NH Board of Medicine Takes On System Failures

After attending the committee meeting of the audit of the NH Board of Medicine, I was stunned that this board issues confidential letters to facilities about system failures. Dr. Cervenka enlightened the committee that the board felt it was their duty to advise and alert facilities when ,in fact, it was not the error of an individual doctor but a system failure. Although I agree that systems do fail in most instances, I was stunned that this board, which rarely acts on substandard care given by physicians, felt they should send confidential letters to these facilities and had the right to do this. In fact, the Department of Health and Human Services (DHHS) administers this chapter (RSA 151) through their Bureau of Health Facilities Administration. The Board is supposed to submit their system failure concerns to the Bureau. Whether this bureau does it’s attended job will be addressed in a later blog. I sat in disbelief since this board seems stretched too far to thoroughly act on their mandated responsibilities but feels the need to advise health care facilities on their failures. All concerns by law should be submitted to the bureau. I will suggest to you that this practice does not make the people of NH safer. In a confidential letter they are alerting these facilities about complaints going forward. The people do not know anything about the “system failures” and the board is not sure of the steps these facilities take to change these failures. At the audit meetings a common theme of “transparency” has been echoed by all and I am amazed that this committee seemed to be weighing towards giving this board the authority to alert facilities with out knowledge to the public, no follow-up necessary. Superficially this may be explained as positive step toward better quality but I think it could also be looked at as a way to alert facilities that may or may not use this information in a positive way.

An example given by the board certainly missed the mark in my book. A healthcare facility was found to not give their patients a release to sign before a vaccine was given. The patient had some kind of devastating consequence after this vaccine and probably through findings from the litigation process it was uncovered. (The board receives all copies of writs submitted to the courts.) It might help the facility to avoid litigation in the future. I do not think this example makes patients any safer.

Much discussion focused on a situation where an anesthesiologist felt targeted by the board for living 30 minutes away from a hospital that does c-sections even though the hospital was fine about this arrangement. The board felt this physician, although he claimed that there was not one instance where he was negligent, was not living up to the “best practice” standard. The complaint was anonymous. Was this political? After a year the board dropped action without any explanation. I understand why obstetricians would want such a standard in place. It is not sufficient to say that this anesthesiologist had not done any thing wrong. Should we wait until something happens to a mother or baby? I clearly understand the obstetricians’ concern but what is puzzling to me is why this is not a system problem? The hospital in question has decided to not follow best practice standards. This is where the board should not have pursued the complaint against the doctor but should have questioned the facility. Why does this hospital accept this practice? These are issues that should not only go to the Bureau of Health facilities but should also be made public. For some reason the NH Board of Medicine seems to make up their own rules and in many instances does not see the need to follow the rules that are all ready in place and for me that is the biggest problem of all.

Lack of Transparency Fuels Anger Towards the NH Board of Medicine

Each time I leave the House Committee Research meeting I wonder why so much time is wasted going over each observation of the Board of Medicine Performance Audit? Each observation and recommendation (there are 34 observations and recommendations) is read aloud by the auditor and the board then explains their response and objections to the recommendations. Is this really a productive way to understand the process of the board?

By the questions asked by some of the legislators, I do not think they understand the process any more than at the beginning of this marathon. I can relate since it took me years to try to understand the workings of this board. Finally, the committee members have a flow chart to try to understand the process of what actually happens when a complaint is submitted. I fail to see why the auditors are grilled so heavily. They are auditors for the state of NH and work out of the Office of Legislative Budget Assistant. The purpose of the audit was to determine how efficiently and effectively the Board of Medicine has administrated its operations and regulatory responsibility according to state law. They did not comment on the merit of a complaint with respect to medical care, a big problem with the NH Board. When the audit was released there was public concern and outrage. I often wonder if Rep. Irwin did not accept public testimony last May so the media would lose interest and it would be business per usual in Concord.

In the year 2007, the board had 14 actions with 5 actions on physicians that were reprimanded in other states and 1 termination of an action. There were only 8 actions by the state of NH. Of those actions not one was related to standard of care with the majority drug related or record related. Why are these numbers so small and why not one related to medical care? In the Union Leader article dated May 4, Dr. Sydney Wolfe, director of Public Citizen’s Health Research Group said nationally NH ranked about in the middle and seriously disciplined 10 physicians. Where did he get those numbers? Since as many as 98,000 people die each year do to medical errors, it is hard to believe not 1 physician in this state delivered substandard care. Colorado in contrast, had 106 board actions with 44 (41%) related to substandard care. (2006)

As I left the NH House Committee meeting on the audit of the NH Board of Medicine, I realized a common theme was the “lack of information” given to both the complainant and the licensee. If no information is given regarding the process of an investigation and how the board determined it’s outcome then both the public and the licensee feels betrayed by the system. Why is it so secretive? Why can’t the board easily explain the process by which they make a ruling? Is the board fair and honest in the process that they go through to come to some kind of action or no action? Why can ‘t they accurately inform the licensee or complainant of the process? Is it because the board and its administration do not view the process in a standard way and stick to the rules? Do they understand the rules and regulations? Those are questions I still cannot answer.

