Sally Clark Doctor Overturns Ban

6:22pm UK, Sunday September 21, 2008

A doctor who accused the husband of solicitor Sally Clark of murdering their two children has won his bid to be allowed to return to work.

Dr David Southall can return to work as a paediatrician

Dr David Southall claimed it was “beyond reasonable doubt” that Steve Clark killed his sons after he watched an interview featuring Mr Clark eight years ago.

The paediatrician was subsequently found guilty of serious professional misconduct and was banned four years ago from engaging in child protection work.

But a General Medical Council panel in Manchester has lifted the ban.

I would like to thank my paediatric colleagues, especially those who came to give evidence on my behalf.

Dr David Southall

Andrew Reid, chairman of the GMC’s Fitness to Practise panel, said Dr Southall had expressed regret and remorse for his actions and demonstrated “considerable insight” into his failings.

Speaking after the hearing, Dr Southall said: “I would like to say how pleased I am by the General Medical Council’s decision today.

“I would like to thank my paediatric colleagues, especially those who came to give evidence on my behalf.”

Dr Southall told the panel last month he still thought he was correct in raising the alarm over Mr Clark, but admitted the language he used in the accusation was “injudicious”.

The 60-year-old believed Mr Clark attempted to suffocate his eldest son, Christopher, in a London hotel room in 1996 following his description in the Channel 4’s Dispatches interview about how the child suffered a nose bleed and breathing difficulties.

The late Sally Clark with husband Steve

He said he owed an apology to the late Mrs Clark for his assumption that if her husband had smothered Christopher he must also have killed their second son, Harry, who died 13 months later.

But he maintained his concerns about the events in the hotel room remained and the incident “has not been explained by the passage of time”.

Mrs Clark, 42, was convicted in 1999 of double murder but cleared by the Court of Appeal four years later.

She died of natural causes at her home in Chelmsford, Essex, last March.

Christopher died nine days after the hotel room incident in December 1996 aged 11 weeks in the sole charge of Mrs Clark.

The couple’s second son, Harry, died at home in January 1998 aged eight weeks.

Mr Clark said he did not want to comment on the ruling

 

How Hospitals Can Turn Deadly

View all headlines Subscribe to RSS
Health

By Robert Roy Britt, LiveScience Managing Editor

The rule of thumb is you go to a hospital to get well. But sometimes it’s the hospitals that make people ill and even prove deadly.

The problem is serious enough that this week Medicare stopped paying for the cost of mistakes. An initial list of 10 things won’t be covered, including surgery to remove items accidentally left inside a person during an initial surgery, treatment for bed sores and in-hospital falls, and treating the aftermath of incompatible blood transfusions. Several major insurance companies have already introduced similar rules in recent years.

The definitive study on the problem, which served as a wake-up call, was a 1999 report by the Institute of Medicine of the National Academies. Titled “To Err Is Human: Building A Safer Health System,” it estimated that somewhere between 44,000 to 98,000 Americans die in hospitals each year as the result of medical errors. Just the lower estimate would make medical errors the eighth leading cause of death at the time (more than motor vehicle accidents, breast cancer or AIDS).Among the leading mistakes: misdiagnoses, equipment failure and infections.

Medical errors were found to cause 238,337 potentially preventable deaths — just among U.S. Medicare patients — over a three-year period ending in 2006, according to a study this year by the HealthGrades rating organization. That works out to 79,446 per year. Those mistakes cost $8.8 billion, HealthGrades calculated. The overall rate of errors for those covered by Medicare, which include the disabled and elderly, was about 3 percent.

The Centers for Medicare and Medicaid Services says 193,566 patients were injured in falls while at the hospital last year.

From systemic issues to exhausted staff to problems that medicine has yet to solve, here are just a few of the problems hospitals, and patients, suffer:

Superbugs

You’d think hospitals are the cleanest places around, but it’s quite a job to totally eliminate deadly microbes. They thrive in many hospitals, just waiting to find a way to crawl inside another victim. According to the U.S. Centers for Disease Control and Prevention (CDC), some 1.7 million hospital-associated infections caused about 99,000 deaths in 2002.

