The state Medical Examining Board ranked 37th in the nation in the annual rate of serious disciplinary actions the board took against physicians accused of wrongdoing from 2017 to 2019, according to a Public Citizen report issued earlier this year.
Connecticut’s board averaged about 13 serious disciplinary actions a year in 2017, 2018 and 2019, according to Public Citizen. The rankings are based on the number of serious disciplinary actions taken by states per 1,000 physicians. Connecticut’s rate was .65 per 1,000 physicians compared to Kentucky, which had the highest rate of serious disciplinary actions at 2.29 per 1,000 physicians, the report said. Public Citizen defines a “serious disciplinary action” as one that has a clear impact on a physician’s ability to practice.
The medical boards, which oversee the discipline of physicians in all 50 states and the District of Columbia, are largely unfunded or under-funded, are not adequately staffed, are reactive to complaints rather than initiating proactive investigations, and have little oversight by state officials or legislators, the report said.
“They are not doing what they are mandated to do,” said Dr. Sidney Wolfe, founder and senior advisor of the Public Citizen’s Health Research Group and one of the authors of the report. “So, what is happening is they are leaving tens of thousands of patients exposed to doctors who shouldn’t be practicing.”
Complaints filed against physicians in Connecticut can take months and sometimes years to investigate and adjudicate. In one recent case, a psychiatrist was allowed to practice while a 2018 complaint was investigated and discipline negotiated on allegations that he had failed to monitor a patient on Lithium and failed to keep the patient’s records during the period under review. His case was settled in June with a $10,000 fine and 18 months of probation.
Attorney Kathryn Emmett, the chair of the Connecticut board, said that the Public Citizen report doesn’t reveal the whole picture. Emmett said she couldn’t speak for the entire board but noted that comparing states by the number of disciplines issued wasn’t the best way to assess their effectiveness.
“I think that the idea that the greatest number of serious disciplines can be used is faulty,” Emmett said. “I don’t think it shows whether the board is accomplishing its goal of protecting the public.”
But at least two public members of the board share the national advocacy group’s concerns. Jean Rexford, who has been a board member for more than a decade and founded the Connecticut Center for Patient Safety, told the board during its May meeting that she wanted to look at whether it was doing enough to address the safety of the public.
“I think the legislation that chartered us was many, many years ago,” Rexford said. “Is it time to take a look at that and bring it up to 2021? Do we need to have better consideration of transparency? I’ve been feeling incredibly powerless on Zoom [where the meetings are now conducted] but also powerless in our role in protecting the public,” Rexford said before suggesting that a committee of board members examine “how we could keep current and do a better job.”
Rexford’s comments prompted the creation of a working group, which met in private for the first time on Sept. 28. The state Department of Public Health (DPH) contends that the meetings are administrative and not open to the public. The Connecticut Health Investigative Team has filed a complaint with the state’s Freedom of Information Commission on the denial of access to the working group meetings.
Med Board’s composition and role
The med board’s composition—which includes physicians, attorneys, and public members—and its duties are laid out in a decades-old law that has been periodically updated. The board has no funding and no staff of its own. Any fines collected from disciplined physicians go into state coffers. All staff members are DPH employees who also deal with complaints against other professions. The board has no independent investigatory or policy-making powers, according to the statute.
The DPH’s Practitioner Licensing and Investigations Section reviews complaints filed against physicians. The same investigators deal with complaints filed against dozens of other professions, including nurses, hair and nail salons, and veterinarians.
There are 18 full-time investigators within the unit who work on 1,200 to 1,500 complaints a year, said Section Chief Christian Andresen. There is also a hearing process for physicians who contest the charges. The agency receives about 450 complaints about physicians a year that result in an average of 43 disciplines a year, DPH officials said.
The DPH hires medical consultants to determine if a physician facing a complaint has met the standard of care or has participated in activities that could be harmful to patients, Andresen said. The range of complaints that come before the medical examining board includes physicians practicing while under the influence of alcohol or drugs, physicians failing to diagnose serious illness accurately, physicians practicing with a serious mental illness, or physicians prescribing to patients without adequate oversight or controls.
Michele Jacklin, a public member of the med board, said the board is “impotent and toothless” compared to medical boards in other states. “Other boards have budgets, publish newsletters and conduct seminars,” Jacklin said during an interview. “The Connecticut Medical Examining Board is totally reactive.”
Jacklin’s concerns range from no orientation process for new board members to the range of fines that can be issued as a discipline, she said.
“Other states routinely issue fines as high as $50,000,” Jacklin said. “In Connecticut, often the penalties are $1,000 to $5,000, which is a slap on the wrist for a physician.”
State statute limits the fines for physician discipline to $25,000.
There are no staff members who can monitor state or national medical issues that may arise, including checking social media for state physicians who are spreading misinformation on COVID-19 vaccines, officials said.
Although a DPH spokesperson said the agency would investigate all complaints related to misinformation about COVID-19, it took more than five weeks for Andresen to act on an anonymous tip that a retired Durham physician was issuing fraudulent exemptions for COVID-19 vaccines and masks to anyone who sent her a self-addressed stamped envelope, documents showed.
Since the complaint against Sue McIntosh was made anonymously, it took five weeks to “triage” before it was presented to Andresen to investigate, DPH officials said.
The board unanimously voted to suspend McIntosh’s medical license on Sept. 24. A few days later, the DPH alerted all long-term care facilities in the state, which require staff to be vaccinated, to review their employees’ COVID-19 vaccine exemptions to see if McIntosh had signed any.
The DPH has declined to provide any information on whether McIntosh had given exemptions to long-term care employees or any state employees, who are also mandated to be vaccinated against COVID-19. The board unanimously agreed to drop the charges against McIntosh last week after she voluntarily relinquished her medical license.
Under the current system, board members have no idea how many complaints have been filed, the substance of the complaints, or how many complaints have been dismissed, Jacklin said. “The discipline is negotiated by DPH attorneys and then what comes to us is a consent order,” she said. “We basically can’t ask any questions or get any other information other than what is in the consent order. All we can do is reject the consent order or rubber-stamp it.”
In general, the board focuses on approving disciplines that educate and monitor physicians so that they improve and provide better care, Emmett said. “I don’t think there’s good data to support that more discipline results in better care for the community,” Emmett added.
But the board could be doing more to protect the public by providing orientation for all board members and by being kept up to date on state legislative happenings and national policy changes, Rexford and Jacklin said.
Rexford said other state boards moved to pass legislation based on a national workgroup report on physician sexual misconduct. “I just feel as if we are missing the boat when I hear that and when I see what other groups are doing,” Rexford said. “At the very least, I would like Chris [Andresen] to attend meetings, I would like everybody to attend an orientation and I would like to feel that we were all working as a team.”