The North Carolina Medical Board And The Myth Of Their Most Excellent Self-Regulation

In anticipation of "Part 3" of the series I'm currently churning out . . . telling my story straight from documents in the legal files . . . I wanted to address a recent article in the North Carolina Medical Board's Quarterly "Forum".

The article, a self-congratulatory piece penned by NCMB President, George Saunders, III, M.D., is from the 4th Quarter 2008 edition, linked here. Dr. Saunders is an Oak Island Family Practitioner, appointed to the Medical Board in June 2003. He's been President since November 2008.

Before we start, let me give you some background. The "Forum" is an interesting little publication sent out to all licensed physicians in North Carolina four times a year. It features a variety of articles - usually on "rules changes" and or CME to understand the rule changes. Medical Board position statements are published at least once a year (in this case, it was in the issue I'm linking), and disciplinary actions (annulments, consent orders, denials, dismissals, revocations, suspensions, surrenders, etc.) bring up the rear.

The disciplinary actions are particularly fascinating/even entertaining . . . most them them about sex (i.e. inappropriate relationships with patients), drugs (narcotic & controlled substance addiction/abuse) and alcohol (DWI's). There's not much "rock & roll" (i.e. real discipline meted out for actual medical malpractice).

More "public letters of concern" (about substandard care or inadequate record-keeping) are published now than used to be - but I suspect those letters do begin to touch the surface of the clinical complaints the Board fields.. Occasionally someone is clocked hard because they failed to remember to pay the Medical Board money to renew their license. I've never thought that should warrant a public whipping or file (compared to the things I've encountered on the road that do), but what do I know? I don't go to all the fancy meetings.

I had actually planned to talk a little bit about the Board's legal and investigative resources, but I think that was covered here;) Since sending that e-mail and putting up that post, the N.C. Medical Board is suddenly very interested in this blog.

It's only taken four years.

We will proceed with Dr. Saunder's letter (in blue). I will comment as we go along in red.

Sayeth the President of the NCMB (addressing his rank & file):

I am thrice blessed. I am blessed to be a physician, a practitioner of the healing arts. I am blessed to practice in the state of North Carolina where physicians are still held in high regard.

Sayeth Steve Eblin, Vice President of Randolph Hospital: "Good Pediatricians are a dime a dozen."

I am blessed to have been nominated by my peers and appointed by the Governor to service on the North Carolina Medical Board - a Board which is among the finest in the country, and which protects its citizens yet treats physicians humanely and fairly.

Yeah, sure.

I meant the words that appear above when I spoke them to physician colleagues at a Medical Board dinner in 2007. Today, I feel even more strongly that I am blessed, in part because of my experience at a recent professional meeting.

In October 2008, I represented the North Carolina Medical Board at an international conference on medical regulation. The theme of the conference was professionalism, a term that had many meanings in the context of the conference and indeed in the practice of medicine. The purpose of the trip was for a member of the Board to see we could learn from other countries that are at similar and dissimilar places in the regulation of physicians.

The subject of physician professionalism always rankles me - especially in terms of the very unprofessional treatment I got at the hands of RMA & Randolph Hospital executives. The Medical Board sets standards of behavior. Doctors are supposed to jump through every hoop . . . and are accountable to the Medical Board if they do not. But in our increasingly corporatized environment, physicians can be put into HORRIBLE situations by administrators . . . situations that put their livelihoods or licenses in jeopardy (as mine did) . . . and those administrators seemingly answer to no one. Employed physicians and/or doctors in public service are especially vulnerable, and can be treated as if they are property.

Moreover, over the last few years, hospital-fueled cottage industry called JCAHO has placed more and more emphasis on identifying and eradicating the "disruptive" physician, without really addressing any of the causative issues.

The few protective laws we do have are not enforced.

The North Carolina Medical Board and North Carolina Medical Society have known this was a problem for a very long time . . . and has done NOTHING to address it.

