The records include some criminal convictions.
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Photo used with permission of Anesthesia & AnalgesiaDr. Scott S. Reuben faked the results of 21 influential medical studies and served time in federal prison for healthcare fraud. But the Board of Registration in Medicine categorized his voluntary license surrender as non-disciplinary and erased his profile from its public database.By CALLUM BORCHERS
and STEPHEN KURKJIAN
Northeastern University Initiative
for Investigative Reporting
Sixteen years ago, it appeared that Dr. Scott S. Reuben, an anesthesiologist at Baystate Medical Center in Springfield, had found the holy grail of pain management.
In a series of 21 influential studies published between 1996 and 2008, Reuben wrote that a class of drugs manufactured by Pfizer and Merck could approximate the effectiveness of opioids during surgical procedures without the harsh side effects of medicines like morphine and fentanyl.
There was just one problem. Reuben, a paid speaker for Pfizer, faked the results of his studies.
He pleaded guilty to health care fraud in February 2010 and received a six-month prison sentence. But Reuben’s conviction was never entered in a public database maintained by the state Board of Registration in Medicine. Beside Reuben’s name, there is only the phrase “voluntary agreement not to practice.” And there is not even a cautionary flag, since the agreement is described as “non-disciplinary.”
The veil of secrecy afforded to Reuben is commonplace in Massachusetts. The state medical board has omitted or removed thousands of embarrassing records – and even some criminal convictions, like Reuben’s – from its physician profile database over the past two decades, according to an in-depth review of state records by the Initiative for Investigative Reporting at Northeastern University.
Among the cases unavailable to the public: a $2 million malpractice judgment against a physician whose negligence led to the death of a 22-year-old basketball player; the recent indecent assault conviction of a Methuen doctor; and a $24 million malpractice award against an obstetrician who caused irreversible brain damage to an infant girl during a delivery at Massachusetts General Hospital.
By almost any measure, Massachusetts is a national leader in medicine. In 1996, the state medical board became the first in the country to make doctors’ profiles public: http://profiles.massmedboard.org/MA-Physician-Profile-Find-Doctor.asp.
Back then, the board chairman proudly declared: “The informed patient, empowered by choice, is our best guarantee for quality care.”
But the board now lags well behind its counterparts in most other states, who have leapfrogged past Massachusetts in the transparency of physician performance:
For example:
- The Massachusetts medical board is one of only three in the country that take down physicians’ online profiles when doctors lose or fail to renew their licenses.
- Massachusetts is one of only four states that wipe doctors’ disciplinary and malpractice slates clean after 10 years. In addition, the board does not post disciplinary documents online, even though its counterparts in 36 other states do.
- The board makes no public disclosure when Massachusetts doctors are penalized by medical boards in other states, even though it is required by law to do so.
- The Massachusetts board is one of only seven that disclose clinical privilege penalties imposed by health care facilities. But the disclosure applies only to hospitals, and omits sanctions where an estimated 80 percent of medical care is provided – at medical clinics, outpatient surgical centers, nursing homes, and other non-hospital settings.
Linda DeBenedictis, president of the New England Patients’ Rights Group, expressed disappointment that the state board is withholding so much information from public scrutiny.
“It’s a system that favors physicians over patients, and it’s tragic,” DeBenedictis said.
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Callum BorchersDr. Stancel M. Riley, the medical board's executive director, defended the practice of removing disciplinary disclosures from physicians' profiles after 10 years. Discipline is posted permanently in 47 other states.Dr. Stancel M. Riley, the medical board’s executive director, asserted in a recent interview that the board’s philosophy “is to make as much information available to the consumer as possible because we think that keeps everybody safe.”
The seven board members, five of them physicians, were appointed by Gov. Deval L. Patrick.
Riley said there is no loss of transparency because the board wipes clean disciplinary and malpractice records after 10 years, and erases the profiles of formerly licensed doctors – even though few other states do the same. He called the 10-year posting window a “reasonable period of time.” And patients, he added, could be confused if the profiles of unlicensed physicians remained in the database.
Forty-seven other states’ medical boards have decided the value of keeping former licensees in their databases outweighs the possibility of confusion.
“Just in case for some reason somebody wanted to check and see what their (doctor’s) history was,” explained R. David Henderson, executive director of the North Carolina Medical Board. “If there had been any disciplinary action in this state, that’s frozen, so they could ... see what, if anything, happened during that time.”
Riley and his deputies did acknowledge that there are significant shortcomings in the openness the Massachusetts board is committed to.
Riley, for one, said the exclusion of non-hospital sanctions from the database is a “big hole.” A national database maintained by the US Department of Health and Human Services shows that 40 percent of all disciplinary actions against Massachusetts doctors during the past decade, 118 in all, were for incidents in nursing homes, medical clinics and managed care facilities. Since they did not involve patient care at hospitals, those disciplinary actions are not listed on the physicians’ public profiles.
