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Bad Doctors or Bad Study? USA Today reported last week on a study by consumer advocacy group Public Citizen, which looked at disciplinary measures taken against physicians who have committed crimes. The study’s authors claimed that medical boards are too easy on doctors who commit drug crimes and insurance fraud, and the USA Today article was headlined, “Bad doctors get slapped on the wrist.” Beyond the risible headline (a bad doctor is more suggestive of incompetence than criminality), the article’s opening paragraphs suggested that justice was not being served. “Doctors who commit crimes often escape harsh professional punishment by state and federal agencies, according to a study of 2,247 physicians disciplined for criminal conduct between 1990 and 1999. Boards are particularly light on doctors who have committed insurance fraud and who have been involved in crimes related to drugs, including prescribing violations and substance abuse, says the report.” And yet the study found that only 36 percent of physicians who committed “drug crimes” (i.e., they were involved in prescription violations and/or use, possession or distribution of controlled substances) received what Public Citizen described “wrist slap” punishments such as being monitored or sent to addiction treatment – which means that nearly two-thirds of drug offenders were given severe punishments. It must be said that highlighting the much lower figure is an odd stance for a notably liberal organization to take, as such groups often argue that “treatment, not punishment” is preferable for drug crimes. In the study, Public Citizen cited with disapproval the case of a doctor who sold and used cocaine and received probation, noting that he was still licensed to practice. The anecodote was also reported by USA Today. But if this had been an ordinary person, a liberal group would normally celebrate his rehabilitation and the reduced cost and humane sensibility shown by using probation rather than expensive incarceration. And in fact, research shows that doctors are far more likely to overcome addictions than those without M.D.’s, with a remarkable 90 percent recovery rate. This went unmentioned. Furthermore, the Public Citizen study only looked at offenses committed between 1990-1999, and thus misses the recent crackdown that has left dozens of physicians incarcerated for drug crimes for terms of 25 years or more. And both the study and USA Today’s coverage also failed to consider the legal difficulties doctors face when prescribing pain medications. There is no medical test for either pain or addiction, and being an addict does not preclude one from suffering pain. Those doctors who err on the side of believing their patients are vulnerable to criminal prosecution for “supplying addicts;” as the recent successful appeal on behalf of pain specialist William Hurwitz showed, they can be prosecuted whether or not they believe they are practicing medicine in good faith. As a result, prescribing offenses can also easily lead to fraud charges, because once someone’s practice has been determined to be “not legitimate medicine,” getting insurance payments for it is de facto fraud. But this wasn’t mentioned, either. USA Today was at least balanced in its coverage, quoting critics, including the chairman of the American Medical Association, who noted that the study actually shows a low level of criminality amongst doctors and that violent crimes and sex crimes do not result in “wrist slaps.” But the paper should also have been aware that more recent data suggests that far from being under-prosecuted for drug crimes, physicians are being targeted and heavily punished for them, even when it is not clear that crimes have actually been committed. This issue represents a complex and contradictory intersection of law and medicine; health care consumers and readers need the full story.
Are doctors who break the law cheating professional sanction?
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