
~/:::::t::::::::t::t::::::t::::::t:::::::::::::::/::::/::/:t::::::::tt:::::::::::::/:::::::::::tmtM~ 
AR................ ............... ....... ........... ................... ..5.: .oi

w;::r:::t:r't:::::::::::::::::::::rr::'t'r::::::':r:::'::r::rr::::r'::ttt1t:::::ri~:~i~ 
ca-............................ ... ............ .......... ....... ... ...... a: 37

.:::t::::1:::r::::r:t::::t1:rr::r:t:r:t:::':rr:::1:r::::::r:':::t::t:::::::r'~:m~ 
DE....................................................................i'.:33 
M::r::::r:::1:r:::::::::::t1::::::::::::::::::::::::::::::::t::::t:::::::::::::::rr:::::t:::::r:t::::~:~lI 
it................................................................... i i.: .9;

M:::::::::::1::::::1:rr::rr:::t1:r:::t::t:r:t1::::::::::t:rr:::::::11:::::::a~:wi.

Hi I...... ..........L .......... ..........7......................3...........4 i t:.Z2


tjt:::::::::r:::::t:::r:1:r:1::1::1::t:r:1:::::rr::::::rrrrrrr::::::::r:1~t~i
:K~;;,..................Y.........."'........... "'......1......,.........5...........,.............4..............,..1................
........1..~...."1u.

iA::::::::::t:::::::::::::::::::::t:::::t::::::::::::::::::::::::::::::::::::::::::::::::tt:t:::::::::::::::::::::::::::,::ah 
ts,::i::m:::::m::::mmm::::m:::::imm:m::IIIt::::::::m:m:m:m:::::m:m:m:::I::II::::a:mp
j\Mmr::::rr:::t:::::::::::::::r::::::::::rr:t::1t::::::tt::::::::::::t:r:::::::::t:::::r::11Wil 
.iE.... .... ... .......... ........ ..... .......... ........... ...... ........ ..6~.52 
i~j.t::::1::::::::t1::1t::t:ri1:r::::::::::::::::rrr:::::::::t:::r:::::::::::t:::r:::::1:I:W-~~ 
~iA...... ....... ............ ..... ....... .... ........ .......... ...... .....7~. 66

m::::::::::::::::::::r::r:11::::::::1::::::::t::::t1:r::::::::rr:::::::1:r:t:r::r::::r::l.:w-$.1: 
M.N..... ........ ........... ...... ..... ... ..... .... ........... ...... .....8~.37

ij:r:1:ri1::111111:rrr::rrrr:111:rrrrr::rrrrrj~:w-~t
M.O................"....................."..... ... ..................i"2 ~ 56 
NH 4.00

m::::::::11::t:::rr:111:::r::::::::::r::rr::::r:::t1:r:::11t:r::r:::::1:::~:*~~: 
NE.."......".. ................................ ...................... 3 ~ 07

NM 4.00

!!:::::::rr::::::::::::r::r::rr::r::::rrrr:::::::::::::t1::::::11:rr::::rr:1:1~:*~~
114::::::::::1:::r::::::r::r:::::::::11::::::1:r:1:::::::r:::11::::::::::::11::::tt:r::1.:*~~
ijjr:::::t::t::::::t::::::::::::::::::::1::tt:::::'t:::::::::r:tt:::::::::::rr:t::t::::::::t::9::~'~ 
NC....... ... .......... ....... .......... ..... ......... ..... ... ........... 6.:.i6

ijjr/'ttttt:::::::::::::::::r:::::::::t:r:::::::::t::::t:r:::::::::t::::::::tt::::::::tm:::~~~ 
O......... ............. .... ....... .......... ................ ........ ...t:ii~

