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Medical Malpractice and Physician Discipline: Process, Issues, and Challenges

Professional oversight bodies are responsible for making sure that all licensed medical professionals meet the licensure requirements and maintain their knowledge and skills. Disciplinary action is part and parcel of the oversight function and should theoretically be applied when there is negligence, but this is not always the case. Lawyers specializing in medical malpractice at Cochran, Kroll & Associates, P.C. can investigate these issues for your claim.

Professional Medical Boards

State Medical Boards

In the USA each state has a State Medical Board, which act as agencies to license doctors practicing in the state; however, their overriding purpose is to protect the public from unqualified, unprofessional or incompetent physicians.

The role of the State Medical Board, in general, encompasses the following functions:

  • Protect the public from incompetence and unprofessional behavior
  • Establish standards for medical practice
  • License medical doctors
  • Investigate any complaints against doctors
  • Discipline delinquent doctors who violate the medical practice act
  • Refer the physician for evaluation and rehabilitation when needed
  • Setting disciplinary rules

However, each state has its laws and regulations governing medical practice and the responsibilities and powers of the Medical Board.

The National Board of Medical Examiners (NBME)

The NBME provides a common evaluation system to all State Medical Boards to ensure equitable standards for quality of care and licensing across the board.

United States Medical Licensing Examination (USMLE)

The Federation of State Medical Boards of the United States (FSMB) and the National Board of Medical Examiners (NBME) established a single 3-step examination, known as the United States Medical Licensing Examination (USMLE). The three steps are taken at different times in their training and culminate in their ability to practice medicine independently without supervision.

They assure relevance by using science and clinical faculty and practicing physicians to assist with the generation of the examinations.

American Medical Association (AMA)

The American Medical Association (AMA) is a professional organization protecting the name, goodwill towards and interests of the physicians in the United States by providing tools and mechanisms, training and codes of conduct to ensure the most professional level of care for the public at all times. They assist with practice management and billing codes, research, litigation, education and advocacy.

There are many state medical societies, and specialty societies providing similar services to the public and medical communities.

Standards of Professional Conduct

The primary purpose of the Medical Board is to protect the public, not to punish physicians. The medical practice act for each state will determine the definition of unprofessional conduct, and complaints that may meet those conditions will be investigated; however, disagreements and poor customer service do not fall under this purview.

Medical boards will evaluate every complaint from patients, review malpractice data, reports or referrals from hospitals and government agencies. They have the power to initiate an investigation at any time, hold hearings and decide on a course of action which may or may not include discipline.

Codes of Ethics, Conduct and Practice

Codes are issued by many organizations as guiding principles for desired behaviors. Professional codes determine what is expected of professional members and may be presented in the form of a Code of Ethics, a Code of Conduct or a Code of Practice, or all three, and in some cases, they overlap.

  • Code of Ethics – normally a short set of ethical principles
  • Code of Conduct – in general more detailed, outlining specific behaviors based on the set of ethics
  • Codes of Practice – rules regarding technical duties based on ethical principles

In some cases, the codes are presented as guidelines rather than rules.

The AMA adopted a Code of Ethics at their founding meeting in 1847, and covers the Principles of Medical Ethics and then outlines practical applications in all situations and relationships:

Professional Conduct – has been defined as “A set of values, behaviors and relationships that underpins the trust the public has in doctors” by the Royal College of Physicians and covers knowledge and skills, moral values and the patient relationship.

Unprofessional Conduct –the medical practice act in each state will typically define what constitutes unprofessional conduct, and could include:

  • Failing to meet continuing medical education requirements
  • Performing duties beyond the scope of a license
  • Practicing without a valid license
  • Not recognizing or acting on common symptoms
  • Inadequate record-keeping or privacy issues
  • Prescribing drugs in excessive amounts without legitimate reason
  • Delegating medical duties to an unlicensed individual
  • Impaired ability to practice due to addiction
  • Dishonesty
  • Ethics transgressions
  • Professional self-regulation failures
  • Physical abuse of a patient
  • Fraud
  • Conviction of a felony

Medical Board disciplinary proceedings have to adhere to substantive due process, providing detailed and clear evaluations and showing common sense and rationality.

Possible Remedies to be Implemented after Investigation

State Medical Boards will, after investigating complaints or reports determine the remedy to be applied, based on what is best for the public as well as for protecting a valuable medical asset for the community. In many cases, additional training or education in particular areas allows for modification of behaviour leading to complaints, or provide the skills needed to perform new procedures.

Studies have found strong correlations between the physician’s patient-communication abilities and level of complaints, and to this purpose, the FSMB has added an additional test to the Stage 2 testing of the medical licensure examinations to evaluate a physician’s ability to communicate with their patients in a way that instils trust.

Remedies include:

  • Modification: additional training or education
  • Reprimand
  • Probation
  • Restrictions on the physician’s license
  • Suspension
  • Revocation of license

Medical Malpractice and Discipline

The AMA litigation center covers a wide array of cases involving their members as individuals or as a professional body, and could include medical liability, peer review payment issues or staff privileges, and often tackles the courts to provide better access and care to specific groups of patients whose rights are being violated. Assistance with medical liability cases has strict requirements regarding the merits of the case.

Patient safety is of paramount importance in medical practice, as outlined in the Institute of Medicine Report: To err is human: building a safer health system, released in 1999. Prompt identification of any professionals that are not sufficiently trained, negligent or incompetent, or that behave unprofessionally is crucial to building a system that favors patient safety.

 

 

In Michigan, you can call Eileen Kroll, a registered nurse and personal injury trial attorney, at Cochran, Kroll & Associates, at 1-866-MICH-LAW (1-866-779-7331) to discuss your reasons for a complaint and possible malpractice litigation. The case evaluation is free, and our law firm never charges a fee unless we win your case.

Nikole has a special interest in medical-legal issues and holds post-basic degrees in medical law and business. She has developed quality improvement and safety plans for many practices and facilities to prevent medical-legal issues and teaches several courses on data protection and privacy, legal, medical examinations and documentation, and professional ethics. She has been writing professionally on legal, business, ethics, patient advocacy, research and medico-legal issues in articles, white papers, business plans, and training courses for over thirty-five years.

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