Six years ago, Oklahoma took away the medical license of a physician over sexual misconduct. A managed care organization in that state took emergency action to suspend the doctor's clinical privileges, and New York also revoked the doctor's license to practice there.
Four years ago, the doctor was kicked out of Medicare and other federal health programs for a felony conviction having to do with controlled substances. The physician, who at some point has held a license to practice in Illinois, has settled at least a half-dozen malpractice cases. One involved brain damage in a patient who was left a quadriplegic. The doctor also has been sued over allegations of sexual misconduct and dispensing the wrong medication.
All of this information would be available to Illinois regulators if they looked for it. The National Practitioner Data Bank, established by federal law, collects it to help identify "problem doctors" and prevent them from moving from state to state.
But unlike officials in many states, the Illinois Department of Financial and Professional Regulation does not regularly query the databank for information about actions taken against the state's physicians.
As of September, there is no record in the databank of the IDFPR's taking any disciplinary action against this doctor, whose identity is cloaked from public view but available to medical board officials.
According to the databank, about 215 doctors who have been licensed in Illinois had their clinical privileges revoked or restricted by their hospitals or managed care organizations over a roughly 20-year period, with no apparent action taken by Illinois' licensing authority. The organizations deemed some of them to be an immediate threat to the health or safety of patients.
"It is rare for hospitals and managed care organizations to take any actions against doctors," said Dr. Sidney Wolfe of the consumer advocacy group Public Citizen, which has been pushing state medical boards to discipline substandard doctors. "And when they do, the actions are usually very serious, which makes it even more inexcusable that the state medical board, in the face of what are very serious actions, has not done anything at all."
Sue Hofer, spokeswoman for IDFPR, said the agency cannot afford to regularly query the databank because of the expense, $4.75 per doctor report. Some states charge higher licensing fees and can better afford it, she said.
She also said information in the databank is not always reliable. "When we have dealt with the National Practitioner Data Bank, we have consistently found discrepancies between our records of licensing and discipline and what appears on their readouts," Hofer said.
But nearly a year after the Tribune first reported on the issues raised by Public Citizen, Hofer said recently that agency staff will check the databank to find out if the doctors cited by the group are still licensed in Illinois, then seek records from the Federation of State Medical Boards to see if disciplinary action should be taken.
"But we will not be in a position to determine whether disciplinary action is necessary or appropriate for months at the soonest," she said. "We're not able to make a judgment without giving that doctor due process and reviewing the case."
In a letter to Public Citizen last month, the chief medical coordinator for IDFPR, Dr. Brian S. Zachariah, listed some possible reasons that no disciplinary action was noted for the 215 doctors.
Among them: Some sanctions listed in the database may be the result of administrative lapses and not related to patient care issues, the incidents may have been investigated but not determined to be violations of the Illinois Medical Practice Act, they may not meet the "clear and convincing" burden-of-proof standard mandated by law or they may still be under investigation.
"In addition, not all medical board actions are discipline," Zachariah wrote. "For example, we may issue a non-public letter of concern or enroll a physician in a care, counseling and treatment program. The record of such an action, if taken, would not be available in your search and I would be prohibited by state law from sharing this information with you."
Wolfe said there's no way of knowing if the reasons given in Zachariah's letter apply to the 215 doctors until IDFPR investigates. The agency, he said, is dragging its feet.
The doctors "have already been through a disciplinary process and gotten their due process, and someone has already decided that they have done something so dangerous that they needed to have their privileges revoked or restricted," said Wolfe, director of Public Citizen's Health Research Group. "They aren't starting from scratch. I don't know why it should take (so) long."
It's not the first time the agency has been criticized for not moving swiftly to discipline doctors. A Tribune review in 2010 uncovered 16 sex offenders who had held state medical licenses within the past 15 years. None had his license permanently revoked following his conviction.
The databank, which began operating in 1990, was designed to stop the movement of "problem practitioners" from one hospital or one state to another.
Licensing boards are required to report actions that revoke, suspend or restrict a license for reasons related to the practitioner's professional competence or conduct. Professional societies must report professional review actions that affect the membership of a physician or dentist, and hospital administrators and managed care organizations must report disciplinary actions that negatively affect a doctor's clinical privileges for more than 30 days. Malpractice insurance carriers and self-insured health facilities also are required to report settlements or adjudications against licensed providers.
By law, databank reports are confidential and available only to hospitals, health care entities, boards of medical examiners, state licensing boards and practitioners requesting information about themselves. Some information is available to the public, but practitioner names and other details are removed so individuals cannot be identified.
In March, Public Citizen issued a report finding that in 32 states, including Illinois, the medical boards responsible for disciplining doctors had failed to impose any sanctions against more than half of physicians whose health care organizations had revoked or restricted their privileges.
The report was based on data from the databank from September 1990 through December 2009. The Tribune also reviewed data through Sept. 30, 2011, the most recent available at the time of the analysis.
State boards can sanction doctors for a range of problems including substance abuse, sexual misconduct, criminal convictions, incompetence and substandard care.
Illinois' ranking among the states for its rate of serious disciplinary actions taken against physicians has been falling in recent years, from 12th place in 2006 and 2007 to 20th in 2010, according to a May report by Public Citizen's Health Research Group based on an analysis of data from the Federation of State Medical Boards.
By comparison, Ohio has consistently been among the top 10 states in taking serious disciplinary actions against physicians, Wolfe said. Over the last 15 years, the average rate of such actions per 1,000 physicians by the Ohio board has been almost twice that of Illinois', he said.
"There's no reason to think that doctors in Illinois need less discipline than doctors in Ohio," he said. "Even though the top boards are seriously disciplining fewer than 1 percent of their doctors each year, they are doing a better job than boards such as Illinois."
Hofer said the state has improved since 2001, when it ranked No. 45.
State Rep. Mary Flowers, D-Chicago, has been critical in the past about how IDFPR does its job but said the agency has been underfunded. She introduced legislation last month that would increase the agency's investigative budget by about $1 million a year by doubling doctor licensing fees.
Tribune reporter Joe Germuska contributed to this report.
Here are two doctors who have had medical licenses in Illinois and whose problems over the last decade, listed in the National Practitioner Data Bank, raise red flags:
•One doctor settled six malpractice cases in Illinois over a 10-year period, which included allegations of improper performance, failure to diagnose and failure to perform a procedure that resulted in major permanent injury to a patient. Last year, the Pennsylvania licensing authority denied the doctor a medical license, citing incompetence.
•In 2006, an Illinois hospital limited a doctor's privileges because of substandard or inadequate care, and a hospital suspended the physician's privileges after the doctor was deemed an "immediate threat to the health or safety" of patients. A hospital also limited the doctor's privileges in 2007, and a managed care organization limited the doctor's privileges that same year because they had been "restricted, suspended, revoked by another hospital." In 2009, the doctor settled a case in which he or she was accused of a delay in performance that resulted in a patient death.