GA Medical Board Rarely Gets Tough With "Bad Doctors"

By Hal Straus

Staff Writer

In Cochran, the doctor refused to examine a field hand complaining of chest pains because the man had no money or insurance, according to an emergency room nurse. Two hours later, the field hand was dead of a heart attack.

In Cornelia, the surgeon stitched up a patient's aorta, cutting off blood flow to his legs. The patient, 24, now is paralyzed below the waist.

In Macon, the doctor wasn't at the hospital while his 4 year old tonsillectomy patient slowly bled to death, according to the child's mother. In Carnesville, the doctor was found negligent by a coroner's jury after the death of a 6 year old patient.

And in College Park, the physician made a surgical career of enlarging women's breasts. Other doctors said he was neither qualified nor competent to perform such surgery. Patient complaints ranged from lumpy, unequal-size breasts to an oversize implant that began to extrude from a partially healed incision.

Each of the five doctors settled malpractice suits arising from the incidents described. Each has settled at least one other medical negligence suit during the past decade as well. The College Park physician has settled seven.

Four of the doctors are still licensed to practice medicine in Georgia. The fifth died two years ago, never having been disciplined by the State Composite Board of Medical Examiners.

The medical board, which regulates 12,500 physicians and osteopaths, is the toughest of the Georgia's professional examining boards.

It was responsible for almost a third of the disciplinary actions meted out by all 37 of the Georgia boards during an 18-month period ending in June.

But the statistics do not mean the public can count on the medical board for protection against bad professionals, based on a review of whom it has disciplined since 1979, how it has disciplined them and whom it has not disciplined.

While racking up an impressive array of sanctions against doctors who over prescribe or become addicted to drugs, the medical board rarely moves against doctors who are just plain bad.

"You know there's poor practice that doesn't involve drugs. You know there's more than we're getting." Says Dr. James Anthony, the board's medical coordinator and in-house investigator. "It bothers me. It bothers me more than just about anything else. But those cases are so darn difficult."

Lack of funds, lack of lawyers and the inherent difficulty of defining in competency sometimes hinder efforts to police the medical profession, say board members and staff. A reluctance by patients and health care workers to complain, then testify about bad doctors also is a problem.

Advocates of regulatory reform, however, question whether money or inclination is the primary problem.

"There is a failure to monitor practice. I don't think they really need to and this is everywhere, not just Georgia," says Ben Shimberg, a researcher for the Educational Testing Service and a nationally recognized expert on professional regulation.

To Tim Ryles, who headed Georgia's Office of Consumer Affairs, under former Gov. George Busbee, the fundamental problem with the medical board is it puts doctors in the position of disciplining colleagues.

"Each profession likes to say they're the only ones able to judge competency, but that just doesn't hold water," says Ryles. "Once you decide that regulation is in the public interest, then you ought to have the public making the decisions, not people who are part of the group being regulated. Otherwise, you're going to have abuse."

Iona Shirah says her daughter "had a bad feeling" about the doctor who removed her appendix Nov. 4, 1972, at Memorial Hospital in Waycross.

"She told me 'Mama, I don't trust him.' said Mrs. Shirah, "But I said Catherine, appendicitis aren't nothing.' Oh Lord, I wish I hadn't said that."

Seventeen days later, Mrs. Shirah's 23-year-old daughter, Catherine Laverne Gill, was dead.

According to a suit filed by Mrs. Shirah, her daughter died because Dr. Malcolm McGoogan did not perform an appendectomy correctly and because he failed to treat various complications, including internal bleeding and infection, until it was too late.

Documents filed in the case allege that McGoogan failed to take the advise of a consulting doctor and perform exploratory surgery to find the cause of the complications until seven days after the advice was given, and 17 days after the initial operation.

McGoogan says he was not negligent in the case. "It was a terrible thing," he says. But he settled the suit July 11, 1974. According to Mrs. Shirah, the settlement came to $85,000.

Nine years later, after an investigation by the medical board, McGoogan signed a consent order in which he agreed to treat only two patients and otherwise not practice medicine.

By the time he signed it, though. McGoogan, 64 had retired.
"I retired about four months before they talked to me," he says.

And in the years since the first malpractice settlement, he had settled four other malpractice suits, each time denying negligence. "You feel terrible when there is a bad result," "And when someone sues you, you feel even worse. I sued to think the only time somebody sued you was when you were wrong, but nowadays things have certainly changed. "They'll sue you for anything."

One of the four suits alleged that the doctor was negligent in his treatment of a worker who caught his hand in a piece of machinery. The worker developed tetanus and later died of complications.