Q.Kttttttttt::tt::1t:rr:::1mrr:111tt:::rrrr:1::::::nM.~~ 
OR ....... ....... ............ ....... .... ..... ........ ........ .......... i3.:.OZ 
,',',',',","'.'.'.'.'.'.'.'.".'.",'.'.",'.','.'.'.'.".".'.'.',',',','.".'.".'.",'.'.'.'.'.'.".',','.','.'.'.',','.'.",'.".'.'....','."."." '.". . 
.l.:.A...,.:.,.:.,.:.:.:.:.:..:.:.,.:.:.:.:.:.:.:..,.:.,.:.:.:.:.:.,,:.:.:..,.:.:.:.,.:.,.:.,.:.,.:.:..:.:.:.:.:.,.:.,.:.,.:.:..:.:.:.:.:.,.:.,.:.,.:.,,:..:.:.,.:.:.:.,.:.,.:.,.:.,.:..,.:.:.:,:.:.:.:.:.:..,.:.,.:.,.:.,.:.:.:.:.:.:.':.,.:.,.:.,.:.,.:.,.:.:..:.:.:.:.:.:.:.:'!:$::.,.:.,.:.:.:.:z:.:u. $:;j;u: ..
 .. 
Y......................................................,............................................,............'.......................8".06

TX 4.49

mtt:rrrrr:::t::::::111::11:r:::::::::::::t:r:::::::::11:::::::::::r::::::::::a~1~ 
~.......................................................~~

VT 3.83

::t:...:.m....:.t..:.)..:.:.:.:..:.:.)..)..).)..:.t.:..m...:..:.:.)..:.:.)..:.t..:.'.:.:.:..',..':..).:..:.:.:..:.t.:.:..:.)..,.t.:.:..:.:.:..:.:.).,:.:.)..:.:..:.t.:..).r..:.:.:..:.:.:..:.:.:.:........:..t.:...:..........................~......9".iu.

't1:r::rrr:111:r:1::::1:r:::tt:r:t:r::::rrr:1::t11t:'t:Mm:~
WI 8.48

vAttt:::):,::)::::))):t:::::::::::::rrr)r)r)))rr)))r))J).~ 
WA..... ........ ........... ....... ....... ..... ... ...... ........ ....... ...5.~.a9

i.t::::::m::?:::::::mm:::m:::::::::I::::::::IIIt::::::t:::m:i::::::::m:m:m:m:It::m~l:~m
imi::::m:::::/:::::m:::::i::::::::i::m:::::::::m:mmi:i::::::::::i::::::::m:::::m:i::m:m::::l:~~ 
8.00 . 
MEDIAN 
KEY: SERIOUS DISCIPLINARY ACTIONS=Revocations, suspensions, and probations;

LICENSEES=Those licensed and practicing in the State.

SOURCE: Federation of State Medical Boards, Federation Bulletin, 1985-1987 editions.

16  TABLE 11

TOTAL BOARD ACTIONS PER 1,000 LICENSEES, 1985-1987

STATE  ACTIONS PER 1.000 LICENSEES 
Em:::::::m:m:m:m:::::::m:::::::m:m:m:::::::::m:::::::::::::::ttm:::::::::::::m:::::m:::::::m:m::::::::::~:ttZ 
~...................................................................~~~

!:::::::::::::::::::::::::::t:m:?:/:::::::::m::::::r::t//::rrr::::::::m::??::?::::::::::::,,:::~~ 
W;::::::m:::::m:::::::::::::m:t::m:::::::::::=:m:::m:::t::::::::::m:::m:::::::::::::m:m:m:::::::::::t:::::::mtM~~ 
ca-.......... ........... ..................... ....... ........ ........ ..~i:i~9

dt:::::::::::::::::t::m:::m:m:::t::::t::::t::m:t::::::::::::::t::::::tt::::::::::m:tt:::::::::::::~:~~~ 
DE....................................................................i4.:S7

