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Wed October 23, 2013
How A Flawed System Of Reviewing Medical Complaints Puts Floridians At Risk
Medical professionals in Florida hang onto their licenses and continue practicing as the state grapples with a lengthy disciplinary process that can take years, according to an analysis by the Florida Center for Investigative Reporting.
Between 2010 and 2012, it took the Florida Board of Medicine an average 434 days to resolve charges of misconduct against doctors, physician assistants and anesthesiology assistants, according to Florida Department of Health records.
Elsewhere, states complete similar investigations in significantly less time. In Texas, it took an average of 282 days to resolve a complaint in the third quarter of this year. In California, the rate was 264 days for its 2012 fiscal year.
The Florida Department of Health, which licenses medical professionals in the state, declined to make anyone available for this report.
The reason for the drawn out action in Florida is due in part to decreased funding for the state’s health department, which still reels from a $55.6 million budget cut in 2011. The cuts, some contend, result in overwhelming caseloads for lawyers investigating complaints.
Others say low pay at the health department has led to too much turnover. Pay for board of medicine attorneys ranges from $52,000 to the low six-figure range, according to state records.
“It’s a revolving door of lawyers there because they are paid so poorly,” said David Spicer, a Palm Beach County attorney who represents medical professionals in licensing and disciplinary disputes. “The public is at risk by this underfunding. It allows doctors to practice while their case is being looked into, when perhaps they shouldn’t be.”
A Process That Helps The Accused
Florida disciplinary actions between 2010 and 2012 include 55 suspensions, 30 revocations and 88 cases where a license was voluntarily surrendered, according to an analysis of records by the Florida Center for Investigative Reporting.
The state has the ability to move quickly when a doctor poses a public hazard. But nonemergency cases, the majority of complaints to the medical board, often drag on. Media reports in 2011 revealed Florida’s spotty record of policing poorly performing physicians. In response, the state established an Emergency Action Unit to review complaints.
Still, the unit has been unable to keep up with new complaints, and some of those emergency actions took over a year to complete. In its first year, the unit issued 287 emergency actions, primarily suspensions and several license removals. Last year, that number jumped to 500, according to the health department.
At the same time, the special interests of the medical profession are at play. The accused in Florida are sometimes accompanied to their medical board hearing by someone from the Professionals Resource Network, which in 2010 received a $5.4 million contract with the state Department of Health to assist medical professionals who have emotional health issues including addiction or mental disorders. The contract was renewed this year for $7.2 million.
Professionals Resource Network uses the same address on its tax filing as the Florida Medical Association, a trade group representing 20,000 physicians. The network also “contracts with them for accounting services and management of employee benefits,” PRN’s medical director, Penelope Ziegler, said in an email. She declined to be interviewed for this story.
Nationwide, delays in investigations of medical professionals have led to those accused of wrongdoing to hop from state to state. Because of the lengthy hearing process, doctors can move across state lines as charges in one state are neglected or undetected in another.
There is no national clearinghouse for sanctioned medical professionals available for the public to check on their own provider. In Florida, patients can research a doctor at the state’s Department of Health Web site. But a clear record doesn’t mean a clear past. Physicians who lose their license can apply for reinstatement, and doctors who are reinstated receive a new license number. If a physician gets in trouble again, the Department of Health records system makes it difficult to connect the two incidents.
The Federation of State Medical Boards, an association representing the 70 medical boards in the United States, used to make available data on the disciplinary actions. But the federation stopped posting the information this year.
When the data was available, consumer advocate group Public Citizen compiled it into an annual report to rate serious actions in each state. Florida ranked in the bottom ten of the list four times between 2001 and 2012, making it among the least active boards in the U.S. “It’s likely the state medical boards didn’t like how we were using the information,” said Dr. Michael Carome, director of the health research arm of Public Citizen.
