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

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 

In April 1990, we issued a draft report entitled "State Medical Boards and Medical 

Committee on Small Business of the United States House of Representatives. 

IN

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


FUDS DED I CATED/RESERVE

STATE YES NO lw::m:::::m:/:::::://::::::m:/::/::::m:m:::::m:::::::/t::::::::t:?X:::::::::::tt//t::::::/:::::::mm:m:m:m:::m:i: AK 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 AR X


!rmr:::::::::::::::::r::::::::::1::::1:r::::m:::::::::::::::::::r?r::?:::';:::::::MatJltM:t¡ll~::::::: 

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 

DE X


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::::::KMi:m:::::::m:::::::::r::r::m:ri:m:::::m:::m:::::::::m:r::::rr::r::::::::m:':':::':::m:::::r::m:::::::::m:::':::::m:m:::::r:::::::::t

~~:::::::1::::::r::r::1:::r:::::::::r:::::r:::r::::::::::1r::::::::/:r:::~:::r::::::::::::1:::::::r::::::::::::::r:::::::r:::::::r:: 

HI X
 IL X
 IA X


~f:::::::11:r:::::::1:::::::::::::r:::::::::::1:?:'::::m1:::mmr:::::::~::::::::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! MN . 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::::::

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

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

NE X
 NH X
 NM X


~~::rm1/::::::1:::::rr:::r::::1::::11:::::::rr:::::r:::::::::::::I::::::::::1:r::::::::::::::r::::::::r::::r¡,::::r:::::~: 

NC X


~~/::1:::::::::::r::::::::::::r:::r:::::::::m::1:¡:::r:::1::::::::::1:¡:::~::r:r:::::/rr:::::¡::::::::1::::::::/:::::r::::::: 

~~::::r:::::::::::::::::::::::::m:::'::::r:::::::::::::::::::::::::::::1:::::::::::::::r:r:~:::r::rm::r:::::::::::::::::::::::::::::::r:¡::::::::::, 

~~r:r:::::::::::::/:::::::::::::r::::::::::::::m:¡:::::::::::::::::::::::::::::::::::::::::::::::rrr:::::r:::r:::::::r:::r::::::r::::::r::::~ 

!i¡tt:1:::::::::::::::::t:::::::::1::::::::::1:::::::::rr::t::::rt::::::r:::1:::::::t:1:::::t:::::11:t:11::1::::1::tk

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:::::: 

TX X
 n X
 WA X


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:~ 

:~:!::::::::::::::::::::::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:::::::::::::~


ME 0


~~/::::::::::/:::::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


~~:::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


SC 4
 TX NOT AVA I LABLE


!:::::¡:::::::::::::::r::::r¡r:::¡::::t::::::::::::::::::::::::::::::::::::::::::/:¡::::::::::::::/:¡:::::¡:¡::::::::mr:r::r:::::::::m::::::::r::::t::::::::::~ 

~t::::::::::::::::::::::::::¡::::::::::::::S.lAtf::::fR§IIlpsr: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


DALJ SDALJ

STATE 1 2 1 2


Aprrrr':m:m:r::::::::mm::::::::::::::::::::r¡:m::::K:m::/:::::m:::::m:::::m:::::t::m:::tt::::::::r:x:::::tt¡::::::::/ AK X


~f-::::mmt::m::::/:m:::::tr::::::r::::tt::::::::::::::~:¡:¡:::::::::::m:t::m:r::m::::/:¡:::rr::::r::::::::::?m:m:::::rrm:m 

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

tt:m:::m:m:m:::::::::::::::::m:m:::::::::::::r::r:::::::::::::::::::::::::::::/:::::::::t::::::':::::::::::::::::::::::::::::::::::::::::W::::::::::m:::t::::: DE X
 ro X
 ~t:::::::::::::::::::tt:::r:tt:::::rr:::::::t::::t::::::::t:::::'t::::::::::::::t:::::::::r:t::::::::::::::::t:::::::X:::::::::::::::::t:::: FL X
 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

:~:~::::::::::r::::::::::::::::::::::m::::::::':::t:::::::::::::::¡/:::::::~::::::::::tt::::~::::::::::::::::::::::::::::::::::::::::::::m:::tI:::::::::::::::::::::: 

HI X
 IL X


¡¡¡:::r::¡::::t:¡:::m:::::t::r:::/::::::t:::::::::t::::t:::::/I:t:::::::::::::'::::m:::t¡::::t:t::t::m::/mX:I:::::::::::m::::::: KY X


!: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:::::::::::::::::::~ 

!~::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:::::: MO X X 

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

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:::::::

NE X
 NH X


ijXj::t'::::::::::::t::rtr::r:::'r::t:t:r::::::::::::::::::::::::r:rtmr::::::::r:rtt::'::::::::::::::::::::::::t::::::t:::::::tK 

NM X
 ~....................................................~........................................


