Critics say New York soft on disciplining dentists
The (Syracuse, N.Y.) Post-Standard’s James Mulder has found that, when it comes to cracking down on less-than-competent dentists, his state appears pretty lax.
Photo by radiant guy via Flickr
In New York, the 18,000 dentists are among, Mulder writes, the 800,000 people from “48 professions — from acupuncturists to veterinarians — policed by the state Education Department’s Office of Professional Discipline.” Last year, the board disciplined 24 of them, revoked the licenses of two and accepted the surrender of four more licenses.
The office took 1.54 disciplinary actions per 1,000 dentists last year, about half the rate of disciplinary actions taken against medical doctors and physician assistants. Discipline against doctors accused of misconduct in New York is handled by a different arm of state government — the state Health Departments Office of Professional Medical Conduct.
Also, the number of serious disciplinary actions against New York dentists declined by 53 percent between 2006 and 2010.
N.Y. reporter finds local doctors in ProPublica database
Filed under: Conflicts of interest, Government, Health data, Pharmaceuticals, Public records
Writing for Gannett’s Binghamton, N.Y., Press & Sun-Bulletin, Julia Hunter localized ProPublica’s investigation of pharmaceutical companies and disciplined doctors by starting with the nonprofit’s database, then adding some investigation of her own. She names names, talks with local physicians and uncovers anecdotes.
There are plenty of tales of medical malfeasance, including that of Dr. Robert Douenias, who lied about a previous criminal conviction when applying for a New York medical license. Until recently, Douenias had spoken on behalf of Avodart to prevent prostate cancer. “He said he stopped because he didn’t want to be associated with the controversial practice of speaking on behalf of pharmaceutical companies.” The FDA has since “voted against the approval of Avodart as a cancer risk-reduction method.”
Hospital management says it wasn’t aware of the physician’s previous conviction, and that it wouldn’t be looking into it further. After all, Hunter writes, “99 percent of patient surveys indicated a ‘good’ or ‘excellent’ experience with Douenias.”
St. Louis reporters find felons practicing medicine
Filed under: Health care reform, Hot Health Headline
The St. Louis Post-Dispatch’s Blythe Bernhard and Jeremy Kohler tell the story of an ophthalmologist to show how a convicted felon can be allowed to return to medical practice, sometimes in the same state in which he or she was convicted. The ophthalmologist in question went to prison after lying to patients, defrauding Medicare and obstructing the resulting investigation, yet now works in an Illinois clinic and has permission to reapply for his Missouri license.
The investigation is strengthened by two sidebars, one listing examples of other felons/physicians and the other explaining how and why an ophthalmologist lied to patients and Medicare about what he was injecting into their eyes.
For the record, my favorite sentence in the entire piece is “Medical boards don’t release statistics on how many active licensees are convicted felons.” It certainly would make things easier.
Earlier stories from Bernhard and Kohler document similar problems with a lack of openness of records and how disciplined doctors can still keep their records clean:
AHCJ members can read about how the pair have done much of the reporting on this ongoing project.
ProPublica investigates pharma payments to doctors
Filed under: Conflicts of interest, Health care reform, Health data, Health journalism, Hot Health Headline, Pharmaceuticals, Public records, Tools
ProPublica’s massive investigation into the hefty fees pharmaceutical companies have paid doctors with dubious track records stamps an exclamation point on what has been a banner year for high-profile assaults on pharma-paid physician/marketers.
Books like Daniel Carlat’s Unhinged and Carl Elliot’s White Coat, Black Hat, and the promotional tours that came with them, led the charge and raised awareness of an issue that reporters Charles Ornstein (you may know him as AHCJ’s president), Tracy Weber and Dan Nguyen have driven home with tens of thousands of carefully researched data points and one flagship story.
The ProPublica database is built upon the voluntary disclosures of seven drug manufacturers (Eli Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer) which represent about 36 percent of the market. Reform law requires the other manufacturers to make similar disclosures by 2013. The package uncovered a bucket of horror stories — that mug shot of high-earner Dr. Donald Ray Taylor next to the paragraph describing why he was disciplined is the very definition of “disturbing” — yet also distinguished itself by giving doctors who rep pharma the opportunity to explain both their work and their motivation.
In its examination of pharma payments, the investigation goes beyond a simple database match with disciplinary records. Some physician/marketers had clearly earned their stripes and displayed impressive resumes and relevant research records, the reporters found, but others had disciplinary records, lacked any board certification or publications or appeared to have been manufactured by the drug-makers themselves.
“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”
If you can’t get enough of the investigation, see the work by ProPublica’s partners at The Boston Globe, Consumer Reports, the Chicago Tribune, Nightly Business Report and NPR.
Finally, don’t miss the comments on the article, headlined by a lengthy response from the leading pharmaceutical industry group.
Lawsuit reveals failures in hospital hiring practices
St. Petersburg Times reporter Curtis Krueger’s story about a successful whistleblower suit against a Florida hospital provides a powerful storyline about how disciplined health care workers continue to get hired. Here, he skips the government agencies and state databases and looks at communication between the hospitals themselves.
After all, don’t hospitals consult references and do background checks when hiring new doctors and nurses? In the corporate world of major hospitals, the answer is apparently “yes, but it doesn’t seem to do any good.”
… in general, (Beth Hardy, a spokeswoman for Morton Plant Mease Hospitals) said, if a hospital calls seeking information about a former employee, the company will simply confirm the worker’s dates of employment and last position held. She said that is “a standard and accepted policy across a lot of large organizations.”
The whistleblower suit itself, which resulted in a $450,000 award, involved a nursing supervisor who was fired soon after she criticized nurse Bernard M. Moran for falsifying records, a practice which got him fired at a previous job. Moran now works at another area hospital, one which says it checks the disciplinary records of all new hires.