A representative from federation, Drew Carlson, declined to be interviewed for this story, but said in an email that the data was removed amidst “Concerns expressed by boards about the FSMB report included that its almost exclusive focus on medical boards’ disciplinary actions was not representative of the broad range of activities medical boards engage in to protect the public. “
Beating The System
Two of every five medical professionals in Florida are licensed in another state or states, according to the Federation of State Medical Boards. The system is a mish-mash of reportage, wherein state health boards and hospital systems report disciplinary actions to large national database, called the National Practitioner’s Data Bank. The names of the sanctioned individuals though, are not available through the data base to the public, allowing suspended doctors to get a license in another state. The system is accessible to hospitals and other qualified health care operations.
The lengthy delay in the hearing process, combined with a seriously flawed national system for reporting medical malfeasance, allows physicians like cardiologist Rick Szumlas to continue to hold a license in Florida – in good standing – while being suspended in Texas after complaining to police that “aliens were invading his head.”
Between November 12, 2010 and February 6, 2011, the 911 dispatch unit in Paris, Texas, received a number of calls from Szumlas. In the calls, he told the dispatcher “basically that he's being harassed by electronic or radio beams and that they are coming into his apartment,” a Paris police detective said in a hearing before the disciplinary panel of the Texas Medical Board in April 2011.
The detective reported the calls to the Texas Medical Board, which eventually suspended the medical license of Szumlas, who also underwent medical treatment for his mental illness. During the hearing, Szumlas also said he planned to return to the Tampa area, where he has a daughter.
“But it's a very competitive market as far as cardiology is concerned,” Szumlas said under questioning. “And I always, when I get the chance to seek new job employment, I always check the Tampa market to see if there is something available so I can be a little bit closer to her. There's definitely one in Florida that's open that they'd like for me to entertain at this time.”
His defense claimed his mental troubles were a thing of the past. A witness said it was a brief episode. The Texas board issued an order in June 2011, agreeing to allow Szumlas to treat patients in a “group or institutional setting” while receiving psychiatric treatment.
His license in Florida notes that Szumlas is “not practicing in Florida,” although his record here has no public complaints and his license status is “clear/active.” Meanwhile, his license in Illinois reflects the action in Texas.
“Outside of the state, it goes on a case by case basis,” said Jay Wolfson, director of the Florida Health Information Center at the University of South Florida. “If I am a physician in Wyoming and I lose my license to practice there, that board has to post that action. And if I am practicing in Florida, I am supposed to tell them. And I have to appear before the board.”
For states to catch up with actions in another state, “it all starts with that original state,” said Jarrett Schneider, a spokesman for the Texas Medical Board. He said state health officials review news accounts as much as anything else in looking for possible license troubles. “We don’t just rely on the National Practitioner’s Data Bank.”
He added that a license revocation in one state may take a while to get into the hands of another, especially when states rely on the sanctioned party to divulge. “There is a timing element here, in which an individual might be caught in a situation in one state and word hasn’t gotten back to the other,” Schneider said.
Or sometimes a sanction in one state simply isn’t caught by another, as in the case of Leesburg physician James Lee Allen, who was forced to surrender his license in Florida in 2010, more than four years after voluntarily surrendering his Wyoming license after pleading guilty to felony child pornography charges. Allen held licenses in three other states, as well. Nevada revoked his license in 2007. Louisiana records show Allen’s license there was expired before his arrest. The reason for the revocation in Florida was a failure to inform the board of the Wyoming action four years before. Nine months after Florida removed his license, Allen unsuccessfully petitioned to get his medical license back in Wyoming.
While “nearly all physicians are OK, they are human,” noted Wolfson, the health information center director. Complaints against doctors often come from disgruntled family members or former patients looking for some solace. Still, there are misdeeds and failing among the ranks that need to be policed. Florida’s lengthy disciplinary delay and state-funded defense of the accused is the result of a strong political presence of the medical profession.
“While there are some lobbying interests for the public, they aren’t as well funded or as targeted as those for physicians. The [American Medical Association] has a laser like ability to focus on legislators and can kill things quickly.”
The Florida Center for Investigative Reporting is a nonprofit news organization supported by foundations and individual contributions. For more information, visit fcir.org.
The Florida Roundup