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Tuesday, October 9, 2007

Doctor Discipline in Texas: A First Look

There's been a lot of talk about the New York Times story about the liability changes in Texas, and whether the increase in disciplinary actions coinciding with an increase in doctor licensures should be seen as an indication of a problem.  One way to get a hint about this is to look at the discipline that's taking place.  If it's disproportionately of new doctors (i.e., those coming to Texas since 2002), that might indicate that the reduction in exposure to potential liability is indeed attracting more negligent doctors.

I have a research assistant doing a more complete look, but just for a glance, I checked the licensure dates of the eleven doctors disciplined recently for quality of care violations.  (The press release is here.  The research assistant will look at all discipline that took place so far in 2007 and all that took place in 2002; if the results are interesting enough either way, I may expand the project.)

Below, I've pasted the press release discussion of the eleven cases and added in the year of medical school graduation ("Grad") and of obtaining a Texas medical license ("TXL").  In some cases, there's a later "registration" date; I have included the license date only below, since I'm assuming that the registration date is an administrative question.  If I'm wrong, please tell me.

    •     CARLSON, DAVID W., GARLAND, TX, Lic. #H0233 Grad: 1985 TXL: 1986
On August 24, 2007, the Board and Dr. Carlson entered into an Agreed Order  requiring Dr. Carlson to obtain 12 hours of CME in cardiovascular disease  and payment of an administrative penalty of $2,000. The action was based  on Dr. Carlson’s inadequate treatment and monitoring of a patient with  atrial fibrillation.

    •     CHANG, JUNE-CHIEH,  M.D., CONROE, TX, Lic. #K4020 Grad: 1972 TXL: 1997
On August 24, 2007, the  Board and Dr. Chang entered into a three-year Agreed Order requiring that  he have his practice monitored by another physician, complete a course in record-keeping, and complete an additional 10 hours of CME in pain management  for each year of the order. The action was based on Dr. Chang’s failure to  maintain adequate medical records, failure to examine whether treatment  followed was effective and if there were any alternatives to that  treatment, and inadequate monitoring of medications prescribed.

    •     DAVIS, JENNIFER L., M.D., CORPUS CHRISTI, TX, Lic. #J4070 Grad: 1992 TXL: 1993
On August 24, 2007, the Board and Dr. Davis entered into an Agreed Order  requiring that she complete 10 hours of CME in risk management and that  she pay an administrative penalty of $1,000. The action was based on Dr.  Davis’s inappropriately prescribing antidepressants to herself and a  family member.

    •     ELDERS, GREGORY J.,  M.D., GRAPEVINE, TX, Lic. #L8677 Grad: 1999 TXL: 2004
On August 24, 2007, the  Board and Dr. Elders entered into a three-year Agreed Order requiring that  Dr. Elder not treat or provide medications to his immediate family or himself, that he maintain a logbook of all prescriptions for controlled  substances or dangerous drugs with addictive potential or potential for  abuse, and that he complete an eight hour course in medical record-keeping  and an eight hour course in ethics/risk management. The action was based  on Dr. Elders’ inappropriate prescribing of medications to family members  without maintaining medical records.

    •     HOZDIC, RICHARD L.  II, M.D., ATLANTA, TX, Lic. #J8587 Grad: 1994 TXL: 1995
On August 24, 2007, the Board and Dr. Hozdic entered into an Agreed Order  requiring that Dr. Hozdic complete 10 hours of CME in the area of  pediatric ENT emergencies and that he pay an administrative penalty of  $1,000. The action was based on Dr. Hozdic’s failure to adequately treat a  patient who had a pebble lodged in his ear.

    •     MASSEY, WARNER,  M.D., GRAND SALINE, TX, Lic. #D6084 Grad: 1969 TXL: 1969
On August 24, 2007, the  Board and Dr. Massey entered into an Agreed Order which is an addendum to  his February 16, 2007 Order and requires that Dr. Massey complete an additional 10 hours CME per year in pain management, 15 hours CME per year  in the areas of psychiatry or psychiatric illnesses, and that he purchase  and use a PDA in his regular practice with PDR/medical software installed.  The action was based on Dr. Massey’s failure to adequately treat two  patients with chronic headaches and anxiety.

    •     MONTELONGO, JUAN  A., M.D., EL  PASO, TX, Lic. #H6445 Grad: 1988 TXL: 1989
On August 24, 2007, the  Board and Dr. Montelongo entered into an Agreed Order publicly  reprimanding Dr. Montelongo and requiring the completion of 30 hours total  in courses related to risk management, pediatric emergencies, and  pediatric surgical conditions; passage of the Texas Medical Jurisprudence  examination with a score of at least 75 within three attempts; completion  of an Advanced Pediatric Life Support Course and Pediatric Life Support  certification. The action was based on Dr. Montelongo’s failure to meet  the standard of care by sending a child patient, who presented with bowel obstruction and gastroenteritis, to the ICU without obtaining an emergent  surgical consultation to evaluate for an acute abdomen as a possible  source of sepsis.