Meanwhile, cases of infection from the so-called superbug methicillin-resistant Staphylococcus aureus, or MRSA, have been increasing each year, in part because they’ve evolved to resist the effects of antibiotics. MRSA killed 18,650 Americans in 2005. Most of the deaths are among the elderly, and officials say most younger, healthy people can survive superbug attacks.

The microbes, unfortunately, seem to breed well even in sanitary hospitals, and researchers are not yet sure how to combat the problem.

Noise

Hospitals have become noisier over the years, stressing staff and potentially contributing to more errors. The decibel level at a typical hospital during the day rose from 57 in 1960 to 72 by 2005. At night, the noise level has gone from 42 to 60 decibels since 1960. Guidelines from the World Health Organization call for a maximum of 35 decibels.

Exhaustion

Many medical errors are attributed to exhausted, sleep-deprived doctors and other staffers. A 2006 study reported in PLoS Medicine, looked at 2,737 medical residents and 17,003 of their monthly reports. In months in which residents worked just one long shift-of 24 hours or more, they were three times more likely to report a fatigue-related significant medical error compared with months with no extended hours.

Bad timing

Heart attack victims who arrive at a hospital during off-hours or on the weekend wait longer for help and are at a higher risk of death, according to a 2005 study in medical journal JAMA.

The study involved patients treated with percutaneous coronary intervention, called PCI. It includes angioplasty, in which a catheter-guided balloon is inserted to open a narrowed coronary artery. From the moment a patient entered the door, it took an average of 94.8 minutes to insert the balloon during regular hours. For patients admitted after hours and on weekends, it took 116.1 minutes.

Along these lines, babies born at night are at least 12 percent more likely to die within 28 days, according to a different 2005 study. The reasons are thought to include fatigue and inattention related to shift changes.

Really getting burned

Data from the Pennsylvania Patient Safety Reporting System finds that every year about 28 patients are burned during surgery by fires, such as when oxygen inside a mask ignited. Extrapolated nationwide, the data suggests 550 to 650 surgical burns occur nationwide each year, including one or two deaths, according to a recent MSNBC analysis. Cathy Lake, the daughter of a surgical burn victim, created http://www.surgicalfire.org to highlight the problem.

Change needed

Many errors result from systemic problems rather than negligence or misconduct, according to the Institute of Medicine. For example, medication mistakes were responsible for 7,000 of the deaths in the 1999 study. A 2006 study found that medication mistakes injure more than 1.5 million Americans every year.

Including a pharmacist on medical rounds can reduce the medication errors by 66 percent, the institute states. Handheld computers and patient barcoding have also been found to reduce errors. Many doctors have begun to lobby for cell phones in the hospital, which reduce errors by making communication more timely.

Change comes slowly, however. In 2005, the CDC reported that only 8 percent of physicians used a computerized system for ordering drugs and diagnostic tests. The system compares requests against dosing standards and a patient’s medical records.

 

Surgeon on trial for removing too much breast tissue

Madison County Record

9/30/2008 7:00 AM

By Steve Gonzalez

A plastic surgeon who allegedly removed too much breast tissue in a reduction surgery nearly nine years ago will go on trial this week in Madison County.

Carrie Zang of Witt, Ill. filed suit against R. Craig McKee, M.D. in 2001, alleging McKee violated the standard of care while performing a bilateral reduction mammoplasty with free nipple graft operation on Nov. 22, 1999 at Anderson Hospital in Maryville.

According to Zang, 41, McKee ignored her directive and desire that she be left with average size breasts that would complement her frame when he proceeded to remove 2,553 grams from her right breast and 2,957 grams from her left breast.

There are 454 grams per pound.

Zang claims that prior to surgery, McKee submitted a pre-operative plan in which he stated he would be removing 1,000 grams of breast tissue from each breast.

