Medical Board Auditor Cites Problems, Recommends Changes

The Medical Board of California should transfer the responsibilities of its investigative staff to the Office of the Attorney General and increase physician licensing fees, according to a board audit discussed at a Senate oversight committee hearing Tuesday, the Orange County Register reports (Heisel/Saar [1], Orange County Register 1/26).

Committee Chair Liz Figueroa (D-Fremont) in 2002 introduced legislation mandating Julie D'Angelo Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego School of Law, to audit the medical board. Fellmeth in November 2004 issued a report recommending that the board make changes to improve patient protection.

The report found that the board:

• Lacks oversight of the substance abuse diversion program;
  
  
• Has poor cooperation among board investigators and lawyers in the attorney general's office;
  
  
• Has a limited number of board-enforcement staff;
  
  
• Is often slow and incomplete in reporting medical malpractice instances and lawsuit settlements;
  
  
• Is slow to collect medical records for investigations (California Healthline, 1/21);
  
  
• Completes investigations against doctors in about 2.63 years on average and about four years if doctors appeal;
  
  
• Sometimes does not disclose information about doctors including medical malpractice settlements, misdemeanor convictions and board decisions to refer investigations to prosecutors; and
  
  
• Uses out-of-date manuals and computer systems.

During her testimony Tuesday, Fellmeth said that many malpractice insurers and court clerks do not inform the board of malpractice judgments or settlements and that many hospitals do not report peer review panel actions against physicians. Fellmeth suggested that the medical board establish deterrents for insurers who do not issue malpractice reports. She also proposed creating an education program for courtroom clerks.

Fellmeth said, "The diversion program is significantly flawed. In most of these cases, the physician remains free to continue practicing during the (investigation)."

Medical board Executive Officer Dave Thornton called the report "fair" and "even-handed." He noted that the board is seeking a fee increase from $600 to $800 for a two-year medical license.

Figueroa said she is "dismayed" that the board has not addressed many issues before the report was issued. She asked, "What are you going to do in a proactive way to ensure that we're not here every two years?"

California Medical Association President Robert Hertzka during his testimony Tuesday requested specific information about how funds raised through a license fee increase would be spent before CMA would support such a move (Kleffman, Contra Costa Times, 1/26).

According to the Register, "CMA's support will be crucial" because association contributions comprise 90% of the board's budget (Heisel/Saar [2], Orange County Register, 1/26).

Hertzka said, "I haven't seen the case made for the fee increase" (Kleffman, Contra Costa Times, 1/26). He added, "There is a lack of trust between the medical profession and the medical board."

Officials from the Office of the Attorney General have not indicated whether the Department of Justice would accept responsibility for the medical board's investigations.

CMA members said that under the proposal the board would continue to pay investigators' salaries, but investigators would work directly with state attorneys, who prosecute lawsuits against physicians.

Medical board Vice President Ronald Wender said, "We're talking about changing culture, and changing culture is not as simple as it sounds in any kind of bureaucracy."

The board on Feb. 17 will meet with CMA members, the Department of Justice and the Department of Consumer Affairs to draft legislation and make changes to the board (Heisel/Saar [2], Orange County Register, 1/26).

The medical board "does far less than what the state requires," and state legislators "need to compel changes," a Riverside Press-Enterprise editorial states. The editorial calls the proposed licensing fee increase an "attractive funding option" to improve the board's oversight issues. The editorial states, "Most California doctors do a fine job," adding, "But the state needs to stop those who don't -- and that won't happen unless legislators give the oversight panel more than just a stethoscope" (Riverside Press-Enterprise, 1/24).