In a Union Leader article dated Nov. 1, 2005 a Portsmouth internist stated, “My big question is why the big secrecy if this could help doctors to learn and maybe prevent mistakes from being repeated? What are secret documents that the public should not see? Does the Attorney Generals Office dictate the board? Why do most doctors in NH choose to settle with the board? Is it to keep the true issue from the public? Some of the laws on hearings seem nonsensical. Since all hearings are public, even those exonerated, many physicians choose to settle so the public does not know the details of the investigation. Does this protect physicians from public disclosure? As you can see, I have more questions than substance. I have this sinking feeling that after this committee makes its determinations the people of the New Hampshire will still be in the dark when it comes to the NH Board of Medicine.

Let our legislatures know your experiences with the NH Board of Medicine-June 19, 2008

A two year long audit of the New Hampshire Board of Medicine uncovered many problems. The audit revealed the board did not investigate 21 percent of the complaints it received in 2005 and 2006 and found “weak if non-existent controls in many of the board’s regulatory and administrative operations (Union Leader, April 30, 2008). After an investigation by the Union Leader it was uncovered that “secret” documents instructing the staffers not to tell the truth to the public about the surrender of a doctor’s license mistakenly was filed with public documents. The Attorney General of New Hampshire is dictating to the board to lie to the public. This revelation in itself is enough for the citizens of New Hampshire to be outraged—never letting the public know the real impetus for the action of the board. What is the relationship with the board and the AG’s office? We need to get answers about the relationship of these two entities.

On May 13, I went to a hearing highlighting the observations of audit and the response of the medical board to these findings. The public was not allowed to speak. I had to sit back and hear the auditors challenged by the board members. Unfortunately, a lot of the time was taken up by the bios or should I say auto-bios of the board members that were present. After the meeting, I decided to try to reach out to some of the committee by explaining my blog and what I hoped to accomplish. I decided against it after the reaction of one of the committee members, Rep. Miller of Durham. I tried to explain my blog was about patient safety and medical error and tried to hand him my business card. He stated, I am a retired doctor and I am not interested in this and gave me back my card. Was he not interested in patient safety, medical error, or the concerns of the public? This response showed both arrogance and rudeness. He could have taken the card and later trashed it. How many legislatures on these committees are retired doctors?

The committee meets again on June 19, 2008 at 10:00 AM in Leg. Office Building (LOB) room 306-308. If you have concerns about the board and can attend the meeting please do. Speak if you would like to, just listen or email your concerns to anne-marieirwin@leg.state.nh.us. If you would like to email Sound Off, I will personally bring your concerns to the meeting (soundoffpatientsafety@gmail.com

Hearing-Audit of NH Board of Medicine-White Coat Analysis

As I sat and listened to the fact finding hearing conducted by Rep. Irwin, I made some initial observations. The audit was done by professionals who conducted themselves at the hearing as such. Dr. Cervenka was clearly upset and took this as a personal attack. He attended the meeting in OR greens and his white coat. What message was he trying to emit? I clearly got the distinct feeling Dr. Cervenka wanted everyone to know that he was a hard working doctor that was so busy he did not have time to change before the meeting. This was a performance audit not specific to medical standards of care but focused on the administration of the board on its operations and regulatory responsibilities. This audit did not question standards of care but procedural problems. I shutter to think what the doctor’s responses would have been had his medical judgments been questioned. The medical board took credit for the audit and in fact stated that it was “us trying to improve ourselves”.

The audit found that 21percent of complaints against doctors was not investigated. Not to worry, Dr. Cervenka had the answer to that number. The vast majority were not in the NH Board of Medicine’s jurisdiction. After looking over the archives of NH Board of medicine, I discovered there were fourteen board actions from the year 2007; five were reciprocal actions meaning the board did not have to do any work. It was all done by other states where the doctor held another license. This was approximately 37% of the board actions in that year. The remainder of the actions was 7% sexual misconduct, 14% professional misconduct, 21% drug related, 14% record related and 7% termination of a previous condition. Distinctly absent were any actions for below standards of care. The only standard of care action was administered by the Colorado State Board of Medical Examiners. Is this because our physicians are better than other places? Do they always administer the standard of care?

There are obviously vast problems with our board of medicine and I only hope this audit will force some kind of change. If the board persists in making excuses and taking the audit personally I am afraid nothing will change. This is a system failure. The audit is not targeting board members but reviewing the system that the board members function in.