She also alleges McKee failed to leave an appropriate amount of tissue necessary for a nipple graft causing one of her nipples to fail and “fall off her chest,” her complaint states.

Zang further alleges McKee severed a nerve and failed to properly close the surgical sites due to the lack of tissue needed to do so.

At trial, Zang will allege the surgery left her permanently and irreversibly disfigured. She will claim pain and discomfort, nerve damage, medical expenses, lost wages and psychological damage.

She is represented by Bob Perica of Wood River and will seek damages in excess of $50,000, plus costs.

Ransom Wuller of Belleville will represent McKee in the case.

Circuit Judge Andy Matoesian will preside over the trial that is expected to last a week.

01 L 1731

 

Welwyn Garden City doctors suspended for altering medical records

12:49 – 30 September 2008

TWO doctors who put dozens of patients at risk by altering medical records have been suspended.

Husband and wife John and Mimi Mercer concocted vital heart data and rounded up cholesterol levels for up to 40 patients at the Hall Grove Group Practice in WGC.

The GMC hearing heard the Burmese couple changed coronary data to wrongly show patients did not need a medical review.

When partners at the Parkway surgery confronted Mr Mercer with the anomalies, he said he had only asked his wife to “assist him” with the records because he was recovering from a bout of flu.

The pair admitted making inappropriate amendments to patients’ medical records on March 3, 2006, but denied their actions were dishonest.

But they were found guilty following a four-day hearing last week, although Mr Mercer was cleared of inappropriately amending discharge summaries and pathology results for some patients.

Panel chairman Brian Alderman told the couple they could have posed a “serious risk to patients”. Suspending Mr Mercer for nine months, Dr Alderman said: “The panel has found your motive in altering records was to show compliance with government targets regardless of the actual level of compliance.

“The panel is particularly concerned about the editing of records of consultations held by other doctors.

“You were also dishonest in creating results which did not exist.”

He said: “You have shown some insight into your wholly inappropriate conduct by acknowledging it was wrong.

“The panel has accepted your assurance your misconduct will not be repeated and is satisfied there is no evidence of harmful deep-seated personality or attitudinal problems.”

Suspending Mrs Mercer for three months, Dr Alderman said the panel was conscious she was acting under the direction of her husband, and it was an “isolated episode of misconduct” in her career.

He added: “As a registered medical practitioner, you are required to exercise your own professional judgement and it is clear you must have known the entries you made were not justified.

 

HOSPITAL-ACQUIRED INFECTIONS KILL 270 PEOPLE A DAY

Posted On: January 2, 2008 by Wingate, Russotti & Shapiro

According to a recent article, published in the New York Times, and in response to widely held public concerns about preventable and deadly hospital-acquired infections, The New York City Health and Hospitals Corporation, began publishing statistics on infections and deaths at its 11 hospitals on September 7th of this year. The New York City Health and Hospitals Corporation, the nation’s largest public health system, treats 1.3 million patients a year according to the Corporation’s website.

The Times reported that the federal Centers for Disease Control estimated that in any given year 1.7 million patients will get a hospital-acquired infection during their hospital stay. Out of those 1.7 million, 99,000 people, or about 270 per day, will die.

A New York medical malpractice law, requiring hospitals to report specific infections to the State Health Department will result in the State Department issuing hospital report cards in 2009. While mandated infection reporting is only required in a few states. New Jersey’s legislature has passed a bill requiring hospitals to report infections, and that bill is now before the Governor. USA Today reported, that many hospitals have ‘balked’ at requests to provide statistics on hospital-acquired infections.

Simple, and easily implemented steps, like physician and staff members washing their hands between patients, would lessen the opportunity for a hospital acquired infection. But, according to Clean Your Hands’ website, a study reported in Emerging Infectious Diseases in April of this year, compliance with hand-washing is poor.

