Physician discipline in Hawai'i needs reform

It's possible to argue that Hawai'i's dead-last rating among the 50 states for discipline imposed on wayward doctors is simply an artifact of our first-rate medical system here.

And surely, one can hope that the generally high quality of our medical professionals is one of the reasons so few of them receive discipline as compared with national averages.

But the numbers are so out of whack with national averages as to support the contention by consumer advocacy group Public Citizen that Hawai'i citizens are not adequately protected against incompetent or impaired physicians.

Discipline rate lowest

Across the nation, the average discipline rate (serious disciplinary actions per 1,000 doctors) is 3.36. Hawai'i's rating is 0.80 per 1,000. That's the lowest among the 50 states.

A partial explanation may be that Hawai'i has an unusually large number of doctors licensed here who do not practice in the Islands on a regular basis ("snowbirds") or physicians who keep their Hawai'i license alive even though they have moved to the Mainland to work.

Still, that cannot completely explain away the statistical disparity.

One indication that the problem is indeed under-discipline is the reaction of the state agency charged with investigating misconduct. According to a spokesperson for the Regulated Industries Complaints Office (RICO), there may be a push at the Legislature for changes to the way medical discipline cases are handled.

Although Hawai'i does have a Board of Medical Examiners, the board lacks teeth. Investigative and enforcement powers are held by RICO, which has to deal with some 47 state licensing boards and commissions, including licensed physicians.

And the RICO staff has no particular medical expertise. When a case comes forward, it must be reviewed by a volunteer outside physician. These volunteers do not always have the time to make a thorough review or may be reluctant to be singled out as the one who proposes sanctioning a colleague.

Among the changes that should be made is to give the Board of Medical Examiners greater powers to order its own investigations, which could then be doctor-driven. And its disciplinary powers should be broadened.

Wider power needed

One key change needed is to give the board the power of intermediate sanctions that are short of suspension or revocation of a license. Today, it is almost all-or-nothing, and some board members might be unwilling to invoke the ultimate sanction when lesser discipline might suffice.

It is clear that Hawai'i has its work cut out for it as it updates and modernizes its discipline procedures. It is not necessary to completely accept Public Citizen's contention that the public is poorly protected in Hawai'i to demand changes.

And it should be local physicians and other medical professionals who lead the charge for reform. Surely, the vast majority are competent. A more vigorous, transparent discipline system would greatly increase public confidence in that caring majority.