E-Mail This Article to a Friend HEALTH CARE Physician oversight overlooked BY DAVID S. BERNSTEIN

The Massachusetts Board of Registration in Medicine (BRM), in its just-released annual report, claims that the days when it could be accused of insufficiently disciplining bad doctors "are long gone." The content of the in-depth report is less reassuring, however: the board disciplined just 60 physicians last year, down from 68 the previous year. Lesser, "non-disciplinary" actions fell even more sharply: the board issued just 21 "letters of concern" in 2003, compared to 41 in 2002, and just one "letter of warning" — the strongest non-disciplinary action it can take — after issuing 30 the previous year.

In addition, according to a report released last month by the Federation of State Medical Boards of the United States (FSMB), Massachusetts’s disciplinary rate ranks 11th among the 14 states with more than 15,000 practicing physicians.

The board acknowledges in its report that discipline is down, but attributes this to stabilization after "years of playing catch-up" since Nancy Achin Audesse became BRM executive director, in 1999. (Audesse was not available to comment for this article.)

In the first four months of 2004, the board took disciplinary action against 17 physicians. Disciplinary hearings are conducted every three weeks. "They’re doing a better job than they had in the past," says Tom Sullivan, outgoing president of the Massachusetts Medical Society, a physicians’ lobbying organization based in Waltham. Nevertheless, he says, the number of disciplinary actions seems inadequate compared to incidents of substandard care. "There needs to be another entity to help address not just disciplinary processes but to improve the quality of care," Sullivan says.

In fact, statutory reports alerting the board to potential physician problems rose sharply in the state last year, from 1899 to 2879. This includes reports of malpractice cases, disciplinary actions taken by health-care facilities, and physicians reporting each other. Consumer complaints dropped slightly, from 677 to 650.

"Patients need to feel that a physician will be held accountable for providing bad care," says Michelle Mello, assistant professor of health policy and law at the Harvard School of Public Health. "The general consensus is that state boards have not historically been active in regulating quality. The structure is in place, but there is no professional commitment to monitor quality."

The BRM has come under increased scrutiny in the past few months. In March, Dr. Robert M. Caulkins, an orthopedic surgeon, agreed to stop practicing after he allegedly arrived inebriated for surgery at Caritas St. Elizabeth’s Medical Center, in Brighton. Previously, Caulkins had had his driver’s license suspended and three earlier drunken-driving convictions, leading to questions about why he was still allowed to practice.

And just this week, the Massachusetts House and Senate agreed to a compromise version of "Taylor’s Law," which would allow patients or their families to make victim-impact statements at BRM hearings. The bill is named for Taylor McCormack, who suffered fatal brain damage while awaiting surgery in 2000; the doctors who failed to note the urgency of her condition received letters of censure rather than harsher punishment. Governor Mitt Romney has not indicated whether he will sign the bill.

The BRM’s annual report normally comes out in March; it also usually releases a midyear report, but failed to do so in 2003. The board provided the report to the Phoenix upon request this week. As of press time, however, it had neither issued a press release nor posted the report on its Web site.