Suggestions to Resolve the Problems;
Clearly the current arrangement with the NCMB being selected largely from the NCMS, which only represents a third of NC medical providers and the NCPHP which is supposed to receive oversight from the NCMS doesn’t work and is a setup for corruption.
The following are suggestions that have been thought out by the group that has done the extensive review of over a decade of NCMB actions while observing the effects/lack of effects brought about by the NC Office of the State Auditor’s action/inaction on the NCPHP.
The involvement of the NCMS is corrupt; when numerous licensees report that the first question they are asked when appearing before a committee of the NCMB is whether or not they are active members of the NCMS, a red flag goes up. Add to that the lawsuit in 2007 that was settled out of court without any recording of the settlement reached demonstrates that this has been an ongoing problem of the “corporate culture” of all three entities.
The next entity of corruption would be at the NC State level of governance and oversight—or more descriptively, the lack thereof.
of no consolation to note that throughout the US, other professional boards,
societies and PHP’s have very similar issues.
Perhaps the biggest shortcoming is that Board members have abdicated their responsibility to the legal staff of the Board’s, which correspondingly grows in size and power enjoying the incestuous relationship created by the cozy arrangements with the Medical Societies and PHP’s.
To that end:
1. Regarding the NCMB;
a. There needs to be a complete replacement of every Medical Board Member, effective immediately. They’ve demonstrated their inability to do their job. The doctrine of “Captain of the ship” holds true in this regard every bit as much as it does in any clinic, hospital and surgical suite. Their licensees have been held to this standard, they need to be held accountable as well. Prior Board members going back at least 10 years need investigation as well.
b. Each Board member needs to have a thorough review of their involvement including not only crimes of commission but crimes of omission as well. Punitive action needs to be taken with no less severity than has been inflicted upon their licensees/wounded healers.
c. The professional staff of the Medical Boards such as attorneys, investigators, administrative staff and others need to be held to the same accountability standards, criminal and civil review and prosecution/accountability/liability. These parties should be held liable criminally and civilly for what has transpired without sovereign immunity due to their malice.
d. Incarceration of an appropriate time span and facility will go a long way to correcting the problems that have evolved in the current corporate culture of corruption. The NC Attorney General is charged with defending state agencies & employees. This agency cannot be the prosecuting agency. Investigation & prosecution should either be done by the Wake County District Attorney or preferably done Federal authorities and courts.
e. All current professional and administrative staff of the Medical Board need to be replaced completely and immediately to end the culture of corruption.
f. All current & past (for at least the past decade) Board Member Professional Staff should be investigated criminally, held fully accountable, be treated appropriately with incarceration where indicated and loss of licensure per the NC State Bar Association, be it by suspension or revocation. This treatment needs to be monitored by the NC Attorney General or preferably by Federal authorities. These people should NEVER be returned to the position in which they committed such criminal damage to the medical providers and loss of life greater than that caused by any allegedly “impaired” provider who they have victimized.
g. The new Medical Board should carefully review and hold accountable prior Medical Board & PHP practitioners without mercy.
h. Criminal charges need to be pressed against any and all appropriate parties no matter their level of involvement in the process.
i. Civil damages need to be assessed as indicated against each and every party culpable.
j. There should be a new category of licensee; “fee-exempt” for those who have been treated unfairly. This would serve notice for any future contemplated action that the Board has unfairly treated this provider in the past. In cases where there is a borderline concern of wrongdoing, this may well be the deciding factor on the pursuit of any individual provider’s alleged wrongdoing.
k. From this point forward the NCMB should be required to adhere to policies such as;
1. Any future Medical Board Member, Professional Staff or Administrative staff that is caught “providing cover” for another party in that organization shall have all punitive, criminal & civil actions doubled. This will help maintain accountability.
2. There should be a rotating Clinician Board Member in the Raleigh office at least 3 days each week to maintain oversight.
3. On-site clinician Board Members should receive fair, standardized compensation for their service in consideration of their time away from their practice during the period that they serve as the “active in-house” member.
4. The on-site clinician Board member should review every complaint made to the NCMB prior to it’s review by any member of the legal staff receives it.
5. The on-site clinician Board member should then assign an investigator as necessary and follow up with the findings of the investigator
6. Only after appropriate investigation and review by the on-site clinician board member and at that members direction, should an investigative committee be formed to review cases that require further review. Cases of no significance should be recorded in a private file—not necessarily the file of the clinician involved and signed off on by the reviewing clinician Board Member.
7. The Legal Department & staff of the Board should be reduced in size as appropriate.
8. Consideration of creating a system in which Board attorney’s cases are reviewed on a routine basis by a panel of the legal department director and one or two other attorneys that were not involved in that particular licensees case.
9. The legal department director should ensure that all licensees are treated equally; one party should not receive a “Private Letter of Concern” for the same offense that another party receives an “Indefinite Suspension”.
