Doctor malpractice sanctions

Federal and State laws and regulations and private sector medical entities have established many methods to discipline and sanction errant members of the medical profession.

Three major activities serve as possible indicators of the quality of medical care:

• disciplinary actions taken by State medical boards,
• sanctions recommended by utilization and quality control peer review organizations
• (PROS) and imposed by the U.S. Department of Health and Human Services (HHS), and
• malpractice compensation, particularly court awards.

Disciplinary actions by State medical boards, PRO/HHS sanctions, and malpractice compensation, either separately or in conjunction with each other and other indicators, may have the potential to identify physicians who do not follow accepted standards of care.

Those physicians who are disciplined, sanctioned, or successfully sued for malpractice may actually provide substandard care.

On the other hand, not all physicians who provide substandard care are disciplined or successfully sued. Studies of avoidable injuries indicate that the universe of avoidable adverse outcomes may be significantly greater than the number of disciplinary actions, sanctions, and malpractice suits.

These studies suggest a large number of poor-quality physicians are not identified or penalized, thereby pointing to the ineffectiveness of existing systems to identify all those individuals providing poor-quality care.

There is a need to evaluate the reliability and validity of disciplinary actions, sanctions, and malpractice compensation as indicators of the quality of care.

Evidence on reliability and validity is derived from examining the structure of the legal bodies,
the grounds for taking actions, the procedures used in taking actions, and the types of actions
taken.

In the case of disciplinary actions by State medical boards and PRO/HHS sanctions, judicial review of the actions is also examined.

The reliability and validity of disciplinary actions, PRO/HHS sanctions, and malpractice compensation as indicators of the quality of medical care depend to a large extent upon peer review.

Differences in criteria used by peer physicians, even experts, in making decisions about medical diagnosis and treatment are well documented.

Such differences may have troublesome implications for the reliability and validity of expert peer opinion in disciplinary actions taken by State medical boards, sanctions recommended by PROS and imposed by HHS, and malpractice compensation.

Next read about validity of disciplinary actions, sanctions, and malpractice compensation as indicators of the quality of care.