Auditor General Confirms a Year of Improvements at State Medical Board
At the request of the Legislature in early 1999, an audit team from the Arizona Auditor General spent several months this summer in residence at the Board of Medical Examiners.  Their report is due to the Joint Legislative Audit Committee by early October, 1999.  We believe that their findings fairly characterize an agency that is in Year Two of a Three Year plan to reengineer itself and meet rising public expectations in healthcare regulation.  Ram Krishna, MD, the Board’s Chairman, noted that the report “shows how far we have come since the series of negative audits which began four and five years ago.  Now, the Board investigates its caseload better, has installed monitoring safeguards on disciplined doctors, and has outlined to plan to attack the backlog of cases we are investigating.”

In brief, the Auditor found that the agency:

Significantly Improved its Complaint Investigations.  In the last twelve months, staff wrote procedures which serve as the blueprint for a quality, timely investigation.  BOMEX investigators, by policy, routinely interview all complainants and witnesses and obtain the necessary records.  Allegations made against the doctor are identified at the outset of the complaint, tracked throughout the process, and completely investigated before the final supervisory review and discussion by the Board.

Established a Compliance Monitoring Program.  When doctors disobey their legal orders and shirk responsibilities prescribed by the Board, their cases are brought before the Board for further action.  New staff (two hires in late 1998) have set up a database to track every doctor under a Board disciplinary or interim order.  Psychiatric, psychological, and medical evaluations are sent into the center, and unannounced audits are also conducted by these staff.  When doctors are non-compliant, their cases are turned over to Investigations for expedited consideration by the Board.

Solved the Board Vacancy Problem.  The BOMEX Omnibus Bill (HB 2487) made two changes in the law governing the appointment of Board members.  Currently, it is a rare event to see the lack of a quorum for votes on important cases.  And in no circumstances has the Board postponed or cancelled a meeting because fewer than seven members were present.

Must Pay Further Attention to the Use of Advisory Letters.  In the test cases examined by the Auditor, the percentage of licensee violations of the law which resulted in an advisory letter fell from 74% to 58% this year.  Furthermore, the numbers of disciplinary actions taken by the Board at each meeting have grown since early summer of 1999.  Nonetheless, the Board decides in each case (as specified by Arizona law) whether it will discipline a doctor in violation of the statute, or whether it will rehabilitate the doctor.  Weak evidence against the doctor or strong indications of remediation of the problem (if the violation is not life-threatening) can steer the Board to use the advisory letter as the best instrument to carry out the letter of the law.

Must Exert Additional Effort to Reduce the Backlog.  The Auditor found a growing backlog of unresolved cases during a three year period.  Investigator vacancies contributed to the problem, but the backlog was a necessary step on the road to improving the quality of the investigation Board staff performs.  More than 100 cases were pulled back from the March 1999 Board agenda, in order to bring them up to investigatory standards set by experienced investigator supervisors.  But what matters now is the Board’s plan of attack:

  • Referring more complaints to the Office of Administrative Hearings, which is another pathway for arriving at a disciplinary result;
  • Increasing the number of staff investigators;
  • Fully implementing the Board’s powers to delegate administrative authority to the Executive Director;
  • Selectively using the Lead Board Member step in preparing cases for Board consideration; and
  • Meeting a higher percentage of the deadlines for investigative steps.
When the entire picture of Board investigative capacity is sized up, the public can see that the agency has solved many of what would normally be multi-year problems in just a twelve month audit period. The infrastructure of adequate agency staff is nearing completion. Designing the best enforcement processes to protect the public — the hallmark of Year Two of our agency’s reengineering — is well underway. Our FY2001 budget reflects this thinking.

Chairman Krishna emphasized that delivering the results that the Legislature wants to see should not be a problem. “The Board will be looking to hire three expert investigators and armor coat our compliance center by adding one permanent position in place of a temporary one.  The budget also sees the Office of Administrative Hearings taking a greater role — to the tune of $20,000 more in hearing costs.  That’s what you call an agency headed for a better place.”