Physician discipline

The development of a taxonomy of wrongdoing in medical practice and research

"Ethical disasters" or egregious violations of professional ethics in medicine often receive substantial amounts of publicity, leading to mistrust of the medical system. Efforts to understand wrongdoing in medical practice and research are hampered by the absence of a clear taxonomy. This article describes the authors' process of developing a taxonomy based on (1) reviews of academic literature, ethics codes, government regulations, and cases of wrongdoing; (2) consultation with experts in health law and healthcare ethics; and (3) application of the taxonomy to published cases of wrongdoing in medical research and practice. The resulting taxonomy includes 14 categories of wrongdoing in medical practice and 15 categories of wrongdoing in medical research. This taxonomy may be useful to oversight bodies, researchers who seek to understand and reduce the prevalence of wrongdoing in medicine, and librarians who index literature on wrongdoing.

Adverse action reports against optometrists: perspectives from the National Practitioner Data Bank over 18 years

PURPOSE

The aim of this analysis is to describe characteristics of National Provider Data Bank (NPDB) adverse action reports against optometrists.

METHODS

NPDB public use files were analyzed for details of reported optometrist adverse actions from 1991 through 2008. Types of actions, basis for actions, and reporting source were identified, along with geographic and demographic data.

RESULTS

Between 1991 and 2008, a total of 216 adverse actions against optometrists were recorded nationally. Exclusion from Medicare or another government program accounted for 92% of all reports; the remaining 8% were related to unfavorable privileging decisions. Most cases with identifiable explanations were the result of either defaults on student loans (55%) or charges of fraud and abuse (39%). Over two thirds of all reports originated in just 12 states, and 74% involved younger optometrists (age 30 to 49). Repeat offenses were reported for 38% of sanctioned optometrists.

CONCLUSION

NPDB reported adverse actions against optometrists are infrequent but most commonly involve exclusion from Medicare or similar government programs. Student loan default, particularly by younger optometrists, is the single most common cause, followed by allegations of fraud and abuse. Because this national database is permanently archived and widely used by licensing and credentialing bodies, optometrists should endeavor to be ethically responsible and strive to avoid behaviors that mandate such action reports.

Performance of state medical boards: implications for hospitals and health systems

The accountabilities and operations of state medical boards can have significant implications for hospitals and health systems in terms of their efforts to ensure quality care and patient safety. This study examined the performance of state medical boards and the reasons for variability in board performance by identifying factors impacting the performance of state medical boards in terms of physician discipline and those variables most critical to medical board performance. The findings suggested that increasing staff support and appointing lay board members would lessen the degree of variability in the performance of state boards although there remained a significant amount of variance to be explained.