Other lapses are more puzzling.
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Callum BorchersRussell Aims, left, the medical board's chief of staff, said documents that explain disciplinary actions cannot be posted online, as they are in three dozen other states, because they are not accessible to people with visual impairments. Attorney Brenda Beaton acknowledged the board fails to disclose discipline by other state medical boards, even though Massachusetts law requires it to do so.
For instance, Brenda Beaton, the medical board’s general counsel, said out-of-state disciplinary actions have been missing from profiles for 16 years because “we don’t really have a good mechanism to make sure that what we would put up on the profile would be absolutely accurate.” Those actions are required to be posted under Massachusetts law.
Another major omission has resulted from a Catch-22-like requirement in state law. Russell Aims, the board’s chief of staff, said the board used to post digital copies of disciplinary orders. But an online accessibility law requires that documents be available in a text-to-speech format for the visually impaired.
Because the PDF format of the disciplinary records is not compatible with text-to-speech software, Aims said, the law dictates that such records cannot appear in the database. If the visually impaired cannot access the information, then no one can.
What’s more, even the speed with which the board resolves complaints against physicians is shrouded in secrecy. Until 2005, the board posted the amount of time it took to close a case – average back then, 370 days – but for seven years now, the board has not known the average, Aims said, because of an “IT problem.”
Massachusetts built the nation’s first physician profile database in 1996 after a string of unchecked medical errors at Quincy Hospital (now Quincy Medical Center) and a series of Boston Globe Spotlight articles revealed how little patients knew about their physicians.
Despite resistance from some members, the Massachusetts Medical Society, the state’s largest physicians’ group, supported the disclosure legislation and even helped write it. But the medical society also pushed for disclosure limitations, such as the removal of malpractice and disciplinary postings after 10 years, and the omission of sanctions by non-hospital providers.
The Massachusetts database became a model for other states’ medical boards. Over the past decade and a half, however, other states have taken advantage of technological advances to make their records increasingly transparent, while the Massachusetts statute has remained unchanged.
That stagnation helps conceal past professional failings by many doctors, like Barry J. Lobovits. In 2000, his insurer paid $745,000 to the family of a 53-year old Dalton woman who died after he failed to diagnose and treat a litany of chronic conditions at his Pittsfield clinic, Berkshire Medical Care.
After the settlement, the medical board assigned a mentor to monitor his record-keeping and clinical judgment. Two health care providers permanently revoked Lobovits’ clinical privileges, citing negligence and unprofessional conduct.
By 2002, the board detected a pattern and decided to suspend Lobovits’ license. When Lobovits earned probationary reinstatement in 2004, the medical board in Connecticut, where Lobovits has held a license since 1993, also placed him on probation.
Very little of this information can be found on Lobovits’ Massachusetts profile. The malpractice payment and mentor assignment were removed in 2010, after a decade had passed. The clinical privilege revocations never were posted because they were levied by non-hospital providers.
The disciplinary order that explains the suspension never appeared online because the Massachusetts board, unlike those in three dozen other states, does not post such documents. The Connecticut probation went unreported also, even though Massachusetts law required the Massachusetts board to list it on Lobovits’ profile.
Lobovits, who declined comment, is off probation in both states and practicing in Pittsfield again.
In search of better ways to rein in substandard physicians, the medical board for four years has been pushing for rigorous – but private and non-punitive – peer reviews, empowering health care facilities to handle most errors internally without reporting them to the board or to the public.
But there is scant evidence that doctors are willing to hold one another accountable. Among roughly 35,000 licensed physicians in Massachusetts, an average of only 41 per year were reported to the medical board by fellow doctors from 2001 to 2010.
“If the medical profession truly believes that self-regulation and peer review are essential to high quality health care, then it must show the public through meaningful reporting that the system works,” said Nancy Achin Audesse, a former state senator and longtime patients’ rights advocate who directed the board from 1999 to 2008.
Hospitals are even less stringent about disciplining doctors. In the past 10 years, Massachusetts hospitals limited, suspended or revoked clinical privileges just 180 times, according to the federally maintained National Practitioner Data Bank, a registry of disciplinary action taken against physicians across the country.
The map above shows what records states offer via physician databases. After clicking the "click to interact" icon, use the drop-down menu at left to choose among different categories of information. States in green provide the information; states in purple do not.
Even the medical board itself has proven to be passive and slow to discipline the state’s doctors. Last spring, Public Citizen rated Massachusetts 47th in the country with just 1.83 medical board penalties per 1,000 doctors.
But the number of cases that go unpublished because of Massachusetts’ failure to keep pace with other states’ disclosure standards is staggering: In all, the Initiative found 711 disciplinary actions taken by the board and 2,984 malpractice payments between 1990 and 2001 are not available in the state database because of the 10-year posting limit.
