BOSTON Massachusetts is a national leader in medicine. However, the state is now falling behind in disclosing physician performance.
Northeastern University’s Initiative for Investigative Reporting has found that the state medical board has omitted or removed thousands of embarrassing records — including some criminal convictions — from its physician profile database.
A lead reporter on the story, Callum Borchers, joined WBUR’s Weekend Edition about the findings.
Sharon Brody: Cal, in your reporting you came across the case of a Massachusetts doctor named Mary Ames-Castro and — although she’s no longer practicing in this state — tell us why she’s part of the story.
Callum Borchers: Ames-Castro is an interesting case because she was found liable in one of the largest malpractice cases in our state’s history — a $24 million judgment in Suffolk Superior Court back in 2005. But it was never entered on her physician profile because she had allowed her license to expire. Just after she was sued by the family — what happened in the case, by the way, was she was an obstetrician. She delivered a baby who had irreversible brain damage because she had used a vacuum extractor to pull the baby out. That was never entered on her profile because she no longer practiced in Massachusetts. She had gone off to Wisconsin, she has since left Wisconsin and gone onto Oregon, and because she left, the physician medical board deleted her profile.
Is that standard practice?
Absolutely, that’s standard. Anytime a doctor leaves the state, it could be because the license just expires, it could be because the medical board takes away the doctor’s license. But in either case, that profile is no longer visible.
And you found that is not an isolated judgment? Could you describe some other cases you uncovered involving doctors in Methuen, in Springfield?
Sure, in Methuen the doctor you’re referring to is Dr. Salah Abbas. In his case, he was convicted of indecent assault — he assaulted one of the nurses who worked at his practice. And he too allowed his license to lapse before he was actually convicted. By the time that prison sentence was going to go on his profile, there was no profile to put it on.
So this is not a bug — this is a feature. This is the way the system was designed to work. Why?
You have to remember that Massachusetts was the first state in the country to introduce any type of database like this. At the time, there was really no precedent. And so when Massachusetts lawmakers were debating how to do this, they got a lot of input from doctors and medical board officials and the Mass. Medical Society supported the legislation but they also wanted some disclosure limitations.
For instance, if you have a malpractice payment or the board suspends your license but eventually you get it back — that information is erased after 10 years go by. The thought is, “It’s old. It’s not really relevant anymore. The public doesn’t need to know about it.”
Or, as we mentioned before, if you leave the state your profile should come down. The argument is that maybe patients would be confused by having former licensees in the database.
But now, that’s not the way other states do things. Almost every other state in the country leaves all that information there. The idea is, “Let’s disclose it to the public and let them decide whether it’s relevant or not.”
Some of these shortcomings are actually codified by law. So the 10-year posting limit, that is in state law.
There’s another gap. If a doctor works at a hospital and the hospital takes away his clinical privileges for a time, that will appear on his profile. But what happens in any other health care setting – a nursing home or a private clinic – it’s not going to go on his profile. And that’s also because the law is narrowly worded; it only refers to hospitals.
And yet a large majority of the care offered to patients happens outside a hospital setting.
Absolutely. The state’s medical board executive director Stan Riley actually suggested to us that about 80 percent of health care in Massachusetts is administered outside of hospital settings. And so the board acknowledges that that is a big hole in the profile’s legislation. So you ask, “Why haven’t things change?” In that case, the board actually shares the frustration of other people that this information should be disclosed to the public.
But on some other things, the board is actually very much in the same camp as the original lawmakers. For instance, the 10 year posting window. They argue that that’s plenty of time — if nothing has happened to a doctor in 10 years, really that indicates that the doctor is pretty good.
Does the state medical board have any plans to change its existing policies in a way that would make doctors’ complete backgrounds accessible to the public?
As I said, there are some of these disclosure limitations that they fully support. There are others that they seem frustrated by and would like to change.
One is this loophole for non-hospital discipline, and that’s something they have pushed for. In fact, last summer, they actually tried to post a disciplinary action against a doctor from his nursing home on the profile. But the doctor made a stink about it, he was supported by the Mass. Medical Society, and they had the law on their side. So the board backed down.
There is an amendment before the legislature right now that would change the definition of that law and would broaden it to all health care facilities.
Cal, in your research, have you come upon anything that you think could change relatively quickly and simply to improve the system?
The easiest thing would be to leave the profiles of former licensees in the database. And I say that because that’s something that would not require a statutory amendment. Some of the other things we talked about are codified by state law and so the medical board is right when it says, “That’s beyond our control. We would have to wait for the legislature to change that.” That would probably be the easiest thing to do first.
The other, of course, would be to begin complying with the law and posting out-of-state discipline as well. They’ve said that is not an easy thing to do — to make sure it’s accurate from every single other state — but they’ve had 16 years to figure it out and they’re required by law to do it.