Good doctors or bad oversight: Depends whose spin you believe

By Marshall Allen (contact)

Thursday, June 21, 2007 | 7:18 a.m.

Nevada doctors are seriously disciplined at a much lower rate than their colleagues in most other states - which, depending on how the numbers are spun, can be interpreted in a positive or negative way.

The Nevada Board of Medical Examiners, for instance, says the low disciplinary rate shows that the system is working - and that Nevada's doctors are good.

Critics say it indicates failure - that the state isn't sufficiently tough on doctors.

A recent annual report by Public Citizen, a national watchdog organization, showed that Nevada ranked 47th among the states for serious disciplinary actions against doctors. The report said in 2006 there were eight serious actions - defined as revocations, suspensions and probations/restrictions - against Nevada's 5,196 physicians. That's a rate of 1.68 actions per 1,000 physicians from 2004 to 2006. The most discipline-oriented medical board was in Alaska, which had 7.3 serious actions per 1,000 physicians.

Bonnie Brand, general counsel for the Nevada Board of Medical Examiners, said the Public Citizen report is fundamentally flawed because it's possible for medical boards to sway the results. For example, many doctors licensed in Nevada live elsewhere. In cases where one is disciplined by another state's medical board , the Nevada board could take action against the doctor, which would boost the statistics, but instead usually chooses to flag the physician's license for scrutiny if he moves to Nevada, she said.

The lower rate of discipline also reflects Nevada's higher licensing standards, Brand said. Nevada requires doctors to complete three years of residency training, whereas most states require one or two , she said.

And in some cases that have not affected patient care, such as alcohol abuse, the board determines it's better to rehabilitate a doctor than take serious disciplinary action, Brand said.

"We are so short of doctors, we want to fix doctors where we can," Brand said.

The Public Citizen report says the "remarkable" variability in the rates of serious disciplinary action is caused by differences in board practices. And there is "considerable evidence" that most boards under discipline physicians, the report said. In a separate report the group found that 67 percent of insurance fraud convictions and 36 percent of convictions for controlled substances warranted only nonsevere discipline.

Attorney Gerald Gillock, who specializes in medical malpractice cases, said physician errors cause tens of thousands of patient deaths nationally, yet malpractice is often not factored into disciplinary actions by the Nevada medical board. He finds it "highly unlikely" that fewer doctors are disciplined in Nevada because they're better than in other states.

"The reason Nevada ranks so low is that doctors haven't done a good job policing their own profession," Gillock said. "They've let people who come before the medical board off the hook."

Dr. Bill Pierce, president of the Nevada Academy of Family Physicians, said he considers the medical board too strict in its discipline. He knows one doctor who did not report a brief stint of practicing out of state to the board, as is required, and was slapped with a fine and public reprimand.

"I think our state rules with an iron fist," Pierce said.