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.
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.
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A stethoscope seen at a doctor's office (Illustration by Andreas Rentz/Getty)