Medical agency aims to fix flaws

By Beverly Creamer
Advertiser Staff Writer

The state agency that investigates alleged misconduct in the medical profession is looking at new ways to overhaul a disciplinary system that has been criticized as failing to safeguard Hawai'i patients.

"We're trying to look at the variables — what's going on here," said JoAnn Uchida, complaints and enforcement officer with RICO, the Regulated Industries Complaints office that examines allegations of wrongdoing against doctors. "We put a task force together internally to do a lot of streamlining of the process, but unfortunately that hasn't translated into 2001 numbers we can be proud of."

In a national report released this morning by Ralph Nader's consumer advocate and watchdog group Public Citizen, Hawai'i ranked last in the nation in 2001 for the number of disciplinary actions taken by the State Board of Medical Examiners per 1,000 physicians. The previous year, Hawai'i finished 47th of the 50 states.

"The state boards should hold physicians to the highest standards," said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen. "If they're not, patients are vulnerable to doctors who are practicing bad medicine and endangering lives."

The advocacy group also today launched an online site for 13 states, including Hawai'i, that lists the names of doctors who have been disciplined by the medical board for incompetence, misprescribing drugs, sexual misconduct, criminal convictions, ethical lapses and other offenses.

The site lists the names of 98 doctors licensed in Hawai'i who have been disciplined under these categories since 1992. After 9 a.m. today there will be public access to the site at www.questionabledoctors.org.

Nader's group said that most of the Hawai'i doctors in the listing were not required to stop practicing, even temporarily.

Uchida said her records show that in the past 10 years, there have been 17 suspensions of doctor's licenses for up to two years, 20 license revocations and 57 cases that involved some other type of sanction, such as a requirement that the physician participate in a treatment program. In addition, there were 45 Hawai'i cases that involved monetary sanctions such as fines, she said.

The Public Citizen study points out that state medical boards that have adequate money and staffing, independent leadership and the power to undertake "significant investigations and follow through with discipline" are most likely to be effective.

Doctors and regulators in Hawai'i agree that the state's system has its flaws and may require legislative revamping. Some of the problems include:

• A lack of teeth in the Board of Medical Examiners itself, which has no investigative or enforcement powers. Those powers have been given to RICO which is responsible for oversight not just of the state's 5,630 licensed physicians — more than half of whom don't live in the state — but of 46 other state boards and commissions, a vast array that stretches investigators to the limit.

"That's where there's a holdup," said Dr. Gerald McKenna, president of the Hawai'i Medical Association. "RICO investigators are often overworked and they may not have the particular expertise ... I've seen (an investigation) take years."

• Limits to the authority of the Board of Medical Examiners and RICO and the limited nature of the sanctions that the board can use.

"The board doesn't always want to 'drop the bomb' with suspension or revocation (of a license)," Uchida said. "Reprimand or censure might be more palatable for the board. So we want to see if maybe giving more alternatives might be worth exploring."

• The statutory provision requiring a volunteer physician to review documents in each case. Of 110 cases in 2000, 19 were dropped for lack of evidence after review by a committee member, Uchida said.

"We don't know if we're not giving (the volunteer physicians) enough information or there's reticence on their part to come up with a recommendation that there's been a violation," she said. "Is it just a matter of human nature that they were uncomfortable being the one making the call?"

Constance Cabral-Makanani, executive director of the Hawai'i Board of Medical Examiners, is equally concerned.

"It would be more comfortable if there is a larger panel," she said. "Some physicians may be reluctant to make certain judgments against another physician or colleague. A lot of times RICO can only get one physician to review a case."

Uchida plans to ask the medical community to put together panels of physicians who might serve as reviewers of cases, rather than having such review fall on individuals.

Reach Beverly Creamer at bcreamer@honoluluadvertiser.com or 525-8013.