    •     PETEREK, WILLIAM,  M.D., GALVESTON, TX, Lic. #D7384 Grad: 1970 TXL: 1970
On August 24, 2007, the Board and Dr. Peterek entered into an Agreed Order  requiring that Dr. Peterek’s practice be monitored by another physician  for two years and that he complete a course in record-keeping of at least  eight hours. The action was based on his failure to adequately treat three  patients with symptoms of hypertension, urinary dysfunction, and/or  prostatitis, and failure to maintain adequate medical records.

    •     ROJAS, PETER P.,  M.D., VICTORIA, TX, Lic. #D7276 Grad: 1970 TXL: 1970
On August 24, 2007, the Board and Dr. Rojas entered into an Agreed Order  requiring that Dr. Rojas complete eight hours of CME in medical  record-keeping and eight hours of CME in risk management, and that he pay  an administrative penalty of $2,000. The action was based on his failure  to meet the standard of care for a patient who underwent ulcer surgery, as  demonstrated by his failure to exercise diligence in his examination and treatment of the patient after the surgery and by failing to make and keep  adequate records of examinations performed on two dates.

    •     SMITH, JEFFREY S.,  M.D., MIDLAND, TX, Lic. #K3476 Grad: 1991 TXL: 1997
On August 24, 2007, the Board and Dr. Smith entered into  a three-year Mediated Agreed Order requiring that Dr. Smith’s practice be  monitored by another physician, that he complete a course in spinal  surgery of at least 20 hours and a course in medical record-keeping of at  least 10 hours, and that he pay an administrative penalty of $3,000. The action was based on Dr. Smith’s not obtaining a discography as part of the  pre-operative workup for two patients who underwent interbody fusions, and  for pre-operative documentation for a patient that did not consistently  document the presence of radiculopathy to substantiate surgical  intervention.

    •     WIENER, ISIDORO,  M.D., HOUSTON, TX, Lic. #G5769 Grad: 1977 TXL: 1983
On August 24, 2007, the Board and Dr. Wiener entered into an Agreed Order  requiring that the physician obtain 10 hours of CME in the management of  surgical complication. The action was based on Dr. Wiener’s delay in  performing a “second-look” laparotomy for a patient who underwent a  laparascopic lysis of adhesions and excision of a cecal cyst initially  completed without complication, but who subsequently developed complications.

So, of the eleven, one obtained his or her license since the medical malpractice liability modifications were put into place, Dr. Elders.  His degree was from the University of Michigan in 1999 (pre-modifications).  Performing a search in Michigan's database indicates that Dr. Elders did not have any disciplinary proceedings there.  His Michigan license was an "educational-limited" variety and lapsed in 2004.

One out of eleven seems roughly in line (or even low) with what you'd expect if the disciplinary proceedings were evenly distributed among physicians; as I noted earlier, doctor supply has increased by 22% since 2002.  [Update: Ted Frank reminds me that given the lag time in investigations, the disciplinary proceedings expected percentage increase would be less than 22%.]  Obviously, the absolute numbers are far too small to reach (or even hint at) any conclusions, but at least we can say that there's not a huge signal of a problem from that limited data set.

I will update as the project proceeds.

--BC

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Comments

And note that Dr. Elders was disciplined not for malpractice, but for shuffling prescription drugs to family members without appropriate recordkeeping. Subtracting the prescription-drug-recordkeeping violations, of the twelve cases of malpractice involving eight doctors, none were from new doctors.

NB that Texas law changed vis-a-vis the Medical Board in 2005, so there may be an apples-to-apples problem: it's not clear to me how much the scope of the Board's powers was expanded by the law, but that expansion may explain why the number of disciplinary actions went up.

Posted by: Ted Frank | Oct 9, 2007 1:27:41 PM

Texas is not a single entity - the Vaslley is a "Judicial HellHole" and there are distinct urban areas (Dallas, Houston etc.) and rural e.g. West and East.

The Excel file shows a lot of older docs.

Is the Board finding that "old dogs can't learn new tricks" and is it seeking to remove Old Docs, like Old cars?

Posted by: David | Mar 20, 2009 10:13:08 AM

Doctors should know their limitation.

-Kaylee

Posted by: pedriatric ENT | Jul 20, 2009 7:25:08 PM

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