California State Medical Board seeks sweeping reforms to discipline bad doctors

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Melody Gutierrez, Brittny Mejia, Jack Dolan and Kim Christensen / Los Angeles Times (TNS)

Long under fire from patients and consumer advocates, the Medical Board of California is calling on lawmakers to pass several sweeping reforms to help it discipline bad doctors, including lowering the standard of evidence needed to prove cases .

In an 11-page letter and memo sent to legislative leaders this week, council officials also called on them to increase the wait times for doctors to seek reinstatement of their revoked licenses. The council is also calling for an increase in physician licensing fees, its main source of income.

“We hear from people every day about the impact the board has on their lives,” President Kristina Lawson said in an interview on Friday. “These proposals were made because we listen, we want to improve, these proposals will help us improve and we need the help of the legislature to improve.”

Lawmakers have said they welcome the recommendations and will consider them as they begin to introduce bills during the legislative session that began on Monday.

Previous efforts to push through major reforms have been hampered by the California Medical Assn., The powerful physician lobby, which has struggled to suppress past license fee increases and measures to strengthen the council’s disciplinary powers. . On Friday, without committing to specific proposals, the association’s president, Dr Robert E. Wailes, pledged to support reforms that protect the public.

“To protect patients and the sanctity of the physician-patient relationship, the Medical Board of California must have a strong and robust licensing and discipline process,” said Wailes. “We look forward to working with the Board of Directors and the Legislature to make the right and necessary reforms that put patient safety first. “

This was good news for lawmakers who opposed the doctor lobby.

“If the California Medical Assn. is ready to sit down and work on comprehensive reform, I am ready to do it, and I am ready to do it now, ”said State Senator Richard Roth (D-Riverside), President of Business, Professions and Economic Development Committee, which oversees licensing boards. “But we can’t deal with these issues piecemeal, and that’s been imposed on us in the past.”

Patients, consumer advocates and some lawmakers have long argued that the board is lenient on bad doctors and is failing in its primary mission of protecting the public.

A Times investigation last month found that since 2013, the board has reinstated 10 doctors who had lost their licenses for sexual misconduct. They included two doctors who abused teenage girls and one who beat two female patients when they reported him for sexually exploiting them.

In July, The Times found that the board of directors had systematically allowed doctors accused of negligence to continue practicing and harming patients, sometimes leaving them dead, paralyzed, cerebral or lacking in limbs.

In previous interviews, Lawson has defended the panel as being “dedicated and committed to protecting California consumers” while acknowledging that it has “room for improvement.” She said the board is bound by rules and regulations that complicate efforts to weed out bad doctors.

The council’s recommendations include changing the standards of evidence to make it faster, easier and less expensive to discipline physicians, according to executive director Bill Prasifka’s note outlining the panel’s legislative demands for 2022.

Under current law, the board must provide “clear and convincing evidence with reasonable certainty” that disciplinary action such as public reprimands, probation, suspension or revocation are warranted.

This is a lower burden of proof than the “beyond a reasonable doubt” standard in criminal prosecutions. But that’s a higher bar than the “preponderance of evidence” in civil litigation, which requires a greater than 50% probability that an allegation is true.

Medical boards in 41 other U.S. states and territories apply the standard of preponderance, according to the memo.

“As a result, California lags behind most other jurisdictions, making it more difficult, longer and more expensive to prosecute unprofessional conduct cases in that state,” he said.

Lawson said the board “really spent some time thinking about whether it made sense that we were required to meet a higher burden of proof in California” than similar panels elsewhere. .

“The council as a group concluded that we wanted to raise this issue and we wanted to seek parity with other councils across the country,” she said in the interview.

The council’s recommendations would also extend the waiting period for doctors to seek the return of revoked licenses from the current three years to five – a move Lawson reported in a previous interview with The Times after reporting questionable reinstatements.

“So while this is not an outright ban on reinstatement, it is a further limitation on their right to petition,” she said in the previous interview.

The council also requested new application fees from doctors seeking reinstatement, to cover the costs of the procedure. In the last fiscal year, the board spent nearly $ 1 million in litigation and hearing costs, with no mechanism to recover those costs, according to the memo.

The council’s recommendations would also improve reporting of physician misconduct. In addition to the reports currently required by health and educational institutions, the council calls on medical groups, health insurance providers, temporary recruiting agencies and others to report any misconduct.

The council memo resurrected earlier demands to increase its funding and change its membership to eight physician members and seven non-physicians known as “public members.” For years, reformers have demanded significant increases in medical licensing fees and a shift in the balance of the board towards a majority of members of the public, in the hope of securing more patient-friendly decisions in disciplinary cases. .

Such measures in the past have been rescinded amid vehement opposition from the lobby of deep-pocketed doctors.

Longtime board critics have greeted the new recommendations with both skepticism and cautious optimism.

“The medical board that makes these recommendations is one thing,” former State Senator Jerry Hill (D-San Mateo) said. “The medical commission that pursues and advocates these changes is another. “

During his time in the legislature, Hill fought for three years to pass a law requiring doctors on probation for sexual misconduct and other violations to notify patients. Hill said the Medical Council is often as much of a barrier as the doctor lobby.

“In many cases, we found that the Medical Board sang the same tune as the California Medical Assn. Hill said. “So if the medical board takes a strong position and communicates it clearly, that would help. “

State Senator Melissa Hurtado (D-Sanger) said she was surprised to receive the council’s legislative demands, as she planned to introduce her own reform bill in the coming weeks. Hurtado said the board’s recommendations show the agency needs to be overhauled to fulfill its core mission of ensuring patient safety.

“This is an important first step for the medical board, but there is so much work to be done,” Hurtado said. “I appreciate their contribution, but I also have mine. We have so many cases that have come out of the town of Bakersfield, which I represent, and it’s something that is personal to me. “

Marian Hollingsworth, co-founder of the patient safety advocacy group, the Patient Safety League, said she was “a little stunned” by the board’s recommendations. In the past, she said, board officials have told advocates that it is up to them to push for legislative reforms.

“I don’t know if it’s the desperation or the panic or the realization that because of the LA Times stories they are in a very bad position in terms of public relations,” she said. “Their reputation is really at stake.”

Hollingsworth said she was encouraged by the requested change in the standard of proof and hopes it may lead to “better patient protection.” It is not completely sold.

“I’ve learned not to be too excited because I know things can change,” she said. “It will be interesting to see what happens. I don’t think a lot of lawmakers really know what’s going on with the Medical Council that they’re supposed to regulate. “

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