About.com had several suggestions on how patients can empower themselves when hospitalized. As a patient, you can:

• Insist that anyone who touches you washes and sanitizes their hands. That includes medical personnel, dinner tray delivery people, visitors, even family members. And, according to about.com, just wearing gloves isn’t good enough. Gloves may protect the wearer, but not the patient because the infection-causing pathogen may be present on the outside of the gloves.
• Insist that anything you touch is clean. That includes the telephone; the TV remote; the doctor’s stethoscope; bandages and dressing; and, catheters

 

Fake doctor jailed over £100,000 thefts

News and Star

By Staff Reporter

Last updated 10:05, Saturday, 07 June 2008

A gang member who posed as a doctor to steal more than £100,000 from health workers across the UK has been jailed for three years.

Gary Francis O’Neil: Jailed for three years after admitting conspiracy to steal and conspiracy to obtain by deception

For eight months the gang got away with breaking into doctors’ lockers in hospitals, taking cash and cards – until they came to Carlisle and a quick-thinking bank clerk realised something was wrong.

Thirty-six-year-old Gary O’Neil was the last member to be caught and he was jailed at Carlisle Crown Court yesterday after admitting conspiracy charges.

Prosecutor Tim Evans told how the three-strong gang broke into lockers while surgeons were in the operating theatre and stole cash, credit cards and personal items.

They dressed smartly and even wore stethoscopes and name badges to make people think they were genuine health workers.

The cards would then be used at banks or in shops, emptying accounts of thousands of pounds.

On some occasions, the gang even called up victims posing as police officers or bank officials to trick them into divulging PIN numbers.

Around 10 hospitals across the UK were targeted by Lee Watson, George Quinn and O’Neil from October 2006.

When they struck at the Cumberland Infirmary last June they took the credit cards and driving licence of Dr Dylan Jones, who was in theatre.

Less than two hours later, they walked into the Royal Bank of Scotland where Quinn withdrew £4,200, posing as Dr Jones.

He tried the same thing at another branch but the clerk became suspicious because she knew the real Dr Jones, Mr Evans said.

He left the bank and got into a green Mondeo – the registration was noted by bank staff – and police were called.

“The green Mondeo was stopped by police at St Nicholas Gate with three occupants,” Mr Evans said.

“Two fled leaving Watson in the car.”

The capture of Watson prompted a huge police investigation – led by DC Gary Watson – involving 14 police forces across the UK.

It emerged the trio had struck at hospitals in Durham, Derbyshire, Lincoln, Cheshire, Stockport, Devon and Cornwall, Sheffield, the west Midlands and Hampshire, before coming to Carlisle.

After Watson’s arrest, O’Neil and Quinn carried out two further thefts without him in Ipswich last July. The total amount stolen amounted to £109,629.28.

Quinn and Watson, both from the Coventry area, were jailed in February for four-and-a-half years.

Carlisle Crown Court heard how O’Neil, who is also from Coventry, initially drove the others around and claimed not to have known what they were doing.

He gradually became aware, however, and was ‘recruited to the team.’

He was described as ‘quite vulnerable’ due to tragic personal circumstances and had become addicted to drugs.

Judge Peter Hughes QC, who described the thefts as professionally executed and sophisticated, and said Watson and Quinn had developed the crime until it became a ‘practised art.’

O’Neil was jailed for three years after admitting conspiracy to steal and conspiracy to obtain by deception.

Speaking after the case, DC Watson said the case had been built on evidence from the Carlisle incident and he was proud that a team which had targeted the UK had been stopped in Cumbria. Judge Hughes paid tribute to DC Watson, who led the inquiry and asked for his comments to be passed to the Chief Constable.

