Health Care

This tool can help state medical boards spot problem doctors. Why do so few use it?

The Missouri medical board revoked the license of pediatric surgeon Guy Rosenschein in April because of child pornography charges.

That same month the board also revoked the license of physician Abhishek Jain after he pleaded guilty in St. Louis County court to sexually assaulting patients.

Chester Stone voluntarily surrendered his Missouri license to the board in January after he was accused of having sex with a patient in Kansas.

What did all three doctors have in common, other than inappropriate sexual behavior? Other states had flagged them as problematic providers months or even years earlier and, by law, had to add those flags to a national list.

In the United States, the licensing and disciplining of doctors is left up to states. The patchwork of state medical boards sometimes allows physicians to keep practicing in one state even if they have a history of poor care or unethical behavior in another — particularly a problem in metro areas like Kansas City that straddle two states.

The federal government keeps a database with a wealth of information about doctors’ professional and criminal histories across all states — the National Practitioner Data Bank. But The Star found that most state medical boards, including Kansas and Missouri’s, don’t take full advantage of it. Experts say that puts patients at risk unnecessarily.

“I think it is a big issue because, you know, it only takes one (doctor) to cause a severe injury to a patient or to have a death resulting from malpractice,” said Robert Oshel of the Patient Safety Action Network. “So you really want to know if you’ve got someone who has a poor record in another state.”

Last year an investigation by USA Today and the health care website MedPage Today found at least 500 doctors who had been disciplined in one state but were practicing with a clean record in another.

Oshel previously worked as an analyst on the National Practitioner Data Bank, which was supposed to make it easier for states to share information about doctors. It brings together reports from every state on:

Medical malpractice lawsuit payments.

Marks against federal or state licenses or certifications (like losing a license in one state or losing the federal permission to prescribe controlled substances or bill Medicare).

Losing clinical privileges to work at a hospital or other medical center.

Being kicked out of a professional society, such as the American Medical Association or the American College of Surgeons.

Health care-related criminal convictions.

Public use of the database has been restricted since 2011, when The Star combined it with other public information to identify Johnson County neurosurgeon Robert Tenny as a provider with a long history of malpractice suits.

Tenny complained to the federal government, arguing the database is supposed to allow identification of doctors only by groups that have their unique provider numbers. The feds briefly took down the public file, and when they put it back up it included a “Data Use Agreement” that required users to agree that they would not triangulate it with other data to identify individual doctors like The Star did.

Not used

State medical boards have the unique provider numbers and are able to use the database. But most of the boards, which are supposed to protect the public by making sure doctors live up to ethical and clinical standards, don’t use it much.

The Star requested information on how many times state medical boards queried the database each of the last three years. It revealed large discrepancies from state to state, with a few states using it to vet nearly all their doctors in real-time, some checking it when a doctor applies for a license or a renewal and some not using it at all.

Seven states, including Missouri, didn’t use the data bank at all in 2018. The Missouri board used it once in the first three months of 2019 and four times total in 2016 and 2017. The board oversees more than 20,000 practicing doctors.

Lori Croy a spokeswoman for the Missouri board, said while it usually doesn’t query the database directly, it requires doctors to do so — and pay for it — when they apply for a license and then submit a report from the database to the state.

Lisa Robin of the Federation of State Medical Boards said other states also do it that way.

The Kansas Board of Healing Arts instead opts to query the database directly. Executive director Kathleen Lippert said staff checks the database each time a doctor applies for a Kansas license and whenever one of the state’s approximately 8,000 practicing doctors apply to renew their license (which is required every two years).

Kansas used the database about 1,500 to 1,700 times a year in 2016-2018.

But neither Kansas nor Missouri use the database’s “continuous query” feature — a powerful tool that runs ongoing checks of doctors and notifies every state board within 24 hours when an enrolled doctor gets a black mark in any state.

That’s the gold standard in patient protection, said Michael Carome of the non-profit consumer protection group Public Citizen.

“We think real-time data on a continuous basis is invaluable,” said Carome, a physician. “Suppose someone two months after they renew their license has their license revoked in another state for serious misconduct? I think the state medical board would want to know that information sooner than two years (after).”

Cost

The federal government has been urging states to use continuous query for years, gradually lowering the price to enroll a doctor for one year to $2 — the same amount as a one-time check.

But on a two-year basis that’s still double what it would cost to just check the database at renewal time and Lippert said the “significant additional cost” has been a barrier for Kansas. But she said her organization is exploring it and it will be a factor the next time the board sets licensing fees, which is how it funds all of its operations.

Croy said the Missouri medical board doesn’t need to purchase continuous query services, because it gets most of the information in the database for free. Many of the organizations that are required to report doctor discipline to the feds are also required to report it to state medical boards.

The Federation of State Medical Boards also sends alerts to all members when doctors lose their licenses in other states.

But the federation doesn’t keep all of the information on doctors that the feds do, Robin said.

“That’s why we’d suggest that both are used,” Robin said. “The majority of the information in the National Practitioner Data Bank is malpractice.”

Only 12 states enrolled any of their providers in the federal database’s continuous query last year. Florida has enrolled the most — a whopping 83,705 of them.

At $2 each, that cost the state licensing board $167,410. In a statement released by spokesman Brad Dalton, the Florida medical board said that after the price dropped in 2012, the board started using continuous query for all its doctors to ensure the board had the most up-to-date information.

Massachusetts, Nevada, Oregon, South Dakota, Vermont and Wyoming have also enrolled thousands of their doctors in continuous query.

More work

The Florida medical board said using continuous query is less work for staff than running thousands of individual queries.

But it can create more work in other areas. The Florida board gets an average of about 100 alerts a month about its doctors from the federal database.

Each one of those has to be examined and in some cases investigated independently. If the board decides a disciplinary hearing is in order, that triggers a legal process that can potentially take months.

Carome said it’s possible that some medical boards don’t use continuous query because they already have their hands full investigating complaints submitted by doctors’ patients or co-workers. But he said that if that’s the case, they’re not doing their job.

“To knowingly blind yourself to that type of information makes no sense and is certainly not in the interests of protecting patients,” Carome said. “If resources are a problem… then the state needs to provide additional resources so that the state medical board can fulfill its obligations.”

The Missouri board has lagged behind other states when it comes to getting problem practitioners out of circulation, allowing practitioners like Stone and Rosenschein to keep their licenses long after other states had revoked them.

Stone’s Kansas license was revoked about six months before he gave up his Missouri license and Rosenschein remained licensed in Missouri more than two years after New Mexico revoked his license.

The board still hasn’t acted on the license of Brian Lahey, a psychiatrist from Overland Park whose Kansas license was suspended on an emergency basis for drug use in July 2018 and then was suspended indefinitely in April for having sex with patients.

Then there’s Jain.

Jain had negative marks in Kansas (where he was denied a license because he got dismissed from his residency program and wasn’t truthful with the Kansas board about why) and California (where he had to surrender his license for undisclosed reasons) when he was granted a probationary license in Missouri in 2016.

Within a year of getting his license, Jain was charged with sexually assaulting two patients at the St. Louis County pain clinic where he worked.

He pleaded guilty and in early January was sentenced to 30 days in jail and five years probation. Jain, who went to medical school in India, agreed to leave the U.S. as part of his plea deal.

The Missouri board revoked his license to practice medicine in May, about 18 months after the criminal charges were filed.

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.
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