Health disciplinary boards fall behind on complaints

Va. health disciplinary boards fall behind on complaints

By NANCY YOUNG, The Virginian-Pilot
 © April 1, 2007

State boards that discipline doctors, dentists and people in dozens of other health fields have been falling behind in resolving complaints - despite new state guidelines that call for a speedup.

Goals established by Gov. Timothy M. Kaine call for 90 percent of complaints involving patient care to be resolved within 250 days by mid-2009, but that's happening only in about half of the cases, according to state records.

The delays create the potential to allow health professionals "who are dangers to the public to keep practicing," said Dr. Sidney Wolfe, director of the Health Research Group for Public Citizen, a nonprofit consumer advocacy group that assesses state medical boards across the country.

The Board of Medicine, which regulates physicians, chiropractors, respiratory therapists and several other types of professionals, took an average of 436.5 days to resolve complaints that were closed in the last quarter of 2006, according to board records.

The Board of Dentistry took an average of 525.3 days.

For each board, that was longer than it took to resolve cases in 2005. And most of the state's 12 other health regulatory boards also have been falling behind, according to state figures.

"We know there's a real problem with how long this takes," Sandra Whitley Ryals, director of the Department of Health Professions, told members of the Board of Medicine during a recent meeting. "More than a year, sometimes two and three years."

The problem has been exacerbated by an increase in complaints.

The health professions boards logged a total of 7,065 complaints in the fiscal year that ended June 30, up from 5,611 in the previous fiscal year.

The Board of Medicine had the largest increase. Its 3,160 complaints in the latest fiscal year were up from 2,039 in the previous 12-month period.

The increases do not necessarily indicate more problems with the quality of care. Whitley Ryals said the rise in complaints is partly due to tougher laws passed in the past few years mandating that hospitals and other health care facilities report potential violations. There is also a greater public awareness of how and where to complain, she said.

Whitley Ryals said the Department of Health Professions has added 11 investigators in the past year and now has 55.

"I have no doubt we will need additional staff," she said.

Even before the governor's broad 250-day goal came down in January, the health boards weren't meeting their own internal goals in more than half the cases. Those guidelines vary from 30 to 440 days, depending on the type of case.

The health professions department is looking for ways to streamline the complaint resolution process, Whitley Ryals said.

Faye Lemon, the department's director of enforcement, said at the Board of Medicine meeting that morale has suffered as investigators' workloads have increased. Because they can be assigned cases in any field overseen by the department, they must master regulations on professionals from speech pathologists to funeral directors.

For new hires, it's trial by fire, she said. "We have to throw them to the dogs because we have too many cases."

The increasing case load has also burdened board members - volunteers who are appointed by the governor and ultimately decide on disciplinary actions.

Many of the complaints the boards receive are minor, said Stephen Heretick, a Portsmouth lawyer who is vice president of the Board of Medicine.

Regardless, at least one of the 18 board members reviews "every last complaint that comes in," said Heretick, who is also a member of the Portsmouth City Council. "This is intensive, and it's a huge time commitment."

He said the Board of Medicine is looking at whether some things that are handled by board members might be better dealt with administratively.

Currently, once a complaint is logged, an investigator reviews it and gives it a priority level. The most serious include accusations of sexual misconduct or physical harm to patients from bad care. The goal is to resolve those cases within 30 days, Lemon said.

The lowest-priority cases, such as allegations of misleading advertising, will continue to be investigated but may be kept longer on the back burner, Lemon said.

If, in the future, an advertising case "comes rolling in here after three years, don't be surprised," she told Board of Medicine members.

Michael Goodman, a lawyer with offices in Norfolk, Richmond and Charlottesville, has represented numerous medical professionals in disciplinary proceedings. He said the health professions department and the public would be better off if investigators could spend more of their time on the most serious of cases.

"There are so many little regulations that physicians are unaware of," Goodman said. In those cases where "no ill intent is meant and no harm is done," Goodman said, he would like to see an expansion of an option in which health professionals can essentially just receive a private warning letter from their licensing boards.

The governor's office may be receptive to funding more investigative staff members, said Jane Kusiak, executive director of the Council on Virginia's Future, the group chaired by Kaine that set the new goals.

"To strike targets without aligning your resources to them, then they're just pie in the sky where you can't really hold an agency accountable," Kusiak said.

The council oversees the Virginia Performs Web site, which was launched in January. The public can use the site to track progress on the 250-day goal as well as improvement measures for all state agencies.

Whatever balance is ultimately struck, the pressure of meeting the new goal should not lead to investigations that are less thorough, Heretick said.

"We want to do it faster, but we don't want to sacrifice the integrity of the process," he said. "Certainly, we will not sacrifice due process for speed."ďż˝