Medical examiners draw criticism

Molly Ball

Monday, June 6, 2005 | 9:20 a.m.

Actions taken Friday by the state Board of Medical Examiners, which declined to discipline three Southern Nevada doctors accused of malpractice, could fuel the continuing controversy over the board's effectiveness.

The medical board has been criticized for disciplining what some say are too few physicians and for operating largely out of the public eye.

The criticisms play a role in Nevada's volatile medical malpractice debate.

In arguing for some of America's most restrictive laws limiting medical liability -- passed by voters last November -- doctors' groups claimed that physicians were being driven out of the state because they couldn't afford malpractice insurance premiums, which in turn were being driven up by "frivolous lawsuits."

Their opponents, largely lawyers' groups, countered that suing bad doctors was the only way to hold them accountable for wrongdoing, in part because the state medical board was seen as ineffectual.

By some measures, the Nevada medical board is one of the nation's least active. The Washington-based watchdog group Public Citizen surveyed medical boards across the country and ranked Nevada's 46th based on its rate of serious disciplinary actions, which was just 2 per 1,000 physicians over the three-year period from 2002 to 2004.

In 2004, the board's rate was even lower. It took serious action against six doctors out of the 5,993 it had licensed as of Dec. 31, or 1 per 1,000.

The board has defended itself by saying last year was an anomaly and more actions are being taken in 2005. Executive Director Tony Clark told the Sun previously that the board was "catching up on disciplinary cases."

The board also questions the Public Citizen report, which counts only restrictions, suspensions and revocations of medical licenses, not lighter penalties like reprimands or fines.

At Friday's meeting, Board President Dr. Stephen Montoya and Secretary-Treasurer Donald Baepler called the report's author a vindictive disciple of Ralph Nader whose methods were questionable at best. Montoya ridiculed the report's premise, which he described as "you're a good board if you take away a certain number of licenses."

The author, Dr. Sidney Wolfe, has said just that, arguing that punishing a certain amount of doctors is a sign that the medical community is being actively policed and the public protected.

In addition to its activities, the board's lack of openness has been criticized. Although most of the population it serves is in Southern Nevada, the board's disciplinary cases are heard at its office in Reno without teleconference to other parts of the state.

Transcripts of these hearings are available from a Reno court reporting company that charges $2.25 per page. For a two-day hearing, that can come to more than $300 for a member of the public to learn about his or her doctor. Without those documents, it is impossible to know the detailed accusations against a physician and the physician's defense.

The medical board's actions may be within the letter of Nevada public-access laws. But a comparison with the much-smaller Board of Osteopathic Medicine is instructive.

Osteopathic physicians, whose names are followed by "D.O." instead of "M.D.," go to different schools, but their medical license is functionally the same; they may practice in all medical specialties, prescribe medications and so on.

But of late, the osteopathic board has taken an aggressive tack toward a few doctors accused of wrongdoing -- so aggressive that it has been accused of witch-hunting.

It polices just over one-tenth as many physicians as the medical board, 677, but it has pursued three disciplinary cases over the past year, revoking one license and suspending another, with one action still pending. That works out to a rate of 3 serious actions per 1,000 doctors -- higher than the medical board, if not dramatically so.

The osteopathic board has not been shy about these pursuits, either. It has held its hearings on Las Vegas-area doctors in Las Vegas, which has allowed both supporters and alleged victims of the accused doctors to observe the proceedings. The hearings have been announced to the local media, with electronic copies of documents and transcripts provided free of charge.

The osteopathic board's deputy executive director, Trey Delap, said the board is committed to serving the public interest through transparency.

"A major part of public protection is letting the public know we are protecting them," Delap said. "We do that through openness."