Medical Licensing in Missouri

The Post-Dispatch is currently publishing a thorough series about how the Missouri state medical board disciplines doctors for medical errors or other crimes in Missouri. I commend the Post for the detail that the series includes. I, like a lot of people, think that long-form investigative journalism is the type of content that will keep newspapers a part of our lives going forward. You can’t just replace a series like this with bloggers.

There is a lot of good information in the series, and there are some solid recommendations for improvement in medical care. There are also some suggestions that make no sense at all, and the articles take some harsh and inaccurate shots on people I have known for a long time. For example, I don’t think there is anything wrong with a lawyer who represents doctors in civil cases serving on the medical licensing board. However, should the board itself have more than one public member? That is another question, but a good one raised by this series. I think the answer is that it should, which is similar to what I recommended a while back for judicial appointment boards.

This is the first time that I have blogged about a story in which my own dad is quoted, although the quote itself is not germane to this post.

The heart of the story is that Missouri’s medical licensing system is not strict enough. There are some frightening stories here about how doctors who have harmed people can continue to practice, leading to greater harms. Closely related are stories about doctors who have committed crimes unrelated to practicing medicine, who also continue to practice.

Not surprisingly, the series has led to calls for the licensing board to toughen up the penalties for doctors. That is different and more defensible than calls to toughen up the licensing of doctors in the first place. However, I think that the best improvements are the ones that involve making more information about doctors available to the public so that patients — and hospitals who hire doctors — have better data available all along. As Sen. Bill Stouffer said, in a quote with which I entirely agree:

State Sen. Bill Stouffer, R-Napton, said changes to the state laws should start with making the letters of concern a public record and allowing patients to compare doctors’ performance.

“I think transparency would cure a lot of our problems in health care,” Stouffer said. “It’s amazing what the light of day cleans up.”

We do have a system in which doctors who harm patients can be held accountable. It is our very robust civil court system. I supported tort reform back in 2005, but even with those needed changes, doctors that irresponsibly treat patients can still be readily held accountable. Is that enough, though? Do we need tighter changes to state criminal penalties and licensing restrictions in order to monitor medical care?

If those changes involve improving the information available to everyone, then I support them, although I understand that concerns of doctors who would fear that some members of the public would not be able to tell the difference between a bogus malpractice suit and a legitimate claim.

If the changes involve restricting the license to practice medicine for those convicted of a crime related to medical care (i.e., sexual abuse of patients, or Medicare fraud), then I can also support that. If the changes involve restricting the license to practice for those convicted of a crime unrelated to medical care, then I have to question the benefit of stripping their license. If they commit a crime, they should receive the proper punishment for that crime. I fail to see why, after they have served the punishment for that crime, they should not be allowed to earn a living in their profession. A person who does not pay taxes on their rental property at the Lake of the Ozarks should be properly punished for that, but not prevented from filling my cavities or diagnosing the debilitating case of globophobia I currently suffer from.

So, don’t come after me and ask whether I think a child rapist should be allowed to practice medicine, because child rapists should receive prison terms long enough to make the practice of medicine moot.