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zoom RSS 監視下の医師 2%/米国医療事情 ニューヨーク

<<   作成日時 : 2008/05/08 00:02   >>

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画像 ニューヨーク州の医師の2%以上が、薬物乱用や精神的問題、医療行為上の問題などで医療評議会(medical board)の監視リスト下にある。監視下医師の数は全国平均の2倍に上り、全国第7位に位置している。昨年1,400人が監視を受けた。60%は医療過誤や患者からの申し立てなどの医療行為上の問題で、残りの40%はアルコールや薬物の乱用、行動や精神上の問題などである。
 他の州に比べてニューヨーク州では、監視下に置くための医師への訴えの実証に必要な立証責任が低い。バージニアやフロリダなどは、明瞭な納得できる証拠を必要としているのに対してニューヨーク州では有力な証拠のみでよい。またニューヨーク州法では医師の懲戒処分のレポートを州のボードに報告するよう病院に求めている。さらに、いくつかの州ではより制限された情報を監視データに含めていたかどうかが明瞭でなかったと連邦役員は警告している(?)。
 現在、nydoctorprofile.com において専門医としての実績は見ることができるが、薬物やアルコールの中毒などは公表されていない。
 患者からの訴えや病院からの報告は、州の医療評議会に送付される。158メンバー評議会は3メンバー委員会(処分される医師の分野の医師1人を含む)に問題を送る。評議会が監視が必要と決めると、多くの形で監督することができる。ある種の治療手技に問題がある場合は実行する際に専門家の監視下で行う。評議会のスタッフが予告無しで査察やカルテのレビューを行う。セクハラで訴えられた医師は付き添いが必要となる。薬物やアルコール中毒の場合は回復計画に従い、薬物検査も必要である。場合によってはライセンスの一次停止も伴う。専門的診療に問題があれば3年間の監視下に置かれ、5年間は州医師会による修正プログラムに置かれる。
 州医師会の役員は、監視下の医師数の多さは、懸念というより成功の合図だと言う。他の州が非難・叱責・罰金を与えるところで、公的な保護機構として監視を使い、その後医師は再び診療を再開する。
 ライセンス効力停止と言った重大な処分は最近全国的に減少傾向にあるという。
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State Watch for 2 Percent of Doctors
http://www.nytimes.com/2008/05/07/nyregion/07doctors.html?_r=1&ref=health&oref=slogin
By DANNY HAKIM
Published: May 7, 2008

ALBANY ― More than 2 percent of all doctors practicing in New York last year landed on the state medical board’s watch list because of problems including substance abuse, mental health concerns or their professional conduct.

The data was in a report released last month from the Federation of State Medical Boards. It shows that the percentage of doctors being monitored in New York was twice the national average and seventh highest among all states.

Last year, 1,400 of the more than 65,000 physicians practicing in New York were monitored at some point during 2007.

Of those, 60 percent were placed on the watch list because of concerns about their professional conduct, such as a medical mistake or patient complaints. The remaining 40 percent were in the state’s physicians impairment program, because of alcohol or drug abuse, a behavior or anger management problem or mental health issues.

State health officials said the numbers reflected a more aggressive regulatory and enforcement system in the state, not poor quality among New York doctors.

New York’s board has a lower burden of proof than some other states for substantiating complaints against doctors and taking action against them, including putting them under supervision. While states like Virginia and Florida require clear and convincing evidence, New York requires only a preponderance of evidence. State law in New York also requires hospitals to report disciplinary action involving doctors to the state board. In addition, officials at the federation cautioned that it was not clear whether some states included more limited information in the monitoring data.

Still, the number of doctors under supervision here is troubling to those who have pushed for more disclosure about physicians and their conduct. Currently, the public can obtain only some information: Most cases involving professional conduct are listed on nydoctorprofile.com, but the majority of cases involving drug or alcohol abuse are kept confidential, and patients have no way of finding out if their doctors have a problem.

Dr. Richard F. Daines, New York’s health commissioner, said “the higher numbers reflect active, good programs, rather than bad physicians.”

“It denotes a healthier professional community than one where you see very low numbers,” he added.

Dr. Daines, former president of St. Luke’s-Roosevelt Hospital Center, was himself a monitor more than a decade ago and helped a doctor with a drug abuse problem return to his job. He said that publicizing the names of doctors who referred themselves for treatment would discourage them from doing so.

“If self-referral were tantamount to having your name posted publicly, you’d have to think it would have a chilling effect,” he said, echoing a common argument in the medical community.

But Blair Horner, the legislative director of the New York Public Interest Research Group, said, “The rights of the licensed provider don’t trump the patient’s right to know,” he said. “These are life-and-death decisions for the patient. Who should win out? The patient.”

Doctors, he added, are “not being monitored because they jaywalked.”

“They’re being monitored because of substance abuse, sexual abuse or misconduct. Patients should know that, and they should know it in advance of going to see their doctor.”

Problems involving physicians can be referred to the state medical board in many ways, including patient complaints and reports from hospitals. The 158-member board then forwards the matter to a three-member committee, typically including one doctor from the field of the physician who is facing discipline.

If the board decides the doctor should be monitored, the supervision can take a number of forms: A doctor who has had difficulty performing a certain kind of procedure may be required to have another specialist present when undertaking it. Enforcement staff for the board might show up unannounced to do site visits or review records. Doctors accused of sexual harassment might be required to have chaperones. And those with drug or alcohol problems have so called “therapy monitors” to make sure they are sticking to their recovery plan and are fit to practice. The doctors can also be subject to mandatory drug tests.

