Andy G/Flick
A costly new method of prosecuting questionable doctors has not resulted in better enforcement, according to a management consultant hired by the state.
The report will be presented this week and already has generated strong opposition.
Attorney General Jerry Brown’s office issued a vehement response to the report [PDF], criticizing the methodology and offering conclusions that are the exact opposite of the consultant’s report.
The medical board report [PDF] examined the effect of a 2006 change in the way the medical board conducts its enforcement actions. The board's enforcement branch investigates and reprimands physicians who breach professional standards or harm patients.
The new enforcement method is referred to as “vertical enforcement” and means that attorneys now have greater involvement in every step of the investigation process.
The result has been that “costs for legal services provided by the Attorney General escalated rapidly while … the number of cases referred for investigation, the number of completed investigations referred for prosecution and … the number of disciplinary actions all declined,” the medical board report says.
The report by management consultant Benjamin Frank zeroed in on costs that escalated most dramatically in the Los Angeles enforcement office.
That office was neck-and-neck with the Northern California office in terms of the number of cases it closed or referred for prosecution, both at just over 300 in the 2008-09 fiscal year.
However, Frank found that costs were far higher in Los Angeles, due to heavy attorney involvement. The average attorney cost per case in Los Angeles was $7,900 compared to $2,370 in Northern California.
The higher costs don't appear to be yielding dramatically higher cases of serious discipline, according to the report. Frank noted that the Los Angeles office had a rate of 82 percent for such cases, compared to 75 percent in Sacramento and 80 percent in San Francisco.
Frank concluded that the heavy attorney involvement in Los Angeles is not worth the added cost to the public.
The state Department of Justice, though, took exception with Frank’s report, submitting a pointed rebuttal [PDF] to the medical board.
In it, senior assistant attorney general Carlos Ramirez calls Frank’s “key findings, conclusions and recommendations … incorrect as a matter of fact, law or both.”
The report refutes nearly all of Frank’s major findings, saying he disregarded statistical information suppled by the state Department of Justice. The attorney general's office also identifies different problems standing in the way of top-notch enforcement against doctors.
One such problem, the attorney general’s office writes, is the fact that the medical board's health care consultants who review medical records and consult on cases are scarce, contributing to “lengthy investigations and inefficient operations.”
“Medical consultants across the state continue to be unavailable in the district office, often for the majority of the work week," the report says. "Investigations are stalled, subject interviews delayed, medical records are unreviewed … and the entire process grinds to a halt.”
The attorney general's rebuttal also says the new report understated the need to improve the medical board’s expert review program, which employs physicians to examine investigative findings.
The rebuttal is silent on one of Frank's more incendiary points: The medical board sat for months on finished investigations before filing charges against doctors.
One case sat for nine months after a doctor failed to follow the board’s orders that he be chaperoned when seeing children. Other doctors performed unnecessary surgeries or prescribed drugs inappropriately, the medical board found. But their cases lay dormant for five months or more without action.
The Frank report is expected to be presented during a medical board meeting [PDF] scheduled for Thursday and Friday in Long Beach.
Comments
via Twitter