~r:::/:m:::::::::::::::m:::::::::::::m:m:::::m::::::::=:r::::::::::::r:m:::::::::::::::m:::::::::m:::::::::m::l!::~~ 
~=r:=::::::::::::/:m:::::::m::::::::::::::::::::::::::::::::::r::mm::r::::::/r:mm:::r:::::::::::::::::;g::~r 
lltt::t::::m:m:::m:m:::::::m::::::r::rr::::::::::::::::::r::r:::t::t:r::::::r:t:::::::::l~::~~ 
l~:r::::::r:::::::::::t:::::::::::::::r::::::j::::r::j::::::r:t::t:::::::::r::::::::r::::::::::::::::~:::~~ 
~~::::::/::r::::/r:::::::::m:::::::::::::?::::::::::m:m:::::m:::::m::::::::::/::rr::r:::::::?::::~:~~~ 
~~r:::mr:::::::::::m:?::::::::::::::::::::::::::m:::::::::::::::ir:::::m:m:::::m::::r:?::::::::::::::m:l~:~al 
!::r:m:m::::::::::::i:::::::/:::m:m:::m:::::::::::::m:m:m:m:::::::m::::r:m::r::::r::::::::r::~:~::~~ 
~W:::::::::r::::::::::j:::::::t:/:t::::::tt=/j:::::::::::t:/j:::::::::::t:::::::::::::::::/:t::~JM 
~...................................................................ti~~

!:::::::::::::::::::::::::::::::m::i:::m:m:::::m:m:::::m:::::::m::::::::::::::::::::::::::::m::::::::::::::i::::,::~~ 
!:=:m:::m::r:::::m:::::::m::::::::::::::::::::::::::r:m::::::=::::=:m:m:m:m::::::::::r:::::::::::::::::::::m:::I::H 
~:::::::t:j::::j::::::::/::r::::::::/j/::::::j::::::j::j:::tt::t::://j::::j::::::~:~~~ 
~!::::::jj:::::t::::::t:::::j::::::::/j:::::::::::::t:j:::::::::::::t:::::::::::/j::::::::::j:::::~:~~ 
~f:::r::::::t::::::::::r::r::::rr:m::::r:::::::m::::::::::/:::::::m::::::::/:::rr::::t:::m::l:~::l~ 
~~m:m:::m:m:::::::::m:m:m::::::::::::::::::::::::::::::::::::::::r:m::m::m::::::r:::::t::::t:mt:::::lZ:tJ 
!:r:::m:t::m:::::::tmmm:::::t:::::r::r:::::::::::t:::/::r:::::::::::::::::tt:::r:::::t:~r:~~ 
f-f::::::m:tm:m::r/:::m:m:::::::::::::::::t:::::r:::::m:::::::::::::::::t::::::t::m:::t:::::::::r:~:l::l~ 
~::::::m:::::::::::::::t::::::::::::::m:::::::::t::::::m::r:::m::rr:::::::m:m::::::::r::::::::i::::::::~l::~~ 
VT 11.49

~~::::::m:::m::=:::::::::::::::::::::::::::::::::::ri::i::m:::::::::::m:?=:::t:::::I::::I:::::::::::::::::::::~:f~ 
4N/j/::::::::/r:::::::::::::::::::::::::tt:/:::::::::tt:::j:=:::::t:/:::::::::m::::::::::::::~:~i~
~fttt=:t:j:::t:/::::::::::::::::::::jr:::::::::t::tmj::jj:::::::tt:::::/:t:::::::~:~Zr 
~:r:::::::m:m:::::::m:m::::::::::::::::r::::::::r::::r::::::::::::i::::::::::::::::::::::::r::::=:r/:::fi:~~~ 
u::r/r::r:::::://:::::tm:::::::::::::m::/:m:::::m:::m:t:::r:::::::::::::::::::::::rmm:::m:~Hi;; 
MED I AN  14.25 
KEY: LICENSEES=Those licensed and practicing in the State.

SOURCE: Federation of State Medical Boards, Federation Bulletin, 1985-87 editions.

17
 CONCLUSION

Each State medical board is a product of its State government environment and is in 
some way unique. Each works within a distinctive political, economic, and social 
context. 
Yet the boards do address the same basic issues and have the same basic objectives. 
Through a regular review of comparative data along the lines presented in this 
report, State offcials can gain a better understanding of the strengths and 
weaknesses of their own boards. It can also help them determine the kinds of 
actions that they can take to improve their boards' performance. 
In this context, we recommended in our prior report that the State boards, working 
through the FSMB, commit themselves to the development of performance indicators 
which they can regularly use to assess their performance. Such indicators, 
particularly if expressed in terms of ratios or percentages, would faciltate 
comparisons not only between boards in different States, but of a particular board's 
own performance over time. 
18