Posted on: Friday, April 20, 2001
Hawai'i criticized in disciplining of doctors
By Beverly Creamer
Advertiser Staff Writer
Hawai'i has been slammed by Ralph Nader's national watch-dog group for being "one of the worst states" in the nation for failing to be tough in pursuing disciplinary actions against doctors.
In its highly critical report, Public Citizen's Health Research Group puts Hawai'i third from the bottom in the number of disciplinary actions taken by the state medical board against dangerous physicians.
The reports notes that this raises questions of whether patients are being protected "from physicians who might well be barred from practice in states with boards that are doing a better job."
According to the report, Hawai'i takes 1.33 disciplinary actions per 1,000 physicians, compared with 12.43 disciplinary actions per 1,000 physicians in North Dakota, the state ranked highest.
The woman who runs the state's Regulated Industries Complaints Office says the criticism is partly justified because of flaws in the state oversight system
"I certainly agree that our ranking is too low," said Joann Uchida, who heads RICO, the state agency responsible for oversight of 46 different state boards and commissions.
However, a prominent physician maintains that the state's impressive peer review structure limits the need for disciplinary action and offers patients a high standard of care.
Dr. Don Parsa, the plastic surgeon who chairs the Hawai'i Medical Association's peer review committee, said the ranking is low because Hawai'i's comprehensive set-up of peer review in hospitals, and by county and state medical associations, weeds out those who may be a danger long before formal disciplinary action is necessary.
"Policing is so good at different hospitals in our state that physicians know they are accountable for their practice to their peers," said Parsa. "We're very strict in our evaluation of our peers. They're rated and this goes in their records."
If sanctions are necessary, he said, hospital privileges may be suspended and this is automatically reported to the Board of Medical and Osteopathic Examiner's office.
However, at the state disciplinary level, Uchida said there has been difficulty in the year and a half she has headed RICO, finding medical professionals willing to serve as advisory committee members and put themselves in the pool of those reviewing the often voluminous records to check for a violation.
"We've had some difficulty getting people to volunteer," she said.
Often medical experts don't have the time to do it, she said, or don't want to testify at an official proceeding that may grow out of their review.
"Some may look at the record and change their mind about testifying," she said. "For a variety of reasons they don't want to speak out against their fellow professionals."
Under Hawai'i's system advisory committee members are not paid for their work in reviewing cases that have come to RICO for investigation.
"We certainly recognize this is a problem and we're trying to take a logical approach," said Uchida. "First we're trying to work within the framework we have, and if we can't, we'll look at changing the law." She suggests looking at paying the experts who review these cases.
Uchida said 86 investigations were conducted last year by RICO's 19 investigators throughout the state. Of those, 56 cases were dropped; 5 resulted in disciplinary action and 25 are still pending.
"It is likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistent top performances," the report said.
Dr. Sidney Wolfe, who formed the consumer watch-dog group 30 years ago with Nader, said from Washington that over the past few years Hawai'i has consistently been one of the worst states in the country for its low number of disciplinary actions.
"There's not a shred of evidence that Hawai'i's physicians are better than anywhere else," he said. "The only evidence to explain why there are differences is the boards do a better or worse job."
Parsa disputes that, and so does Stephanie Aveiro, executive director of the Hawai'i Medical Association who notes that there are several investigative levels within the state and county medical associations, as well as an "intervention" system to force doctors with substance abuse problems into treatment.
Parsa said that in his years of residency and practice in Hawai'i and other areas of the country, he has seen a high — if not higher — level of care in the 50th state. That validates results from the annual surveys done by the Hawai'i Medical Services Association (HMSA) that have included thousands of patients who generally give their physicians high marks.
In the year and a half Uchida has headed RICO, she said she's been revising the list of experts for the medical review process to find those truly willing to participate. It's a slow process, she said, but she hopes the efforts will make the system more effective.
And if there are continuing problems, Uchida said she will go to the Legislature and ask for changes.
"Over the past year we've been taking a hard look at that," she said. "Sometimes we don't have a specialist in the area locally so we have a very small pool of people to pull from. So we're looking at getting people from the Mainland, or to what extent we could use those from other areas of expertise."
The report only quantifies the number of disciplinary actions (license revocations, surrenders, suspensions and probation/restrictions), handled by the Federation of State Medical Boards. It does not include listings of private lawsuits filed against physicians, or a listing of investigations conducted by medical associations themselves.
In its self-policing efforts the Hawai'i Medical Association includes a series of investigative levels for complaints from patients. Aveiro said that while 4-6 complaints come in a month, "a lot of them are venting." No internal investigations were referred to RICO last year, she said.
"We try our very best at the HMA and County Medical Society to handle complaints at the very early level," said Aveiro.
