Public Citizen report slams Minnesota Medical Board

Is the Minnesota Board of Medical Practice too lax on discipline, or are Minnesota doctors just that good?

Public Citizen, the consumer watchdog group founded by Ralph Nader, released a stinging report Monday that calls Minnesota the worst state in the nation in punishing wayward docs. From 2007 to 2009, Minnesota issued only 1.07 serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 physicians, the fewest in the United States, according to the report.

Of course, the lack of disciplinary action does not necessarily mean there’s something to discipline. But 1.07 per 1,000 does seem kind of low, considering problem docs have become a growing issue in recent years.

According to a 2003 survey of 2,000 nurses, pharmacists and other staff by the Institute for Safe Medication Practices, nearly half of the respondents reported intimidating behavior, mostly from doctors, such as strong verbal abuse and threatening body language. Four percent even reported physical abuse. Experts say burned-out doctors, if unchecked, often resort to substance abuse and even criminal behavior that could harm patient safety.

In 2008, The Joint Commission, an independent, nonprofit organization that accredits and certifies more than 17,000 health care organizations, established new standards that require hospitals to develop ’a code of conduct that defines acceptable and disruptive and inappropriate behaviors’ and ’create and implement a process for managing’ such behaviors.

’The presence of intimidating and disruptive behaviors in an organization erodes professional behavior and creates an unhealthy or even hostile work environment–one that is readily recognized by patients and their families,’ The Joint Commission said. ’Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients.’

Perhaps hospitals are heeding the Joint Committee’s call and dealing with doctors before the Minnesota Medical Board intervenes. Some even say discipline is not the best way to correct bad behavior.

“What I can tell you is that in the past, the Board has said that the results of the Public Citizen survey are skewed because [the group] doesn’t take into account that Minnesota issues far more Agreements for Corrective Action (which are considered nondisciplinary, and are not reported to the Federation of State Medical Boards) than it does disciplinary actions,” Karolyn Stirewalt, a lawyer for the Minnesota Medical Association, wrote to MedCity News in an e-mail.

“It does this because Agreements for Corrective Action are remedial and work better than disciplinary actions,” Smith continued. Most other states don’t have Agreements for Corrective Action.”

Stirewalt also noted Minnesota receives far fewer complaints than most states. Yes, but the number of complaints has been rising. According to its most recent report, the Minnesota Medical Board reported 832 complaints in 2007, an 8.4 percent jump over the previous year, and 868 complaints in 2008, a 4.2 percent rise from the previous year. The vast majority of them involved unprofessional/unethical conduct.

The board took action on 8.1 percent of those cases. Of the 139 discipline orders issued over those two years, the board only once revoked a doctor’s license.