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


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

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

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

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 ~ X
 w X
 ß X
 ~,:::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 

MW::::::::m:m:::::::::i::::::m:::::::/i:::¡::/m:::::::m:::::I::::::::::::::::I::::::::::::t::::::::::::II:*~~ AK 10.03


~/:::::t::::::::t::t::::::t::::::t:::::::::::::::/::::/::/:t::::::::tt:::::::::::::/:::::::::::tmtM~ 

ÄR................ ............... ....... ........... ................... ..5.: .öï


w;::r:::t:r't:::::::::::::::::::::rr::'t'r::::::':r:::'::r::rr::::r'::ttt1t:::::ri~:~i~ 

ca-............................ ... ............ .......... ....... ... ...... ä: 37


ø.:::t::::1:::r::::r:t::::t1:rr::r:t:r:t:::':rr:::1:r::::::r:':::t::t:::::::r'~:m~ 

DË....................................................................ï'.:33 

M::r::::r:::1:r:::::::::::t1::::::::::::::::::::::::::::::::t::::t:::::::::::::::rr:::::t:::::r:t::::~:~lI 

it................................................................... ï ï.: .9;


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


H Ï................ .................................................... i t:.Z2


tjt:::::::::r:::::t:::r:1:r:1::1::1::t:r:1:::::rr::::::rrrrrrr::::::::r:1~t~i

:~;;,............................"'..........."'............,....................,..........................,..........................1..~...."1u.


i L 7.34


iÁ::::::::::t:::::::::::::::::::::t:::::t::::::::::::::::::::::::::::::::::::::::::::::::tt:t:::::::::::::::::::::::::::,¡::ãh 

ts,::i::m:::::m::::mmm::::m:::::imm:m::IIIt::::::::m:m:m:m:::::m:m:m:::I::II::::ä:mp KY 15.41


j¡\Mmr::::rr:::t:::::::::::::::r::::::::::rr:t::1t::::::tt::::::::::::t:r:::::::::t:::::r::11Wil 

¡.ïE.... .... ... .......... ........ ..... .......... ........... ...... ........ ..6~.52 

ì~j¡.t::::1::::::::t1::1t::t:ri1:r::::::::::::::::rrr:::::::::t:::r:::::::::::t:::r:::::1:I:W-~~ 

~ïÄ...... ....... ............ ..... ....... .... ........ .......... ...... .....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.Ö................"....................."..... ... ..................ï"2 ~ 56 

m::::::::11::t:::rr:111:::r::::::::::r::rr::::r:::t1:r:::11t:r::r:::::1:::~:*~~: 

NË.."......".. ................................ ...................... 3 ~ 07


!!:::::::rr::::::::::::r::r::rr::r::::rrrr:::::::::::::t1::::::11:rr::::rr:1:1~:*~~ NH 4.00


114::::::::::1:::r::::::r::r:::::::::11::::::1:r:1:::::::r:::11::::::::::::11::::tt:r::1ø.:*~~ NM 4.00


ijjr:::::t::t::::::t::::::::::::::::::::1::tt:::::'t:::::::::r:tt:::::::::::rr:t::t::::::::t::9::~'~ 

NC....... ... .......... ....... .......... ..... ......... ..... ... ........... 6.:.ï6


ijjr/'ttttt:::::::::::::::::r:::::::::t:r:::::::::t::::t:r:::::::::t::::::::tt::::::::tm:::~~~ 

Ö¡¡......... ............. .... ....... .......... ................ ........ ...t:ïï~


Q.Kttttttttt::tt::1t:rr:::1mrr:111tt:::rrrr:1::::::nM.~~ 

ÖR ....... ....... ............ ....... .... ..... ........ ........ .......... ï3.:.ÖZ ,',',',',","'.'.'.'.'.'.'.'.".'.",'.'.",'.','.'.'.'.".".'.'.',',',','.".'.".'.",'.'.'.'.'.'.".',','.','.'.'.',','.'.",'.".'.'....','."."." '.". . 

....................................,..........................................,....................,....................'....................'!$.......z.u$ju.
 l:A,:,:,:::::::,:::::::,:,:::::,:::,:::,:,:,:,:::::::,:,:,:::::::,:,:,:,:::,:::,:,:,:,:,:::::::::,:,:,:,:::::::,:,:,:,:,:::::::::::::,:,::::::. :;;: . .. 

¡Y......................................................,............................................,............'.......................8".06


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

~.......................................................~~


:t....................................................................................,..........................................................~......9".iu.
 ::.:m:t:)::::::)))):t:m:::)::):t:':::',':):::::t:::),t:::::::)::):::t:)r::::::::::...:t:.:... TX 4.49


ø't1:r::rrr:111:r:1::::1:r:::tt:r:t:r::::rrr:1::t11t:'t:Mm:¥~ VT 3.83


vAttt:::):,::)::::))):t:::::::::::::rrr)r)r)))rr)))r))JØ)ø.~ 

WÄ..... ........ ........... ....... ....... ..... ... ...... ........ ....... ...5.~.ä9
 WI 8.48
 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:~§~ 

MEDIAN 8.00 . 

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:ï~9


dt:::::::::::::::::t::m:::m:m:::t::::t::::t::m:t::::::::::::::t::::::tt::::::::::m:tt:::::::::::::~:~~~ 

DË....................................................................ï4.: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~:~ãl 

!::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:::::lŽ: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::~~ 

~~::::::m:::m::=:::::::::::::::::::::::::::::::::::ri::i::m:::::::::::m:?=:::t:::::I::::I:::::::::::::::::::::~:f~ VT 11.49
 4N/j/::::::::/r:::::::::::::::::::::::::tt:/:::::::::tt:::j:=:::::t:/:::::::::m::::::::::::::~:~i~

~fttt=:t:j:::t:/::::::::::::::::::::jr:::::::::t::tmj::jj:::::::tt:::::/:t:::::::~¡:~Žr 

~: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