One-size-fits-all disciplinary system a disservice to doctors and patients

Incompetence, corruption or dishonest or unethical conduct on the part of members of the medical profession is reprehensible and needs to be dealt with in an expeditious and fair, effective manner. In addition to posing a real or potential threat to patients, such conduct undermines the public's confidence in my profession. There is nothing more sacred than the trust between a patient and his or her physician(s), and we must preserve it.

The disciplinary system needs to be fixed. We at the Washington State Medical Association have clearly and consistently stated that. Equally clear is the fact that some of the approaches that have been suggested — such as the one-size-fits-all approach suggested by some in the Legislature — will not make things better.

Each of the 62 health-care professions is unique. We believe, and feel most of the public will agree, that physicians should not be disciplined under the same structure as an animal massage therapist.

The Medical Quality Assurance Commission, the body that oversees physician discipline, needs to be moved out of the Washington Department of Health and given the resources to do its job.

The governor should continue to appoint the members of the commission, but the commission should hire its own designated staff and control its budget. Additionally, the adjudication phase of discipline should be conducted by an entity outside of the commission — that is, an expert panel of physicians and public members, all appointed by the governor.

Today, the Department of Health oversees four commissions, 12 boards and eight advisory committees dealing with licensing standards for 62 health professions, from acupuncturists to X-ray technicians.

In an effort to treat the various professions more consistently, the state health department centralized the health-care investigators and legal staff into a pool. Investigators and legal staff are now assigned on an as-needed basis to the various boards and commissions. This one-size-fits-all approach is not working.

A move to standardize guidelines among all professions further exacerbates these problems.

The authority of the commission to discipline physicians is eroded by shifting important responsibilities to central staff at the Department of Health. In a report released by Public Citizen, a national public watchdog group, four of the top-five state medical boards for disciplining physicians are independently run and have control over their own budgets and staffing.

Because of the inability of commission members to meaningfully participate in any discussions on budget, staffing or priorities — all held at the departmental staff level — the Medical Quality Assurance Commission is failing to properly discipline physicians and physician-assistants in a timely manner. A commission member acknowledges "significant delays" in the process of investigating and bringing charges against physicians and physician-assistants who have engaged in unprofessional conduct.

Those delays hurt both complainants and those being complained about — and bolster the public perception that medical discipline is erratic, at best.

Due to the special nature of medical discipline cases, it is imperative that the commission have its own staff trained in medical disciplinary cases. (Today, the job requirement of an investigator states that a health-care background is "desirable," but not required.) Moving the commission out of the health department and forming a freestanding entity will allow the special attention that medical discipline cases warrant.

The notion that if the disciplinary system is to be fixed, it must address all professions in one fell swoop, is wrong. The approach of treating all the professions the same doesn't fix the shortcomings of the current system.

To significantly improve the way physicians are disciplined in our state, the Legislature should do its due diligence and address each profession, its unique problems and needs, individually, as we have proposed. How much more time will be wasted on ineffectual solutions?