By the end of this year, the 73 board actions and 222 malpractice payments from 2002 will vanish also.
In addition, disciplinary actions taken by the board against 283 doctors during the past 10 years are missing from the state website. Since the doctors have either left the state or given up the practice of medicine, their profiles have been taken down by the state medical board.
Which is what happened with Reuben.
Dr. Steven L. Shafer, editor-in-chief of Anesthesia & Analgesia, a medical journal that printed some of Reuben’s painkiller studies, said he “cannot support the lack of disclosure” in Massachusetts’ profile database.
Recalling how Reuben duped the profession, Shafer said, “His work was really at the vanguard of identifying alternative strategies to the use of opioids. They heavily influenced people’s thinking.”
Meanwhile, Reuben has applied for a medical license in Vermont and could receive one as early as next month.
Shafer, whose journal retracted Reuben’s studies, said “Dr. Reuben acted with callous disregard for the well-being of patients. He should not be entrusted with the care of patients after he repeatedly and egregiously violated the trust that society places in physicians. He should not practice medicine again.”
A month after the medical board signed the non-disciplinary agreement with Reuben, it signed with Dr. Salah Abass, who voluntarily agreed to practice restrictions. Abass was convicted in March 2011 of indecent assault and battery on a female nurse who worked at his Methuen office. At that point, his license had expired, and the board already had removed his name from its database.
Abass received a two-year prison sentence but served less than seven months and was released on parole in October. He continues to hold a license in Michigan, and has faced no disciplinary action by that state’s medical board because of his crime.
And when it comes to recent malpractice payments, more than a quarter of the 2,467 payments made during the past decade are no longer shown on the profiles of the doctors responsible for the malpractice. Most of those doctors, too, have either given up their practices or left the state, and their profiles have been taken down.
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Photo used with permission of Eastern Connecticut State UniversityAntwoine Key, a senior on the Eastern Connecticut State basketball team, collapsed on-court and died in 2005 of a congenital heart defect. The doctor who had detected a murmur in Key's heart, but cleared him to play anyway, lost a $2.4 million malpractice suit, but the payment went unreported by the state medical board for two years.Dr. Mary Ames-Castro, who lost a $23.8 million malpractice case in 2005, moved out of Massachusetts and is now practicing in Oregon under her maiden name, Mary Beth Ames. Jurors determined her misuse of a vacuum extractor left a baby girl with cerebral palsy, but Ames-Castro’s departure from the Bay State kept the massive award off her public profile, which the state medical board deleted.
But some doctors continue to practice here with spotless profiles because the state medical board has not been officially informed of the payments by the doctors’ malpractice insurers.
For two years, the profile of Dr. Dorina Abdulah of Quincy made no mention of a $2.4 million judgment in March 2010. During a 2001 physical examination, court documents show, Abdulah noted a “slight systolic murmur” in the heart of Antwoine Key, a college basketball recruit from West Roxbury High. Though the abnormality is commonly associated with hypertrophic cardiomyopathy (HCM), a congenital defect similar to the one that killed Boston Celtics star Reggie Lewis in 1993, Abdulah cleared Key to play.
Four years later, during Key’s senior season at Eastern Connecticut State University, the 22-year-old died after collapsing during a game at Worcester State University. An autopsy revealed the cause of death: HCM.
Key’s family sued Abdulah and won, but because of a missing link in the medical board’s malpractice reporting chain, the payment was not posted online until March 3 of this year, after reporters made several inquiries about the omission. Board officials said they do not post malpractice claims until they are formally notified by insurers, even if they have been legally notified by court clerks.
Medical board officials said they are confident that malpractice insurance companies are complying with state and federal laws and reporting virtually every disposition. But the board’s annual reports show that in 2004, 2005 and 2009, insurers filed a total of 250 fewer closed claim reports than court clerks did.
Last year, the Board of Registration in Medicine appeared ready to make its profile database more transparent in at least one department: It planned to start posting non-hospital disciplinary actions, and even notified a doctor who had been censured by a nursing home that the punishment would be listed on his profile. Medical board lawyers had interpreted the physician profile law as “a floor, not a ceiling.”
But the board backed down when the physician, supported by the Massachusetts Medical Society, objected. The nursing home discipline never was posted.
Also contributing to this report were Jesse Nankin and Melissa Tabeek. The Initiative for Investigative Reporting, in the School of Journalism at Northeastern University, is funded by a grant from the John S. and James L. Knight Foundation to support nonprofit investigative reporting. Further information about this issue can be found at the website northeastern.edu/watchdognewengland.
Trader Kenneth Polcari works on the floor of the New York Stock Exchange. (AP Photo/Richard Drew)
