In California, Doctors on Probation Not Required to Tell You. Should They?

When you call to set up your next check-up, you may be unknowingly arranging for care from a physician in trouble for drug abuse, sexual misconduct, patient negligence or harm.

In California, physicians on probation for such punishments are already required to report them to their malpractice insurers and hospitals where they work, yet there is no rule requiring similar pro-active notifications of patients.

The advocacy group Consumers Union wants that to change. They are calling for the Medical Board of California to make doctors on probation responsible for informing their patients. The board is scheduled to consider the idea on Friday at its quarterly meeting in San Diego. But it is unlikely to win approval.

“Maybe if patients knew, they wouldn’t see the doctor,” said Lisa McGiffert, Director of the Safe Patient Project at Consumers Union. “Maybe they still would. But they are doing it with their eyes open.”

Under the proposed rule, doctors on probation would have to alert their patients when they call for an appointment as well as verbally and in writing during the visit. Consumers Union filed a 9-page petition with the board outlining its proposal. The petition was signed by more than 5,000 Californians.

Doctors' Group Resistant

Since the disciplinary actions against doctors are posted on the board’s website, the state’s biggest physician group, the California Medical Association, says the proposed changes of the notification requirements would go too far.

In a statement Paul Hegyi, a spokesman for the association, said they worry this type of rule would “put a burden on the physician-patient relationship," especially when appointment time is already limited.  “This information is already public and available online and can be accessed by anyone," he said. "This is a duplicative burden that will interfere with patient care.”

The board rejected a similar measure when it was proposed by board staff in 2012. In fact, the board has just begun a public relations effort to encourage patients to take it upon themselves to research the disciplinary actions against their doctors.

Board officials even held a tutorial to show people how to use their website at a mall in Sacramento last week. Those who don’t have access to computers can call the board’s office for assistance, a statement from the board said.

Advocates see the board’s outreach as a response to their efforts but say it doesn’t go far enough. The burden to find the information shouldn’t be placed on patients, who may not think to look it up, know how to do so, or have access to the Internet, McGiffert said.

Other patients may not be able to research the information due to mental or physical impairments. They could be missing out on important information about the doctors they have trusted with their care, she said.

Of the approximately 137,000 licensed medical doctors in California, nearly 500 are on probation for offenses including sexual misconduct, gross negligence, substance abuse, inappropriate prescribing, and conviction of a felony, Consumers Union said. The group compiled a list of doctors on probation.

Patient advocate Marian Hollingsworth, who works for Consumers Union, described in a Sacramento Bee opinion piece how she felt when she discovered her doctor’s probation.

“I was stunned to learn that the doctor I had been referred to for a routine colonoscopy was about to start a 30-day suspension and seven-year probation,” she wrote. “He had a long history of substance abuse and DUIs, but what finally got the board’s attention is that he went after a patient with a hatchet in an alcohol-fueled rage.”

The doctors who got into trouble are from all over the state -- in big cities like Los Angeles and rural areas like Humboldt County. In some areas with doctor shortages, if a doctor is on probation it may present an even bigger dilemma for patients. Those patients should be able to decide whether they still want to see the doctor even if it’s their only option for miles, McGiffert said

By agreeing to go on probation, doctors are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles, McGiffert said.

Physicians on probation may be barred from performing specific procedures, or prescribing certain medicines for a period of time. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.

The issue of physician discipline has been difficult for the board. It has come under fire in recent years for failing to hold problem doctors accountable. Some legislators in 2013 called for stripping the board of its investigative powers. This issue will draw renewed public attention to whether the board is aggressive enough in protecting the public from dangerous doctors.

McGiffert said there is concern in the medical field that requiring doctors to tell patients about their probationary status is too awkward.

“The objection is that, gee, this would be very uncomfortable for doctors,” McGiffert said. “What does that tell you? Sometimes you need that kind of pressure.”

Update: In its meeting on Friday, the Medical Board of California voted to deny the petition that would have required doctors on probation to notify their patients. But it did agree to form a committee to review the petition more closely and potentially develop a plan to improve notification to patients of doctors on probation.