10. “Consent Orders” should become a rare option.
11. There should be a readily available system for a licensee to contest any inaccuracies, irregularities or inconsistencies in their documentation.
l. The current appellate process to Wake County Superior Court seems inadequate & ineffective at best. Ideally, there should be an appeal to a Federal Medical Board. Since this does not exist at this time, consideration should be made to either;
1. Simplify/encourage the process to access the Wake County Superior Court
2. Hold the NCMB liable for all legal fees incurred from the moment of notification of existence of information for each case dismissed by the Wake County Superior Court to discourage frivolous actions
3. Consider using the NC Institute Of Medicine for an ongoing role in a supervisory process for the NCMB
2. Regarding the NCPHP;
a. The NCPHP should have its Board of Directors replaced. Just as the current Medical Board allowed this malfeasance to occur and continue, the NCPHP Board of Directors is equally guilty.
b. The NCPHP Board of Directors should be investigated for crimes of commission and/or omission and treated appropriately.
c. The NCPHP Board of Directors should be held liable criminally and civilly for what has transpired without sovereign immunity.
d. The NCPHP Clinical staff & investigators need to be replaced immediately as does the Board of Directors.
e. The NCPHP administrative staff should have full investigation and replaced as indicated as a result of the investigation.
f. Review of the NCPHP’s actions should extend back at least a decade.
g. Evidence of collusion between the NCPHP, it’s referral centers, the NCMB & NCMS should be especially sought after and dealt with, preferably by Federal authorities.
h. Appeals/Problems with the NCPHP should be directed to the Wake County Superior Court or to the NC Institute of Medicine (IOM).
i. A disciplinary process for the NCPHP needs to be put into effect to discourage future abuse as has occurred to date.
i. The NCPHP should lose any tax-exempt status and be funded entirely by the NCMB with future oversight from the Joint Commission for the Evaluation of State Programs and/or the NC IOM
j. The State of NC should be held directly liable for any future wrongdoing by the NCPHP.
3. Regarding the NCMS;
a. Any association with the NCMB needs to be terminated immediately. The NCMS represents less than a third of medical providers in the state.
b. The NCMS needs to be held liable criminally & civilly with a review extending back at least a decade.
c. The NCMS should have no involvement in the future with either the NCMB or the NCPHP.
d. The NCMS should lose any tax-exempt status
4. Selection of future NCMB members;
a. Interested parties should be encouraged to contact the office of the Governor who would assign a committee to review the parties who apply for the position
5. Regarding Licensees;
a. Licensees prosecuted under this corrupt system should be pardoned immediately in all but the most egregious cases.
1. Our research has not disclosed a single incident of patient harm.
b. The vast majority of these cases involved substance abuse, which is a disease and is largely covered under the Americans with Disabilities Act (ADA)
1. The ADA mandates accommodation, not punishment for disabilities.
c. HIPAA-Protected Health Information has been violated in the case of the vast majority of these licensees.
d. National Practitioner Database (NPDB) reports have been filed against these licensees.
1. These reports follow the licensee throughout their career, across state and national lines, for the remainder of each career.
2. These reports were malicious and either severely distorted or outright false with little, if any basis in truth.
3. These reports cause irreparable harm to the licensees.
e. Licensees have been subjected to incalculable damage.
1. No rational third party would believe that such activity by a supposedly impartial agency such as a state medical board could ever possibly occur.
2. The first casualty to a licensee is their own sense of identity and self-esteem.
3. Loss or severe restriction of employment and professional capacity occurs.
4. Loss of financial income, means to support self & family comes next.
5. Indefinite periods of unemployment without any way to gauge potential length of discipline is another great hardship
a. Should one abandon medicine forever altogether and search for a new career or will the licensee eventually be able to return to some form of practice in their chosen profession?
b. Disability-Income insurance is often unavailable after adverse disciplinary board actions
c. The parties at the board responsible for this behavior recognize the duress that this calculated tactic imposes upon its victims and use this intentionally for maximum effect/damage.
d. The licensee’s practice will likely be lost, if employed, loss of job, pension/retirement/health insurance all occur in short order.
e. Without means of support, the practice location/office will be lost if the licensee is an owner of the facility
f. Loss of home occurs without the means to continue making mortgage payments.
1. Future increase in value of this investment is thus lost.
2. Current equity is lost as the property invariably is sold in a distressed manner.
f. Frequently, divorce also accompanies all of these other issues due to the immense stress such actions cause to each member of the nuclear and extended family structure.
g. At the very least, each licensee case going back at least a decade needs to be reviewed carefully for lack of due process of any type. As soon as any lack of due process, proper procedure or evidence of prejudice or other wrongdoing is noted, the case needs to be dismissed or re-heard as appropriate.