Thursday, October 25, 2012

Biased Medical Board Members

The first phase of a lawsuit by physician organization AAPS against the Texas Medical Board ended earlier this month, proving that state medical boards can no longer operate with impunity, not just in my state (Doctor Bites Medical Board), but perhaps nation wide. Conflict of interest and other ethical transgressions among board members may be among the issues raised in the Texas litigation, so I read with interest the description in a recent email about Robert Small, MD, a "Pro-Tem (ad hoc)" psychiatrist member of the Washington Medical Quality Assurance Commission (MQAC) who also reportedly acts as "Behavioral Health Medical Director for health plans administered by Premera Blue Cross and LifeWise Health Plans... [and] Behavioral Health Medical Director for the CHAMPUS/TRICARE program for Washington, Oregon, Northern Idaho and Alaska."

First, even though Dr. Small, as an ad hoc member, may only fill in as needed, I wonder how a physician member of MQAC can represent the viewpoint of and knowledgeably judge the conduct of other physicians without practicing full time. It might reassure me that I do find Dr. Small listed in the usual rating Web sites, but I wonder how much time his insurance company duties leave him for clinical work.

If Dr. Small were acting as an expert witness in, say, a malpractice trial, opposing counsel could easily cross examine him to establish possible bias. But as a voting member of the board I am not sure a defending physician can raise such questions. Besides, given that all physicians either contract with companies like those for which Dr. Small works (or their competitors), or not, I argue that these other relationships always imply potential bias or prejudice, or at least the appearance thereof. Such a board member might, for example, want to minimize evidence against a physician who contracts with one of his companies, or exaggerate that against one who contracts with a competing company, or one, like myself, who contracts with no one other than my patients.

And how would Dr. Small maintain freedom from bias and prejudice in a case involving a subscriber to one of these plans he represents?

I question the ethics of a physician contracting with health plans in general (at least depending on the contract terms), so I believe physician members of MQAC should have no such relationships to skew their decisions. Dr. Small and any other physicians similarly encumbered should resign from medical boards now to be replaced with physicians in full time private practice with no conflicting relationships to payers, perhaps even to their employers. (I may address the question of whether employed physicians are really professionals who should be licensed and sanctioned by medical boards in a later post.)

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