The story only came to light because of the lawsuit. To understand just how many blind eyes were turned toward Moran’s behavior during this series of events, just take a look at Krueger’s story.
(Hat tip to Health News Florida)
CMS failed to report disciplined providers
Filed under: Government, Health data, Hot Health Headline
ProPublica’s Marian Wang reports that the Centers for Medicare & Medicaid Services “essentially undermined” HHS efforts to create a national database of disciplined health care providers by failing to report disciplinary actions. The news comes from a report by the HHS Office of Inspector General (23-page PDF).
According to Wang, the investigation “found that CMS, which oversees health care programs serving about 45 million Medicare beneficiaries and 59 million Medicaid beneficiaries, took disciplinary action against numerous bad medical providers but did not report those actions to the Healthcare Integrity and Protection Data Bank.” As anyone who’s been following ProPublica’s award-winning “When Caregivers Harm” series knows, the database is chronically deficient, and – despite federal requirements – CMS isn’t helping.
CMS is required by law to report the following types of disciplinary action to the database: revocations and suspensions of laboratory certifications; terminations of providers from participation in Medicare; civil monetary penalties against all types of providers, managed care plans, and prescription drug plans.
Some of the data that should’ve been reported includes 148 sanctions imposed against laboratories in 2007 and 30 sanctions taken against managed care and prescription drug plans between January 2006 and July 31, 2009. From 2004 to 2008, the agency banned 45 nursing homes from participating in Medicare, and those actions were not reported until fall 2009, long after the required reporting timeframe, the inspector general’s office said.
According to officials, it was all just a big misunderstanding.
Disciplined doc gets top rank in Google
In SF Weekly, Ashley Harrell investigated the disconnect between a local plastic surgeon’s record of “gross negligence” which left one patient in a fatal coma and several others with burns, and the legions of glowing reviews of her practice posted all over the internet.
The reviews, she found, were connected to the astroturfing efforts of a PR agency the doctor had hired. The group also earned the doctor a top spot in Google’s PageRank algorithm at the same time that she was serving a three-year probation set by the state medical board.
Harrell’s story, Doctoring the Web, examines ways that some doctors are trying to game online ratings systems, as well as the current weakness of enforcement, both federal and local, in the arena.
Heisel’s ‘Doctors Behaving Badly’ goes viral
Filed under: Health data, Health journalism, Hot Health Headline, Member news, Nursing
As anybody who follows the Reporting on Health blog knows, William Heisel’s virtual roadshow of physician background research has been gaining ridiculous amounts of steam lately. His Doctors Behaving Badly brand has taken on a life of its own, propelled by a Google Map he put together to place his findings into geographic context.
View Doctors Behaving Badly in a larger map
That geographic context has become the focus of his investigation, as Heisel has turned what was once a quirky little recurring item into a systematic, state-by-state way into how the public can check up on disciplined (or otherwise problematic) doctors. He’s almost reached the halfway point, and he’s reached some interesting conclusions. My favorite is that he doesn’t think states that have terrible sites with which to check up on doctors are being malicious, they’re just bad at making websites.
I think the problem lies in poor website design. A board starts with a simple site that allows people to see if a doctor has a valid license. Then that same board adds scanned documents from its disciplinary files, but instead of linking these two things together, it puts them in completely different parts of its site. When the board gets around to adding malpractice information or criminal histories, it layers those on top, too, instead of fully integrating them.
The effect is a stratified system of information that lets patients think their physicians have a clean history when, in fact, their records are simply too hard to find.
Heisel recently appeared on Fox News to explain what he’d found thus far.
On the whole, Heisel’s effort helps illuminate the power of my favorite online reporting tool: The progressively investigated database.
How bad docs keep clean records
The St. Louis Post-Dispatch’s Jeremy Kohler and Blythe Bernhard used the example of one litigious St. Louis psychiatrist to demonstrate how doctors can work the system to keep their records clean and professional prospects bright despite work histories that are sometimes anything but. The strong anecdote provides engaging context for a well-analyzed report on the reporting of physician errors under the current system.
Critics say hospitals are underreporting and that puts patients in harm’s way. As long ago as 1996, a government agency concluded that the number of hospital reports was “unreasonably low.” It has gotten even lower. In 2008, the number of reports was three-fourths of the 1996 total, according to the newspaper’s analysis.
Disciplined docs turn up on Pfizer payroll
Filed under: Health data, Health journalism, Hot Health Headline
New Scientist’s Peter Aldhous and Jim Giles created an interesting mash-up of two popular health stories, disciplined caregivers and conflicts of interest, by matching a set of Pfizer disclosures on payments to doctors and researchers in 2009 with discipline records from the FDA and the country’s most populous states. They found 26 matches on the state level and four from the feds, matches which accounted for about one in every 50 Pfizer-paid doctors in the states they’d investigated.
They assembled a number of anecdotes for the story, but the most telling related to a physician who was disciplined for faulty research related to a Pfizer drug, yet still paid by the company to lecture on it.
Other Pfizer experts ran into trouble during their research. Among them is Thomas Gazda of Scottsdale, Arizona, who was paid to lecture about Geodon after being reprimanded by the FDA over irregularities in his conduct of a trial of the same drug’s use in children and adolescents with bipolar disorder – one of whom was given more than the maximum allowable dose for five days. The FDA had earlier told Pfizer to exclude Gazda’s data from the results submitted by Pfizer during its efforts to win approval to use the drug for this purpose.
AHCJ has extensive resources for folks looking to do both sides of the mashup, with tips for investigating conflicts of interest from John Fauber of the Milwaukee Journal Sentinel and recommendations for looking into disciplined caregivers from ProPublica’s Charles Ornstein and Tracy Weber.
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