7 Takeaways From a Year-long Investigation Into the Country’s Broken Medical License System

By John Fauber and Matt Wynn, USA TODAY NETWORK. 

Some peddled opioids and others sold snake oil treatments. Some had sex with vulnerable patients. Still others botched surgeries or were implicated in patients’ deaths.

A year-long investigation by the Milwaukee Journal Sentinel, USA TODAY and MedPage Today has revealed that failures in the country’s medical license system are widespread and leaves hundreds of potentially dangerous doctors practicing with clean records in some states despite documented disciplinary problems in other states.

Meanwhile, patients are kept in the dark – even as more of them become victims – thanks to a disjointed and antiquated discipline tracking system that is often shrouded in secrecy.

Here are the key takeaways from our Bad Medicine investigation.

1. Troubled doctors can escape past discipline by crossing state lines.

Even after being caught and disciplined in one state, doctors are free and clear to practice in another state. Many hold a fistful of medical licenses from different states.

Our investigation found at least 500 physicians who’ve been publicly disciplined, chastised or barred from practicing by one state medical board, but are allowed to practice elsewhere with a clean license.

2. In the face of long odds, some doctors simply surrender their license. But some keep practicing elsewhere.

Surrendering a license to the state medical board is often done by doctors in the face of overwhelming evidence of misconduct such as repeated surgical mishaps, churning out improper opioid prescriptions or years of having sex with patients. A license surrender can spare a doctor the time, expense and reputational harm that might come with formal charges and a hearing before a state’s medical board. Typically it comes with no restriction on practicing elsewhere, leaving the burden on other states to keep up with disciplinary records. 

Our investigation found more than 250 doctors who surrendered a medical license in one state were able to practice in another. Here’s why: as with other matters in the broken world of doctor discipline, states following up on what their licensed doctors are up to in other states is spotty at best. Some states don’t even search a national database of troubled physicians. And, voluntary license surrenders can mean the records about what happened remain secret.

A surrendered medical license doesn’t always stop a doctor from practicing. The doctor can just move to another state. 

3. Despite disciplinary action, doctors still taking millions in Medicare checks from taxpayers

Even after losing their medical license or being barred from receiving state-funded health care payments, our investigation found at least 216 doctors still able to bill Medicare for treating elderly patients. In 2015 alone, taxpayers paid those 216 doctors more than $25 million via Medicare.

Medicare is part of the U.S. Department of Health and Human Services — the same federal agency that operates the National Practitioner Data Bank, which tracks discipline against doctors, including sanctions by state medical boards. Yet connection after connection is missed. So, Medicare keeps paying millions to troubled doctors it could know about if it were checking the agency’s own database.

One New York doctor still getting payments from taxpayers is only allowed to treat women with a chaperone present after not contesting charges of inappropriate sexual interactions with a female patient. He’s settled at least three malpractice cases, including one for failing to diagnose the cancer that eventually killed a patient. He was paid more than $280,000 through Medicare in 2015, the last year the government has released complete payment data. Other individual doctors who faced serious sanctions were paid as much as $1.4 million that year.

4. There’s a tool to help states track problem doctors. Few use it.

For three decades, the federal government has built and kept up a database of malpractice payments, discipline and other actions taken against doctors. Its purpose: help state medical boards track trouble in the pasts of the physicians they license. There’s just one problem: they rarely use it.

In 2017, about half of state medical boards checked the database fewer than 100 times, according to federal records of their searches. Thirteen medical boards didn’t check the database even once.

Congress created the National Practitioner Data Bank in 1986, saying it would improve healthcare quality and reduce fraud and abuse.

It’s a nationwide repository that captures malpractice payments, state disciplinary actions, restrictions placed on doctors by health insurance plans or hospitals – among other actions – against doctors, nurses, dentists and other health care workers. There are 1.3 million records dating back to 1990.

The data bank logs more than 7 million searches a year. But state medical boards – which oversee about 950,000 doctors nationwide – only searched 137,000 times last year. And more than two-thirds of those searches were conducted by just 2 states, Wyoming and Florida, which have set up automated searches flagging them of changes in doctors’ records.

5. Where you live determines what you find out about a doctor

“That is their responsibility. And, yes, it’s our responsibility to police that, but we don’t have the staff to do that. We don’t have the staff to look at 44,000 profiles on a regular basis.” Patricia Sherman, manager of the Office of Investigations & Enforcement for Georgia’s medical board

North Carolina and Georgia share a border and many doctors. But they couldn’t be farther apart when it comes to reporting doctor transgressions. North Carolina has a 52-person staff, paid out of licensing fees, and maintains one of the most detailed medical board websites in the nation. In Georgia, the medical board is supported by the state’s general fund, a scenario that pits it against other budget priorities. It has a staff of 31.

While Georgia’s website purports to include discipline from any state, the state relies on doctors to report information about their own out-of-state discipline. They could face discipline if they do not.

The result: 26 doctors who hold licenses in both states were held accountable in North Carolina, but received no public action in Georgia. And the amount of information about that available to the public is vastly different depending on where a patient lives.

6. Preying on desperate patients’ hope, doctors sell controversial MS treatment without consequence

Some require patients to pay as much as $10,000 up front for a procedure they say treats a chronic condition linked to multiple sclerosis. But the FDA has warned the procedure doesn’t work and is not safe. Yet, despite the repeated federal government warnings to stop what they’re doing, we found at least 30 doctors continuing to sell the unproven MS treatment in many states – without discipline – even as patients remain in the dark.

“There is no scientific or medical legitimacy to it all. I think it is completely unethical to offer a treatment to a patient that is not valid and gives them false hope.” Steven Novella, assistant professor of neurology at Yale School of Medicine. One reason: A lack of communication between the FDA, which oversees medical research, and state medical boards, which regulate the practice of medicine.

One California doctor acknowledges doing the procedure 2,000 times and has been the subject of three FDA warning letters alleging violations of federal regulations designed to keep patients safe. But none of the three states where he’s licensed to practice medicine took any public action against his license until after USA Today reported his story.

The California medical board began possible license revocation action against Arata three months after the story ran. That case is still pending. Multiple sclerosis, which has no cure, affects an estimated 400,000 people in the U.S. Symptoms include trouble walking, loss of balance, vision problems, fatigue and tremors, which worsen over time and leave some patients desperate for hope.

In 2012, the FDA issued a safety alert saying the procedure was linked to serious injuries and deaths.

It also said there was no reliable evidence of its effectiveness and that promotion of it may lead people with MS to make treatment decisions without being aware of the risks. One such danger: stents migrating through the body to places such as the heart.

7. When the FDA flags problems, state medical boards often do nothing

A doctor in California has been peddling his own $1,800-a-month “cure” to desperate cancer patients for years. Despite four years of warnings from the U.S. Food and Drug Administration, a patient lawsuit, scathing online reviews and a raid by federal agents, the state’s medical board has not taken action. 

Our investigation found Benedict Liao is just one of 73 doctors around the country with active medical licenses who got FDA warning letters over a five-year period alleging serious problems. Only one was disciplined by a state medical board.

The warning letters are sent after FDA officials inspect offices, clinics and medical facilities to determine if federal rules designed to protect patients are being violated.

State boards took no action on a wide range of problems: Fertility clinics that didn’t test donors of eggs and sperm for communicable diseases; researchers who didn’t follow rules designed to protect patients who volunteer for trials of drugs and devices; and doctors who pushed dubious treatments and supplements to unwitting customers. 

This investigation is a joint reporting effort by the Milwaukee Journal Sentinel, MedPage Today and the USA TODAY Network.

Nov. 30, 2018