In some cases, monitoring follows a temporary suspension of a license.

Doctors are typically monitored for three years if they have a professional conduct problem, and for five years under the impairment program, which is contracted out to the Medical Society of the State of New York.

“The medical society’s position is that the public is advantaged by having programs like ours offering service to doctors who may need help, and it’s our goal to get help for physicians,” said Terrance M. Bedient, the vice president of the Medical Society, and director of its committee for physician health.

Officials in New York said the state’s relatively high number of monitored doctors was a sign of success, not concern.

“I think different medical boards use various mechanisms in the process in different ways,” said Keith W. Servis, director of the Health Department’s Office of Professional Medical Conduct.

“Some of the states that have very low numbers, it could be that they don’t use a monitoring mechanism in the same way we do,” he said. “We use monitoring as a public protection mechanism where other states may just give physicians a censure or reprimand, a fine, and then the physician resumes practice.”

A recent Public Citizen report found that serious disciplinary actions ― from revocations to suspensions of licenses ― were declining nationwide at medical boards.

Dr. Sidney M. Wolfe, director of the health research program at Public Citizen, said “if you were going to a physician, you would probably like to know if your doctor has a drug or alcohol problem, and mainly you can’t find that out unless your doctor has been disciplined.”

“We disagree with that,” he added. “It shouldn’t take getting caught to have patients find out.”

But Dr. Wolfe agreed with state officials said that New York’s high number of monitored doctors could be interpreted as a good sign. Kentucky, the state with the highest percentage of doctors being monitored, has generally been seen as an aggressive enforcer, Dr. Wolfe said.

“Doing more monitoring is a reflection on the medical board,” he said. “It says that the New York State medical board is watching more doctors in the sense of active monitoring than other states are, and that’s good.”

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Professional Misconduct and Physician Discipline
http://www.health.state.ny.us/nysdoh/opmc/main.htm

The Office of Professional Medical Conduct (OPMC) is responsible for investigating complaints about physicians, physician assistants and specialist assistants. The Office also monitors practitioners who have been placed on probation.

The Office serves as staff to the Board for Professional Medical Conduct which is comprised of some 200 physicians and lay members. Board members are responsible for the adjudication of cases and for developing direction and policy regarding medical conduct issues.

(The Department of Health presents the information on this Web Site as a service to the public. The Department has attempted to ensure that the information is as accurate as possible. However, the Department makes no warranty or guarantee concerning the accuracy or reliability of the content of this Web Site. No posted information or materials provided are intended to constitute legal or medical advice. Before considering taking any action, confirm information by contacting OPMC at the address below.)
Frequently Asked Questions (FAQs)

* FAQs - Learn more about New York's medical conduct system.

Disciplinary Actions

This section provides a listing of all physicians, physician assistants and specialist assistants who have been disciplined since 1990.

For information about physicians disciplined prior to 1990:

* Call: 1-800-663-6114 (Monday-Friday 9 a.m.- 5 p.m.),
* Email: opmc@health.state.ny.us, or
* Write to:
NYS Department of Health, OPMC
433 River St., Suite 303
Troy, N.Y. 12180

Physician Search

The following button provides a link to look-up physician's license numbers.

Physician License Number Look-up
To File a Complaint

If you wish to file a complaint, please review the following brochure before printing and filling out a complaint form: How to Choose the Right Physician - How to Tell Us if You Don't.

If you have a complaint or need information about professionals other than physicians, physician assistants or specialist assistants, please contact the New York State Education Department.
Other Useful Information:
* New York State Physician Profile Web Site
o Do You Want to Know More About Your Doctor?

Brochures and Reports
* Pain Management: A Guide for Physicians
* Pain Management: A Guide for Patients
* Do I Have a Right to See My Medical Records?
* Fraud in Medicine
* How to Choose the Right Physician - How to Tell Us if You Don't
* Understanding New York's Medical Conduct Program
* Reference Information: Registered Physician Assistant
* Policy Statement on Physician Sexual Misconduct
* Statements on Telemedicine - Board for Professional Medical Conduct
* Annual Reports
* Press Releases

Relevant New York State Laws Compliments of the NYS Senate
Public Health Law
* Section 230. State board for professional medical conduct; proceedings
* Section 230-a. Penalties for professional misconduct
* Section 230-a. Infection control standards
* Section 230-b. Disciplinary proceedings for physician's assistants and specialist's assistants
* Section 230-c. Administrative review board for professional medical conduct
* Section 18. Access to patient records

To access Section 230 of Public Health Law:
* Visit the NYS Senate Web site at http://public.leginfo.state.ny.us/menuf.cgi
* Select the link for "Laws of New York."
* Select law PBH Public Health
* Scroll to Article 2, Title 2-A Professional Medical Conduct

Education Law
* Section 6530. Definitions of professional misconduct
* Section 6531. Additional definition of professional misconduct, limited application
* Section 6532. Enforcement, administration and interpretation of this article

To access the above-referenced sections of Education Law:
* Visit the NYS Senate Web site at http://public.leginfo.state.ny.us/menuf.cgi
* Select the link for "Laws of New York."
* Select law EDN Education
* Scroll to Article 131-A Definitions of Professional Misconduct Applicable to Physicians, Physician's Assistants and Specialist's Assistants

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