If/when I file a lawsuit, expect it to be about that. And I will not settle until the law is enforced.

Having attended a number of Federation of State Medical Board meetings during my tenure, I knew that North Carolina is a national leader both in the protection it affords to its citizens and for the fair manner in which it regulates its physicians. I always come away from these meetings with new ways of thinking about the job we do. I felt confident the international conference also would prove useful.

Again, this statement just rankles. I have personally seen a number of situations (not just the ones I've blogged about) in which the only thing standing between a "bad" or impaired doctor and a patient is another doctor willing to step up and go above/beyond. Usually, it is the doctor who goes above and beyond who gets burned.

I don't think the way the execution debacle (i.e. let the ethics of the profession be slowly eroded way until the Board is forced into a corner and has to make a stand) demonstrates new ways of thinking. I don't think the Board's handling of the Mel Levine case (in which there most certainly should have been a public hearing) demonstrated anything but the same/tired, "cover-our-collective-ass" mindset".

I was struck by the undercurrent of loos that permeated the meeting. Doctors in many other countries felt that they had lost the regulation and control of medicine. While your medical board if comprised mainly of physicians, lay people hold a majority of board seats in many other Anglophone countries. The lay board members present were forthright, even strident in their positions. Some of these positions were well intentioned but misinformed. A number of formal presentation, ans the informal conversations that occurred between sessions, confirmed my unease with government-run regulatory systems.

This was such an "ivory tower" statement. This Medical Board does not know anything about real physicians on the front lines and "loss". They have not wanted to know. In my case, they have determinedly and methodically avoided knowing - or doing. Moreover, you don't have to go outside the state of North Carolina to find doctors cowering in fear (or sucking up) to powerful outside cliques. The Medical Board has allowed lay people to control hospitals in this state for years.

Nowhere could you find a more medically "un-informed" Board of Directors than the one that runs Randolph Hospital. Two executives lead a bunch of hand-picked mill-town bosses (and one or two "most-favored" doctors) around by the nose.

In that time, they've built fancy/expensive ER's and cancer centers, while driving primary care doctors out-of-town. "Good Pediatricians are a dime-a-dozen" (I mean my God, how can the misanthrope who uttered that statement still be employed as a hospital adminstrator?). The corporate salaries go sky-high (feel free to look them up), while nurses are laid off and doctors struggle to survive. It's just wrong.

And no one can understand why medicine is in "crisis".

On returning to North Carolina, I was grateful to be home. I felt grateful - truly blessed - to practice medicine in the United States. Listening to my brother and sister physicians from abroad, I realized that physicians in the United States are fortunate. For the most part, are trusted to uphold the best interests of their patients.

We may well be trusted to uphold the best interests of patients. And indeed, I thought that was part of the job description. But when a Pediatrician in Asheboro put the best interests of a dying infant before her own eleven years ago, she was kicked to the curb.

And shortly after she was kicked to the curb, when she was asked to do it again, she absolutely could not risk it.

And the *&^%$#@! lawyers still had the cheek to try and paint the box she was put in - by people who were not doctors - as her fault!

Meanwhile . . . oh hell, I'm so tired of it.

In other countries, where medicine is regulated by lay people, physicians do not enjoy this type of public trust. Often, there have been high profiles cases where physicians-led regulatory bodies did not adequately protect the public and patients suffered or died. The price of those lapses was the loss of self-regulation.

Back to my first "Yeah, sure", patients don't die from unaddressed bad medical behavior in North Carolina?

How close are we to losing self-regulation in North Carolina? In my opinion, we are closer than some might think. A few years ago, after some very public lapses here, the Board faced both a lawsuit and proposed legislation that would have, in my opinion, gutted the Board. We could have ended up with a Board dominated by political appointees or physicians handpicked by special interest groups. Instead the Board stepped up and proposed alternative changes and legislation that gave greater public protection while preserving physician regulation of medicine. Even with all of these changes - changes that benefited the citizens of North Carolina - we can still lose the authority to self-regulate.

