Legislative Analysts Recommend Changes to Maryland’s Physician Discipline System

Legislative analysts released a report Nov. 7 "criticiz[ing]" Maryland's disciplinary system for physicians, particularly the involvement of the state's medical society in the process, the Baltimore Sun reports. The report, written as a "sunset review," or periodic evaluation of state agencies, examines the Maryland Board of Physician Quality Assurance, saying it has taken "fewer disciplinary actions against doctors in recent years, even as the number of complaints has increased." The report also says that the time the board spends "resolving complaints against doctors take[s] far too long," usually lasting more than two years and leading to a "significant backlog" of cases. According to the report, 503 complaints were pending at the close of fiscal year 2001, compared to 99 at the end of fiscal 1998. In addition, the number of formal actions taken against doctors declined from 113 in 1998 to 69 in 2001. The report says that this decrease is a "sign of the board's inability to fulfill the part of its mission related to protecting the public." In order for regulators to "more easily pursue cases against doctors accused of wrongdoing," the report suggests "limiting the role" of the state's medical society, known as the Medical and Chirurgical Faculty of Maryland, which under current law performs peer review for the board on cases concerning charges of substandard care. The society taps two physicians to review the case and takes disciplinary action only if both reviewers agree that the physician in question "failed to meet accepted standards of care."

Changing the System
The analysts' report suggests that the society use only one physician reviewer and that state law be changed to allow the board to "competitively contract with an outside body or bodies" to complete the review process. In a written response, MedChi said it "strongly opposes" both suggestions. T. Michael Preston, executive director of MedChi, said, "The concern we have with many of the recommendations is that they come at too high a cost in terms of due process and assuring that the review of complaints that are (against doctors) is fair and objective." MedChi voted to propose a "different system" at its convention in September, under which physicians who self-report their errors would be protected from punishment. Though the society says that shifting focus away from sanctions will create more thorough medical error reporting, the proposal has received a "generally cool reception" from state legislators (Garland, Baltimore Sun, 11/8).