By Stacey Kusterbeck
Ethicists address a wide array of ethical issues in the hospital setting, ranging from conflicts among clinical team members and concerns about potentially inappropriate end-of-life care. But what if a nurse or clinician reports that a physician has committed serious wrongdoing? In such cases, the situation has to be reported to a state medical board.
“Ethicists should report to a board when they think a physician’s conduct poses a threat to the public. Broadly, people should report to boards in cases involving illegal, dangerous, or grossly incompetent conduct,” says Tristan McIntosh, PhD, an assistant professor of medicine in the Bioethics Research Center at Washington University School of Medicine in St. Louis, MO.
State medical boards need to be involved if physicians are suspected of sexually abusing patients or performing unnecessary invasive procedures for financial gain, for example. To protect the public, state medical boards can revoke or suspend the licenses of physicians who commit wrongdoing. However, state medical boards vary widely in the severity of disciplinary actions taken against physicians.1
“There are promising practices that all state medical boards can follow. But not all boards follow those promising practices,” says McIntosh.
McIntosh and colleagues identified policies and practices that are within the power of most state medical boards to enact without the need for legislative changes.2 “The paper focuses on practices that are low-hanging fruit for boards to easily adopt: those that do not require major new resources or changes to state law,” says McIntosh. For example, state medical boards can implement a screening committee to triage incoming complaints. Doing so can speed investigation of complaints that pose an immediate threat to public safety.
“Anyone can make a report to a state medical board. Unfortunately, many people do not know that state medical boards exist or what their purpose is,” notes McIntosh. To address this, state medical boards can provide public-facing information on board websites and social media, the authors recommended. Helpful information includes the purpose of boards, what behaviors should be reported, how to make a report, and what can be expected during the investigation process.
“A second easy-to-adopt practice is for boards to provide consistent and complete disciplinary information to national databases,” says McIntosh. This allows other boards and hospitals to access information about highly problematic physician behavior through the Physician Data Center and National Practitioner Data Bank. “Transparent information-sharing is essential for other entities to make informed decisions about physician licensure. That becomes especially important when physicians change employers or move states,” emphasizes McIntosh.
If boards do not consistently implement good practices, offending physicians are able to continue practicing medicine. Those doctors are likely to continue engaging in egregious behaviors. “This puts patients at risk and undermines public trust in healthcare providers,” warns McIntosh.
An important consideration is whether leaders within the hospital are aware of egregious ethics violations. Ideally, hospitals have reporting mechanisms in place for these situations, and respond appropriately. “Ethicists can use these reporting mechanisms as a tool for taking action when they are made aware of egregious ethical violations,” says McIntosh.
Hospitals may have internal reporting hotlines or online incident reports that ethicists and others can use to share their concerns about egregious physician behavior. “While I am not aware of any data on this, I strongly suspect that there is great variety in the extent to which hospitals have these formal internal reporting systems in place,” says McIntosh. If those mechanisms do not exist at a hospital, ethicists can communicate their concerns directly to hospital leadership. For example, ethicists can alert a chief medical officer so that leaders are aware of the problem. From there, they can determine what additional information needs to be gathered, and from whom, prior to reporting to a board.
However, reporting these instances internally is not a perfect solution. Hospitals may avoid taking the next requisite step of reporting these instances to state medical boards. “This is why reports of egregious wrongdoing should be reported both internally and to state medical boards,” McIntosh concludes.
- Harris JA, Byhoff E. Variations by state in physician disciplinary actions by US medical licensure boards. BMJ Qual Saf 2017;26:200-208.
- McIntosh T, Pendo E, Walsh HA, et al. What can state medical boards do to effectively address serious ethical violations? J Law Med Ethics 2023;51:941-953.
