Medicine

What if the DMV were like the state medical board?

By Chris Rangel MD ⋅ June 3, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

What it boils down to is the fact that the state medical board is a solely reactive and overtly political institution dependent almost entirely on complaints to deal with problem physicians. It’s likely that most of the complaints to the board are not legitimate or the investigation cannot find grounds to “punish” the physician (one patient threatened to turn me into the board for “making” her wait almost two hours for her visit). It is also VERY likely that only a very small percentage of “problem physicians” are caught or reported even when they cause harm to patients or put them at risk.

Therefore the board is left with no choice but to come down extra hard on those physicians who they do “catch” so that they can give the appearance that they are “protecting the public” in order to satisfy their political mandate.

Since most lay people don’t understand what the big deal is let’s consider the following analogy*; what if the DMV was like the state medical board? In this system the police would no longer patrol the streets on the lookout for bad drivers, speeders, etc. The only way to get caught is if you crash or someone reports you (for speeding or reckless driving for example). Most complaints would be minor or baseless or have too little evidence available and so the DMV would be awash in a backlog of mostly worthless complaints.

You, in this hypothetical scenario, are a good driver and almost always obey the traffic laws, unlike those jerks you see everyday speeding and driving dangerously (you don’t report them because you don’t think it will make any difference).

One day you are late for an important meeting and using bad judgment you speed. Even though you do not crash you do get reported by two other drivers. You are called to meet with the DMV and since it would cost $10,000 + to hire your own “DMV lawyer” you don’t bother with getting one. After all, it’s just a speeding ticket! But when you get to “traffic court” you find that it’s actually an informal meeting with a DMV representative and two DMV lawyers.

At first they berate you saying that your actions could have caused multiple deaths and that you are likely a chronic speeder who has put the public at risk on many other occasions but were lucky enough not to get caught. You protest by pointing out that your driving record is otherwise completely clean. You remind the DMV that several people have written letters to the DMV on your behalf stating that despite this one incident you are a very good and safe driver and in good standing in your community.

You apologize to the DMV and promise that it won’t happen again but the DMV threatens to go so far as to revoke your license. Then they appear to back down and offer you a “deal”. They will forgo their threat to revoke your license if you agree to the following; Your license is temporarily suspended for 90 days. You will have to pay a $5,000 fine. You will take 24 hours of defensive driving courses. Your license is placed on five years probation during which you have to regularly provide the court with documentation of your good driving record and randomly every 1-2 weeks an officer of the court must ride with you (at your expense of $20/hour) for an entire day wherever you go to ensure that you are obeying every traffic rule. During the period of suspension a second traffic violation no matter how minor automatically results in your license suspension for a year or more.

Because this disciplinary activity by the DMV is public record it’s not long before your name appears in the local paper under the heading of “unsafe driver; a threat to public safety” in a list that also includes people who have lost their license after being convicted of intoxication manslaughter. The public information on your violation is vague at best and does not say anything about your otherwise clean record. This leads readers to assume that you must be a really dangerous and negligent driver to have been disciplined by the DMV and that there must be other more serious details that were not included in the short blurb.

You are stunned at the severity of the actions by the DMV and correctly assume that the court is doing this to make it appear that they are “being tough” on speeders. You know that the DMV is trying to send a message that speeding can kill and cost you your license by using your case as an example. You are furious but to fight this ruling would cost tens of thousands of dollars, take years, and likely be unsuccessful. To make matters worse, your livelihood depends upon being able to drive and the brief suspension and harm to your local reputation as a “bad driver” begins to take a toll on your business.

Now everyday as you crawl to work at 50 mph you see other drivers passing you by doing 90 mph or more and dangerously weaving in and out of traffic. It is painfully obvious to you that this sort of “judge Roy Bean” justice of making examples of poor bastards like you is not working at all to deter speeding and dangerous drivers. However, it does seem to be working to make the DMV popular as a “protector” of the state’s lawful drivers.

This is how the Texas State Medical Board does business and I haven’t even touched on how it stonewalls and mistreats physicians who have histories of mental illness or substance abuse but who have recovered and are no longer treats to patients.

So fine! Right? The medical board SHOULD deal harshly with every complaint! After all, we are talking about people’s lives and health here! Right? Well yea, but has it ever occurred to you why speeders and dangerous drivers don’t get the same treatment like the theoretical scenario I presented above? About 43,000 people die in the US each year and most of those are alcohol and/or speed related and yet the US has some of the most lenient laws regarding speeding and impaired driving of any industrialized nation in the world (in general, penalties in the US are based on prior occurrences while in other courtiers the penalty is based on the severity of the violation).

Bad and impaired physicians can certainly be a threat to patient safety but when was the last time you heard of a bad or intoxicated physician going into an exam room and causing the deaths of an entire family? Yet this happens with drivers all the time and often involves people who have a record of multiple speeding citations and/or accidents. So why the unequal justice? Here we have two licensing systems where the potential exists for rules violators to cause serious harm and death but while first time speeders get a slap on the wrist physicians who forget to date and time a note get their name in the paper.

Part of the reason is political. While there are only about 38,000 or so physicians in the state of Texas there are 13 million licensed Texas drivers. Guess which group the legislature is more afraid of pissing off? And if you ask the average Texan if the state medical board should be more lenient on first time physician offenders you are more likely to get a response along the lines of “No way! Get rid of all the bad docs!” But you get a much different response if you ask the same person whether they should get a harsher punishment for their first time speeding ticket.

Keep this in mind. My point here is not to suggest that the state medical board become much more lenient on first time offenders but to highlight the frustration that physicians feel when they become targets of what they see as a licensing agency acting more politically than practically. So if you are one of those who don’t understand why physicians hate/fear the state board AND you have ever been ticketed for a moving violation then I suggest that you voluntarily stop driving for 90 days and donate $5,000 to charity because statistically you are just as much a threat to public safety as a physician with a minor violation and/or or first time offence.

*For the purposes of this analogy the physician offense would be something like speeding i.e. is not a serious violation of the law (felony offence), does not result in injury or death, and does not involve multiple prior complaints or conspiracy to defraud or otherwise place patients at risk.