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State Medical Board Threats Replace Lawsuit Threats.

By Chris Rangel MD ⋅ May 23, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Tort reform and the rise of the state medical board.

“I’m gonna get a lawyer and sue you!”

I’ve heard this phrase a few times since I started practicing. Every doc no matter how skilled and competent has heard this line or some derivation thereof from an irate patient or family member. Sometimes it’s warranted. Most of the time it’s not. Most of the time it’s born of frustration, misunderstanding, or miscommunication. And too often it’s an attempt by the patient or family to force the physician to do what they want.

Usually I’ve heard this phrase from a patient with an obvious addiction to certain prescription medications and who is displaying obvious drug seeking behavior. I do my best to try and convenience them to start tapering their usage of these medications and they do their best to negotiate with me to get more pills and refills per prescription. The phrase usually comes into play when they realize that I’m being serious about decreasing their medication and their tactics change from negotiation to outright threats.

Not surprisingly none of these threats have ever materialized. Suing a doctor is not easy especially when the doctor clearly documents his concern about the patient’s abuse of addictive medications. Besides, it’s the threat that’s important, not the follow-through because it takes a lot of time, effort, and sometimes a lot of money to find a lawyer willing to take cases like these.

Before 2003 manipulative patients in Texas could depend on a threat of litigation to have some teeth because of the lack of limits on jury awards for pain and suffering. Most physicians would get this visceral sense of panic to the threat of litigation. They know that such a suit would be very unlikely to succeed and yet deep down they feared the remote possibility that this would be that one multimillion dollar award that ruins their career. In this context it’s much easier to give in while that patient is stomping around the office proclaiming in a loud voice about their plans to sue.

But in 2003 Texas voters approved limits on jury awards in personal injury cases. Not only is the threat of multimillion dollar awards gone but also lawyers are now even less likely to take these cases. The threat no longer has any teeth! What is a drug-seeking patient to do? Well, how about threatening to report the physician to the state licensing board?!?!

In 2002 the Dallas Morning News ran a series of articles about how the Texas State Board of Medical Examiners was being too lenient on disciplining physicians who had multiple malpractice judgments against them, who had caused or contributed to patient injury or death, or demonstrated grossly unprofessional behavior and/or direct danger to patient safety. In many cases this criticism was warranted and these articles caused a firestorm in Austin, which lead to a new mandate and more funding for the board.

Since 2003 disciplinary actions by the board have dramatically increased and many physicians fear that the board is getting out of control (I read about one doc fined $500, ordered to take classes on documentation, publicly reprimanded, and all for forgetting to time and date an addendum note in a chart). The rare but potential risk of a multimillion-dollar jury award has been supplanted by a rare but increasing potential risk of medical license suspension or even loss. Patients now know this and are increasingly willing to use it to their advantage.

I had never had a patient threaten to report me to the board until after 2003. Since then I have had a few patients make this threat and all of them were exhibiting clear drug seeking behavior. Just recently I refused to refill a patient’s prescription for a controlled substance because she was clearly abusing it, clearly had significant problems with acute severe depression, and I was afraid that she might intentionally or accidentally overdose. I carefully explained this to the patient and included an alternative treatment plan for her condition. No matter. She stormed out yelling that she was reporting me to the medical board so that they will “take your license away!”

Do I think that this will amount to anything? No. Am I worried? Yea. Making an anonymous complaint to the board is as easy as picking up the phone. I’ve talked to physicians who’ve been the target of board investigations and even if the complaint has no merit the attitude of the investigators is that the physician is guilty until proven innocent. To make matters worse the investigators appear to be RNs and other non-MD medical professionals who hate doctors in the way librarians hate children and noise.

The board need not adhere to investigating the original complaint. Will they review my charts and find an addendum note that I forgot to date and sign? I understand the increasing public clamor to discipline problem physicians but despite what many may think there is no evidence that turning state medical boards into doctor hating institutions will make the public any safer. What this does do is to make my job all that more difficult and stressful.