 

Military doctors allegedly collaborated in prison torture

Bioethicist charges healers violated ethics

and human rights at Iraq’s Abu Ghraib

Reuters file A hooded and wired Iraqi prisoner at Abu Ghraib prison who reportedly was told that he would be electrocuted if he fell off a box, is pictured this undated file photo.

getCSS(“3088874”)

var tcdacmd=”dt”;

updated 4:46 p.m. ET, Fri., Aug. 20, 2004 function UpdateTimeStamp(pdt) { var n = document.getElementById(“udtD”); if(pdt != ” && n && window.DateTime) { var dt = new DateTime(); pdt = dt.T2D(pdt); if(dt.GetTZ(pdt)) {n.innerHTML = dt.D2S(pdt,((”.toLowerCase()==’false’)?false:true));} } } UpdateTimeStamp(‘632286315819830000’);

LONDON – Doctors working for the U.S. military in Iraq collaborated with interrogators in the abuse of detainees at Baghdad’s Abu Ghraib prison, profoundly breaching medical ethics and human rights, a bioethicist charges in The Lancet medical journal.

In a scathing analysis of the behavior of military doctors, nurses and medics, University of Minnesota professor Steven Miles calls for a reform of military medicine and an official investigation into the role played by physicians and other medical staff in the torture scandal.

He cites evidence that doctors or medics falsified death certificates to cover up homicides, hid evidence of beatings and revived a prisoner so he could be further tortured. No reports of abuses were initiated by medical personnel until the official investigation into Abu Ghraib began, he found.

The medical system collaborated with designing and implementing psychologically and physically coercive interrogations,” Miles said in this week’s edition of Lancet. “Army officials stated that a physician and a psychiatrist helped design, approve and monitor interrogations at Abu Ghraib.”

Extent of doctors’ involvement remains unclear

The analysis does not shed light on how many doctors were involved or how widespread the problem of medical complicity was, aspects that Miles said he is now investigating.

A U.S. military spokesman said the incidents recounted by Miles came primarily from the Pentagon’s own investigation of the abuses.

“Many of these cases remain under investigation and charges will be brought against any individual where there is evidence of abuse,” said Lt. Col. Barry Johnson, U.S. Army spokesman for detainee operations in Iraq.

In a related matter, two military officials in Washington said Thursday that a high-level Army inquiry will cite medical personnel who knew of abuse at Abu Ghraib but did not report it up the chain of command. The inquiry also will criticize senior U.S. commanders for a lack of leadership that allowed abuses to occur, but will say there is no evidence they ordered the abuse, said the sources, who spoke condition of anonymity.

Photographs of prisoners being abused and humiliated by U.S. troops in Iraq have sparked worldwide condemnation. Although the conduct of soldiers has been scrutinized, the role of medical staff in the scandal has received relatively little attention.

‘Last line of defense’

“The detaining power’s health personnel are the first and often the last line of defense against human rights abuses. Their failure to assume that role emphasizes to the prisoner how utterly beyond humane appeal they are,” Miles said in a telephone interview with the Associated Press.

He said military medicine reform needs to be enshrined in international law and include more clout for military medical staff in the defense of human rights.

Miles gathered evidence from U.S. congressional hearings, sworn statements of detainees and soldiers, medical journal accounts and press reports to build a picture of physician complicity, and in isolated cases active participation by medical personnel in abuse at the Baghdad prison, as well as in Afghanistan and at the Guantanamo Bay detention center in Cuba.

In one example, cited in a sworn statement from an Abu Ghraib detainee, a prisoner collapsed and was apparently unconscious after a beating. Medical staff revived the detainee and left, allowing the abuse to continue, Miles reported.

Depositions from two detainees at Abu Ghraib described an incident in which a doctor allowed a medically untrained guard to sew up a prisoner’s wound.

IV tube inserted into corpse

A military police officer reported a medic inserted an intravenous tube into the corpse of a detainee who died while being tortured to create evidence that he was alive at the hospital, Miles said.

At prisons in both Iraq and Afghanistan, “Physicians routinely attributed detainee deaths on death certificates to heart attacks, heat stroke or natural causes without noting the unnatural (cause) of the death,” Miles wrote.

He cites an example from a Human Rights Watch report in which soldiers tied a beaten detainee to the top of his cell door and gagged him. The death certificate indicated he died of “natural causes … during his sleep.” However, after media coverage, the Pentagon changed the cause of death to homicide by blunt force injuries and suffocation.

