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State medical boards are not protecting the public from doctors who've committed sexual misconduct, one watchdog group has said.

According to a Public Citizen study published this month in , 70% of physicians (177 out of 253) who had engaged in sexual misconduct that led to sanctions by hospitals or other healthcare organizations or a malpractice payment were not disciplined by state medical boards for their behavior.

The study is the first to tap data on physician sexual misconduct from the National Practitioner Data Bank.

"It's clear that medical boards are allowing some doctors with evidence of sexual misconduct to continue endangering patients and staff," Azza AbuDagga, MD, lead author, said in remarks accompanying the study. "These boards must pay more attention to sexual misconduct that leads to healthcare organizations cracking down or to lawsuits."

The consumer advocacy group Public Citizen examined physician reports in the NPDB from Jan. 1, 2003, through Sept. 30, 2013. The focus was on sexual misconduct-related licensure, clinical privileges, and malpractice payment reports for all physicians, including medical doctors, osteopathic doctors, and intern/resident physicians.

The analysis found that 1,039 physicians had one or more sexual misconduct-related reports, and of these, 786 (76%) had been disciplined only by a medical board. The study also revealed that the remaining 253 physicians had one or more clinical privilege reports or malpractice payment reports related to sexual misconduct, but 177 did not have a report of state medical board licensure action for such misconduct.

Lisa Robin, chief advocacy officer at the , declined to comment on the study's data collection, methodology, or analysis. However, she said state medical boards can only take action when they get a complaint.

"It is an issue for boards to be sure that they get information from the hospitals. Reporting is an issue," Robin says. "That is something that hospitals and other entities need to look at complying with. It is something we would like to bring attention to on behalf of our boards. It is their responsibility not only ethically, but in many states there are reporting requirements for any entities to report to the state boards."

Robin says the NPDB has adopted the continuous query option for the past several years to improve access to reports, but the process is expensive. "We have tried throughout the years to get some relief for the states to be able to get the service to be able to get the reports without charging them. We've been unsuccessful. They will not waive the charge for the states," she said.

And just because a report goes to the NPDB, Robin says state medical boards may not necessarily know it unless the hospital reports it.

'Boards Take It Very Seriously'

"If the privileging action is reported to the NPDB, the medical board might not necessarily know it unless the hospital reports it to them," Robin says. "It's a query when someone applies for a license but at times, even if they now subscribe to the continuous query, that wasn't always available. That is why hospitals are required to report directly to the board. The NPDB recognizes that that is an issue."

In another effort to improve notifications, Robin says hospitals are now told that they must file a report to their state medical board along with any report to the NPDB.

"They recognize that hospitals don't always report to the board for whatever reasons," Robin said. "In the instances of sexual misconduct, boards take it very seriously, when they know about it, and usually the sanctions are very severe."

The study backs her claim. For the 974 NPDB reports of medical boards disciplining physicians in response to physician sexual misconduct, the boards revoked, suspended, or restricted the medical license in 89% of cases. In contrast, state medical boards took such severe actions in only approximately two-thirds of cases involving other types of misconduct.

"These numbers show that when state medical boards take action, the action rightly tends to be much more severe for physicians who engaged in sexual misconduct than other offenses," study co-author Sidney Wolfe, MD, founder of Public Citizen's Health Research Group, said in prepared remarks.

"Now, the medical boards need to pay increased attention to sexual misconduct that led to health care organizations cracking down or to lawsuits. State medical boards have full access to the NPDB data. The boards must protect the public."

The NPDB is the only national repository that receives reports of disciplinary actions taken by state medical boards and clinical peer review committees at hospitals and other healthcare organizations. It also is the only database to receive reports of malpractice payments made on behalf of physicians by malpractice insurance companies or other payers, Public Citizen said.

AbuDagga noted that sexual misconduct-related reports accounted for only 1% of the total reports in the NPDB over an almost 10-year period, and that the study "represents only the tip of the iceberg of physician sexual misconduct in the U.S.

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