Other suits accused McGowan of failing to recognize or treat internal bleeding after operating on a Ware County woman, and performing unnecessary thyroid surgery on a Ware County man. Both patients died.

The final suit McGoogan settled alleged that while performing a colostomy in 1881, the doctor connected a man's colon to his bladder. "It was an honest mistake," says McGoogan. "That was simply that you couldn't tell the difference. They were in so close together."

More doctors disciplined

The medical board today is a far different organization that the one that existed eight years ago, when Busbee asked the board's chairman to step down following newspaper reports that he obtained his medical degree and doctor's license by submitting fraudulent documents.

In 1978, the board more than doubled its license renewal fee, allowing its budget which cannot exceed revenue generated from fees-to rise. In 1980, it got its first consumer member, required under legislation sponsored by Busbee and appointed, like all board members, by the governor.

The board sought and received tougher laws in the area of doctors' prescription writing privileges in 1982, and even a law making the frequently abused drug methaqualone illegal. It moved in 1983 to require insurance companies to report all malpractice settlements above $10,000 and hospitals to report all medical staff resignations.

The results have been dramatic. In 1979, the board publicly disciplined 21 doctors. In the first six months of this year, it imposed 24 public sanctions.

That increase, however, has been achieved largely by going after physicians who overprescribe narcotics or who become addicted to drugs or alcohol.

Of 154 public sanctions issued between Jan. 1, 1979, and June 30, 1984, 13 were imposed for reasons of incompetence and poor patient care. The vast majority were for overprescribing drugs, or for drug or alcohol addiction.

"The drug cases are simple," says Andrew Watry, the medical board's executive director. "Quality of care, they're tough."

For one thing, patients and co-workers tend to complain about doctors who appear drunk or under the influence of drugs, Watry says, giving the board something to look into. Routine audits of pharmacy prescription records, by state and federal law enforcement officials are another source of complaints.

Drug cases are relatively easy to prove and they usually hold up later in court, "There's usually a clear trail of evidence the prescriptions," says Watry.

Quality of care cases, such as the ones mentioned at the beginning of this story are another matter.

"We get a rash of complaints on improper prescribing habits, substance abuse problems, from the public, nursing personnel, office personnel," says former board Chairman Joseph Vinci. "But we don't get that many on doctors not practicing the best brand of medicine. I just don't think people are that willing to ability to cast aspersions on a doctors' ability."

When complaints are received, they are frequently hard to document.

"There's not a sharp line," says Watry, "Sex with a patient? That sounds bad, right? Well, I guarantee you, that if you went after somebody for that, he'd get an expert in here, with all the right degrees, who'd say, "Well, that's not so bad. Doctors have needs, It's not really hurting anyone. I guarantee it."

Finding doctors willing to testify against a colleague, a prerequisite for imposing sanctions, is easier than it once was, according to the board's medical coordinator, Anthony, but still no picnic.

He tells the story of one recent incompetence case in which he asked 16 doctors to review a physician's patient care records before finding one who would do it. After reviewing the charts, that doctor concluded the physician in question was indeed consistently misdiagnosing and treating patients poorly.

So I said, 'Great will you testify?' and he said, 'Heavens, no.' We were back to square one."

'Anthony's Law'

Under Georgia law, doctors sanctioned by the medical board have the option of challenging those sanctions in civil court.

To the physicians involved, the court is a vital safeguard. To medical board members and staff, it is often a discouragingly high hurdle.

A notorious case in the mid-1970s involved a Richland doctor whom the board accused of bad surgical practice, not treating patients he had admitted to the hospital, and leaving the country without making arrangements for his patients' care.

After reviewing some 200 patients charts, the board voted unanimously to revoke Dr. William Calhoun's license, but a Superior Court Judge quickly stayed the sanction on a procedural question.

The board reaffirmed its action in front of dozens of the doctor's supporters. The judge then overturned that decision, saying the sanction was too severe.

Convinced they could not win their case, board members agreed to let the doctor practice, provided he agree not to perform major surgery.

"We have a law, the girls in the office call it "Anthony's Law." It says that the worse a doctor is the better people at home like him, and the more likely he'll win in court," says Anthony.

But others defend the legal procedures that govern disciplinary actions.

"There's a balance in administrative proceedings, an appropriate balance," says Melvin Goldstein, a lawyer, who frequently acts as a hearing officer for the boards.

"You have to protect the public's health, safety and welfare. But at the same time, you have to ensure that the professional's right to defend himself is protected."