Dr. Robert Jay Lifton, a psychiatrist at Harvard University-affiliated Cambridge Hospital who wrote a book on doctors and torture in Nazi Germany, called the Lancet analysis “a very good, detailed description of violations of medical policies involving medical ethics.”

In a July 29 New England Journal of Medicine essay, Lifton urged medics to report what they know about American torture at Abu Ghraib and other prisons, and said in an interview Thursday that a non-military-led investigation of doctors’ conduct is needed.

“They made choices,” he said. “No doctor would have been physically abused or put to death if he or she tried to interrupt that torture. It would have taken courage, but it was a choice they had.”

The World Medical Association, an umbrella group for national medical associations, reiterated its policy of condemning any doctor’s involvement in abuse or torture of detainees.

In an editorial comment, The Lancet condemned the behavior of the doctors, saying that despite dual loyalties, they are doctors first and soldiers second.

Journal urges others to ‘break … silence’

“Health care workers should now break their silence,” the journal said. “Those who were involved or witnessed ill-treatment need to give a full and accurate account of events at Abu Ghraib and Guantanamo Bay. Those who are still in positions where dual commitments prevent them from putting the rights of their patients above other interests should protest loudly and refuse cooperation with authorities.”

Johnson, the Army spokesman, said the U.S. military “will allow no actions that undermine or compromise medical professionals’ commitment to caring for the sick and wounded, regardless of who they are or their circumstances.”

In his article, Miles dismissed Pentagon officials putting the blame for the abuse on poor training, understaffing, racism, pressure to procure intelligence and the stress of war.

“Fundamentally, however, the stage for these offenses was set by policies that were lax or permissive with regard to human rights abuses, and a military command that was inattentive to human rights,” Miles concluded.

 

Guilty doctors spared jail

Friday, 11 April, 2003, 14:31 GMT 15:31 UK

Two junior doctors have walked free despite being found guilty of killing a patient after failing to spot that he was seriously ill.

Sean Phillips died after going into Southampton General Hospital for routine knee surgery in June 2000.

He developed a rare condition called toxic shock syndrome, which was not diagnosed.

A jury at Winchester Crown Court took nine hours to find senior house officers Dr Amit Misra, 34, and Dr Rajeev Srivastava, 38 guilty of manslaughter by gross negligence in a majority verdict.

“ This should never happen again, and no-one should suffer like we have “
Annabel Grant, Mr Phillips’ partner

The judge, Mr Justice Gordon Langley, sentenced the two doctors to 18 months imprisonment, suspended for two years.

He said they had been convicted of a very serious crime which, in normal circumstances, would have resulted in a custodial sentence.

But he said he had taken into account the real remorse the men had shown for Mr Phillips’ death, the exceptional circumstances of the case, their good character and the fact that not all the circumstances that led to the tragic events were of their making.

He said: “I am quite satisfied that these appalling events have left a deep scar on both of you.

“There is a very real need of this court to acknowledge you have been found guilty of an offence that has led to the loss of life of someone who should be here today.”

Racing pulse

Mr Phillips’ partner Annabel Grant, speaking outside the court, said: “Justice has been served for Sean.

“This will not bring Sean back and our son Mitchell is without his father for the rest of his life.

“This should never happen again, and no-one should suffer like we have.”

She said she hoped procedures at the hospital would now improve.

The court heard the doctors had not asked a more senior colleague’s advice or carried out tests when Mr Phillips, a 31-year-old father of one, became ill.

Philip Mott QC, prosecuting, told the jury that even though toxic shock syndrome was relatively uncommon, the doctors should have spotted that Mr Phillips’ condition was worsening.

He had a racing pulse, a raised temperature and low blood pressure.

Mr Mott said it was not “rocket science at all” to diagnose them.

The doctors, both working in the hospital’s orthopaedic department at the time of Mr Phillip’s death, did not take his blood pressure, give him life-savings antibiotics or ask for help.

