Keeping Doctors Honest

THOUGH CONVICTED of rape last June, Harvard-affiliated doctors Arif Hussain. Alan Lefkowitz and Eugene Sherry apparently can still officially practice medicine. The reasons for this amazing paradox: the review process for convicted doctors is so beset by red tape and cumbersome regulations--and the state licensing board is so underfunded--that many physicians more qualified for jail than office hours can continue practicing medicine indefinitely.

In 1981 about 160 complaints filed against licensed doctors with the state licensing board were serious enough to warrant an investigation. But because the board is so hamstrung by insufficient funding it failed to investigate thoroughly all the cases that came to its attention. To make matters worse, excessive regulations effectively forbid the board from fully suspending physicians while they are under investigation; many who should be painting houses continue treating patients.

The board will hear complaints ranging from practicing medicine drunk or without a license to being insane or being convicted of a felony. But no matter what the charge, it must follow the same protracted and complicated review process of investigations and hearing before disciplining a physician. Ironically, a doctor guilty of gang rape and one who may have botched a starlet's nosejob receive identical--and lenient--investment.

The review process is complete and does issue that a case is thoroughly investigated before punishment is moved out. But in some cases, the safeguards against capricious board ruling are unnecessarily restrictive. The board is right to tread slowly in considering cases raising important medical questions of an individual's competence, possibly malpractice, or even drinking habits. But in cases involving doctors who have already been convicted of crimes, the board's scrutiny should be much shorter and quicker. Had the board been empowered to review in speedy fashion a doctor's case immediately after his conviction, Arif Hussain could never have quietly obtained a position on the staff of the Buffalo Children's Hospital some two months after his trial ended, while his case was awaiting appeal. And an embarrassing controversy surrounding the colleagues who recommended Hussain for his Buffalo post would never have erupted.

WHEN LEADERS of the medical profession are increasingly worried about maintaining their public reputation for competence--and are scurrying to dispel the image of some physician as drug addicts--it is silly to waste time investigating a physician whose case has already been decided. Obviously it should never revoke in a knee-jerk reaction to a felony conviction; no punishment should be that automatic. But if, for example, the law required court clerks to send the review board a transcript of the trial along with the notice of physician's conviction--and if the board were willing to simply review the case instead of rehashing the trial in a separate investigation--the process would never much smoother.

Richard Neidinger, an investigator with the board, says his office is anxious to discipline convicted doctors more efficiently but is bogged down by the lengthy administrative process and underfunding. "If [a doctor] is convicted of something serious enough, we would try to get that license." But although" you see physicians getting convicted of felonies in the paper all the time," he says, "not a whole lot" actually have their licenses revoked--thanks to a lengthy review process in which the doctor under investigation can take all sorts of time to "go out and get the biggest legal guns in town."

The bottom line--the statistics the board keeps--shows just why Neidinger and others are frustrated. Although about 25 doctors a year are convicted of felonies, fewer than five ever actually lose their licenses. For those few who are stripped of their license, revocation comes only after a drawn-out process that can take up to five years.

Massachusetts Medical Association President Dr. Stanley M. Wyman argues that the board's understaffing has severity damaged both the medical profession and the community in general. "It seems fairly evident that we could use, more investigators and we could stand a bigger staff all around," Neidinger contends. Explains Wyman: "There are 20,000 physicians in the state of Massachusetts, each one of whom pays a $100 yearly registration fee. That money goes into the general fund. You'd think more of that money could go to the registration board where it is needed." The board's annual budget is only about $300,000. The implication of these shortcomings seem evident.

As the dean of a leading medical school said recently. "The relationship with a doctor is different than the one you have with a plumber. "The state must be freer to protect that relationship.