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Willful Ignorance: Five Tips from the Star Tribune's Medical Board Investigation

Willful Ignorance: Five Tips from the Star Tribune's Medical Board Investigation

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William Heisel, Antidote, doctors behaving badly, minnesota board of medical practice

Minnesota witnessed one of the most bizarre cases of physician misbehavior seen in Antidote's Doctors Behaving Badly tour.

Two years ago, I noted that Dr. Erik Linck has been allowed to practice while other doctors had their licenses summarily suspended for simply failing to pay various taxes.

Now the Minneapolis Star Tribune's Glenn Howatt and Richard Meryhew have found that Linck was just the naughty tip of a very ugly iceberg in Doctors who err escape penalties.

Most boards say they would love to discipline more doctors more effectively. The Minnesota Board of Medical Practice told the Star Tribune that it actively avoids doing anything that would restrict a physician's license. And guess what? Howatt and Meryhew found that one of the few things that seems to jar the board into action is a failure to pay taxes.

Here are five tips from this great investigation. Now go do one of your own.

Apply peer pressure. Typically, one agency taking action prompts another agency to take a similar action. If the medical board in Massachusetts has done all the investigative work, why wouldn't the California board? Minnesota's board operates in an Alice in Wonderland world where up is down and right is left. Howatt and Meryhew write:

The Minnesota board also chose not to act against a state-licensed radiologist who mistakenly inserted a chest tube into the wrong lung of a patient during a procedure in Florida. In that case, 20 states, including Florida, followed with some type of action.

Wow. But surely Robert Leach, the board's executive director, has a good explanation for all this?

Because the board cannot legally release details about investigations that don't result in public action, Leach cannot explain why the board chose not to act in some cases. But he said Minnesota regulators might defer action if board members believe a doctor has been sufficiently punished elsewhere or if a doctor isn't actively practicing in Minnesota.

"What's the point of piling on?" asked Ruth Martinez, supervisor of the board's complaint review unit.

Use the National Practitioner Data Bank. Charles Ornstein underscored in a post praising the Star Tribune series and similarly fine work by Deborah L. Shelton at The Chicago Tribune why it's so important for reporters to push for open access to the data bank. Even under the current restrictions limiting the way journalists can use the data bank, Howatt and Meryhew pulled together some great statistics and context for their piece.

In addition, more than half of the 74 doctors who lost their privileges to work in Minnesota hospitals and clinics over the past decade were never disciplined by the Minnesota board, according to a federal database used by the health care industry to track actions against physicians. At least 13 of the 47 doctors who avoided discipline were flagged for incompetence, substandard care or inadequate skills.

Give due credit. In an investigation that hammers on a government agency, rarely is there this much space devoted to what the agency does right. The Star Tribune carved out more than 12% of its space to give examples of doctors that actually had been disciplined by the board.

Despite its non-punitive philosophy, Minnesota's board has taken action against incompetent doctors and others who pose a threat to their patients. The board can impose discipline when it finds a "preponderance" of evidence against a physician.

Shorewood doctor Gregory L. Seifert caught the board's attention in March 2007, when he reported complaints about his practice while renewing his license. A committee review found "a number of concerns," board records show. Among the issues: Seifert failed to adequately interpret diagnostic tests, provide needed referrals to specialists and fully document his patients' medical histories. The board also cited problems with his prescription of pain medication.

After Seifert disputed the findings, the board asked him to take a skills assessment, which showed additional problems. Five months later, Seifert underwent a neuropsychological exam that revealed "significant health and cognitive concerns." In January 2010, after the board concluded his conduct warranted disciplinary action, Seifert, then 74, gave up his license.

Demystify the malpractice myth. One of the oldest saws in medicine is that doctors are sued all the time and that malpractice lawsuits are driving good doctors out of business. If you like your doctor, and you have a good relationship with that doctor, ask during your next visit how many times the doctor has been sued. You might be surprised to find out the answer is "never" or "once."

About 40 percent of all physicians are sued at least once for malpractice in their career, but less than a quarter are sued twice or more, according to a recent survey by the American Medical Association. In Minnesota, the average malpractice award since 2000 has been $145,000, according to the newspaper's analysis of the National Practitioner Data Bank.

Find the fix-it crew. When a doctor does serious damage to a patient – physically or mentally – the patient usually ends up seeing another doctor, often many other doctors. It is always a good idea to try to talk to those physicians. The best route is to ask the patient to ask the doctor for an interview. The second best route is just calling the doctor directly or going to the doctor's office. Reporters can be too easily dissuaded by a terse secretary or a few unanswered emails. Doctors don't like to talk about other doctors, the theory goes. And often the theory is true. But the Star Tribune showed how being persistent can yield journalistic gold. Howatt and Meryhew wrote about Dr. Patrick Carney's string of bad patient outcomes, including a woman who won a $1 million jury award after her face was severely burned during a chemical peel.

Dr. Richard Tholen, a plastic surgeon in Minneapolis, removed a breast implant from one of Carney's patients in 2009. Carney had performed the surgery more than a week earlier, but the procedure was stopped because the patient was in so much pain, Tholen said. Tholen told the patient to contact the medical board about what had happened.

"I had to correct the half-completed procedure by not completing the procedure, but by undoing the problem he had created for her," Tholen said.

Carney declined to discuss the case, citing patient privacy laws. But he said pain management is "always a top concern," and he said it is standard to halt a procedure if a patient's "pain threshold is determined to be an issue."

Antidote is thrilled to see another newspaper investigate a state medical board. Do you know of a board you think deserves more scrutiny? Post a comment below. And you can follow me on Twitter @wheisel.

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