I am not entirely certainly what legislation Dr. Saunders is referring to, but if it's the changes in the Medical Practice Act I blogged about here, I really don't see the big deal. From the cheap seats, it looks like the Medical Board compromised and painted itself even more into an isolated corner.

As for the "lawsuit" he's referencing, I'm not sure if it's this one or this one. In one instance, a doctor had had enough of the mealy-mouthed double talk (the point I am very much at now), and in the other case a patient's widow wanted answers - and did not get them - even after settling with the Board.

The best way to ensure that we retain the privilege of policing ourselves is to do such a good job that no one else could do better.

Let me be very clear, Dr. Saunders, in the case of Dr. Mary Johnson . . . a physician in public service who went above & beyond eleven years ago to help a critically-ill infant being badly served by another one of your licensees (standing up to threats to do it) . . . a physician who was professionally crucified for it, THE NORTH CAROLINA MEDICAL BOARD HAS BEEN ASLEEP AT THE WHEEL.

And the argument you're putting forth is that no one else can do better? Are you fricking kidding me?

I've lost count of the people who've asked me what in the hell is wrong with the Medical Board . . . why did they so determinedly let me swing?

Many physicians are offended by the new world order that demands that duly licensed medical professionals submit to intense public scrutiny and greater disclosure. We gnash our teeth and talk about the "good old days" when physicians were honored and respected, almost without question.

What actually offends me is the old world order - an order of good names and mill-town cliques in which I could be sacrificed to the "go-along-to-get-along" collegiality gods and no one in "the order" (translation, "the right people") even blinked.

In fact, I would not be surprised to be targeted shortly . . . as Rachel Hunter recently was.

But step back for just a moment. Are we any different from our patients? Are we not suspicious of the car mechanic who says that our vehicle needs a major repair/ Don't we want a second opinion on the cost of the new addition to our house? Why shouldn't our patients want more choice, more information? How many of us would allow a relative stranger to perform surgery on us without making a few phone calls first?

The public has lost all faith in the profession because we let our own greed get the best of us . . . and handed it all over to the suits . . . and the lawyers. Doctors don't run this Medical Board. Lawyers do. In all of my communications with the Board over what happened in Asheboro, I've gotten several letters written by lawyers and signed by doctors, but I've yet to meet face-to-face with a Doctor.

But I have chatted up a great many lawyers. And I never got a straight, honest answer about anything.

At a dinner not very long ago where I believe that I and fellow Medical Board members were on the menu as the main course (I say this only half-jokingly). I state that we are fighting over the choice of wallpaper when our house is burning down.

I know all about being "lunch".

As physicians, we can argue till are blue in the face about the value of malpractice information. We can squander political capital and good will fighting over changes that will not affect 95% of physicians and will have a negligible effect on the other five percent. Or, we can work to change the things that really matter, such as reforming a payment system that values procedures and sickness over prevention and health and reversing the ongoing loss of primary care practices (the backbone of all medical care) that are declaring bankruptcy daily and threatening to implode the entire health care system.

Speaking as someone who has languished in that 5 percent of physicians with "problems" the North Carolina Medical Board has not been willing to fight for, I gotta say, that reasoning is weak. Because we are supposed to stand for the weak, the sick, the lost.

And, heavy sigh, in the end, it all comes down to money doesn't it?

As our health care system continues to fail, continues to leave our patients without adequate care, we need to consider our every action and every lobbying effort very carefully.

Maybe the North Carolina Medical Board just needs to stand for the things that speak to the nobility of the profession and let the chips fall where they may. In fact, Dr. Saunders, if the Board finally did stand for something, more chips might fall your way. Even if you lose, you can hold your head up after the fight.

Medicine will be regulated. The only question is, by who?

Again, from the cheap seats, maybe we need new blood . . . and more doctors as opposed to lawyers.

I'm tired of thinking and linking. This one's going up.

Next up, Part Three.