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Dose of Their Own Medicine

Integrative doctors battle the ethically conflicted NC Medical Board

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When Dr. John Pittman of Raleigh learned about Tucker's case, he was outraged. After Pittman, an integrative doctor, administered ozone and a diluted form of hydrogen peroxide intravenously to a patient who complained of chronic fatigue -- a procedure he performed regularly -- the patient experienced hemolysis, a known but rare side-effect of this treatment. The patient was hospitalized for five days while she recovered, but suffered no permanent physical injury. According to board documents, like Tucker, Pittman failed to properly monitor the patient. As punishment, the board permanently suspended Pittman's license, but stayed all but 60 days of the suspension, meaning that Pittman couldn't practice for two months. More devastating to Pittman's practice, though, was the condition the board put on his ability to practice. He can no longer act as a supervising physician to physician assistants, nurses or clinical pharmacist practitioners, even though failure to supervise employees was never raised as an issue in the charges against him.

"The board thinks I'm more dangerous than a plastic surgeon that kills patients," Pittman wrote in a recent letter to his colleagues. "This guy who kills a patient got off completely."

What some find even more disturbing is that Tucker's case is not an anomaly. In fact, Public Citizen, which studies the effectiveness of the country's state medical boards based on how they discipline doctors who repeatedly harm patients, has consistently ranked the North Carolina medical board at about 45th in the nation.

For the last year, lobbyists for the NC Medical Society have been pushing for changes in state laws that will make it even harder for patients to sue doctors. The society claims this is necessary because malpractice claims are driving up the cost of medicine. But a report by Public Citizen recently documented the lax discipline standards the board has applied to doctors who practice mainstream medicine.

According to the National Practitioner Data Bank (NPDB) and Public Citizen's analysis of NPDB data, disciplinary actions (license suspension or revocation, or a limit on clinical privileges) have been few and far between for North Carolina physicians. Only 15.2 percent (24 of 158) of North Carolina doctors who made three or more malpractice payouts were disciplined by the Board. Of the 22 doctors with five or more malpractice verdicts against them, only five were disciplined by the board.

"Some of these people have three, four, five bad outcomes that don't look like just bad outcomes but look like a pattern, and they are still not disciplined," said Biddle.

Breaden, the director of public affairs at the NC Medical Bard, says the board has limited resources and that there are only so many cases it can take on.

"Each malpractice case is reported to us and evaluated with great care by a committee of this board and an action is taken if appropriate," Breaden said. "In the vast majority of cases, as any look at the history of malpractice will demonstrate, it does not in fact reflect lack of competence, which is our concern, but a variety of other issues that are involved in malpractice decision-making in the case of malpractice liability law."

Breaden says the board isn't concerned about the Public Citizen report.

"This is basically Ralph Nader who has his own agenda," Breaden said. "We're not interested in Mr. Nader's agenda."

Breaden took issue with the statistics in the report because he said doctors often hold licenses in more than one state. So the malpractice actions against North Carolina doctors listed in the Public Citizen report could have actually occurred while the doctors were practicing in another state.

Still, the board regularly disciplines doctors who hold licenses and practice in other states but also hold North Carolina licenses. The board requires the reporting of malpractice claims against doctors licensed here, no matter which state they practice in.

"What if you're a consumer in North Carolina and you are going to be attended to by a physician and someone says, "Oh, but that physician has injured eight patients.' And you say, "That sounds bad,' and they go, "But six of them weren't in North Carolina.'" Public Citizen researcher Pattison asks. "Do you suddenly feel better about that physician?"

Breaden encouraged CL to look at the board's discipline record for 2002 rather than Public Citizen's report, so we did.

In 2002, of the 26,581 physicians the board regulates, 28 were formally charged. The board took action against only four licensees for failing to meet accepted standards of care, and revoked the license of only one despite 1,581 complaints from patients and colleagues registered with the board. Of the 15 licenses it suspended, 10 of the suspensions were stayed, or never acted upon.

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