M Phillips deteriorated as the toxic shock syndrome led to kidney failure. He was transferred to intensive care, but died on June 24.

Password

Dr Srivastava, of Glencapel Road, Dumfries, Scotland had only been at the hospital for a week when the incident happened.

He said he had been given no induction course when he started work at the hospital.

In the doctors’ defence, the court heard that it was unfair to single them out when the system they were working in was failing.

Their ward was understaffed, and both were under pressure.

Defending Dr Misra, of Priestwood, Bracknell, Berkshire, Michael Gledhill QC, said the situation on the ward was “a comprehensive failure from top to bottom.

He said Dr Misra’s career in the UK was effectively wrecked.

Kristan Coonan QC, acting for Dr Srivastava, said his client had received racist hate mail, and that his career too was in ruins.

 

Bad Doctors Get a Free Ride

By SIDNEY M. WOLFE
NY Times

The death of Jésica Santillán, the 17-year-old given a heart and lung transplant last month from an incompatible donor, has become the latest argument in Congress against President Bush’s plan to limit malpractice damage awards. With doctors in several states staging work stoppages to protest the soaring costs of premiums, the plan to put caps on pain-and-suffering payouts had been picking up steam.

Yet in all the discussion of tragic cases and dollar amounts, a major cause of the malpractice problem is ignored: the failure of state medical boards to discipline doctors.

The fact is, only a small percentage of doctors account for most of the money paid out in malpractice cases. From 1990 to 2002, just 5 percent of doctors were involved in 54 percent of the payouts — including jury awards and out-of-court settlements — according to the National Practitioner Data Bank of the Department of Health and Human Services. (The data bank allows hospitals and medical boards to see the records of individual doctors but, thanks to pressure from the American Medical Association, Congress forbids it to release information to doctors or the public.)

Of the 35,000 doctors with two or more payouts during that period, only 8 percent were disciplined by state medical boards. Among the 2,774 doctors who had made payments in five or more cases, only 463 — one out of six — had been disciplined.

Is it any coincidence that the states least likely to discipline doctors are among those with insurance crises? Pennsylvania — where the governor had to intervene to keep doctors from going out on strike over malpractice insurance costs — has disciplined only 5 percent of the 512 doctors who had made payments in malpractice suits five or more times, the lowest percentage of any state. (Arizona, for example, has disciplined nearly half of the doctors in this category.)

And while Pennsylvania has 5.3 percent of the doctors in the United States, they make up 18.5 percent of American doctors with five or more malpractice payments. One doctor there paid 24 claims between 1993 and 2001 totaling more than $8 million (one was for operating on the wrong part of the body; another was for leaving a ”foreign body” in the patient) yet was never disciplined by Pennsylvania authorities.

The state with the next highest overrepresentation of doctors with five or more payouts is West Virginia, where doctors went on strike last month. It has 0.57 percent of the country’s physicians, but they make up 1.69 percent of American doctors who have had made malpractice payments five or more times. Only one-quarter of the state’s doctors with five or more payouts has been disciplined by the medical board.

In New York, another state with a pending malpractice crisis, the number of doctors who have had five or more malpractice payments is two and one-half times higher than would be expected from the number of doctors licensed. Yet only 15 percent of these 698 doctors have been disciplined by the state board.

Amid the uproar about malpractice premium increases, there is a deadly silence from physicians’ groups on the crisis of inadequate doctor discipline. The problem is not the compensation paid to injured patients, but an epidemic of medical errors. If medical boards, which are state agencies, are unwilling to seriously discipline doctors who repeatedly pay for malpractice — including revoking medical licenses from the worst offenders — then legislatures must step in and change the way the boards operate.

Congress should also rethink the secrecy surrounding the practitioner data bank. While a few states release some data to the public, most Americans have no way of finding out their doctors’ backgrounds. What patient would not like to discover the malpractice history of a potential doctor, especially if he is among the 2,774 in the United States who have had five or more payouts?

Sidney M. Wolfe, a physician, is director of the Public Citizen Health Research Group.