Auditors also found gaps in state laws that can shield abusive doctors. Among the weaknesses, Georgia doesn’t require hospitals, law enforcement or courts to report doctor violations to the board, nor are physicians required to report dangerous colleagues.
Of the 68 other state medical boards, 65 have stronger mandatory reporting requirements, according to the audit.
Members of the medical board will talk about the audit at their meeting next week, Executive Director LaSharn Hughes said, and look for areas to make improvements to best serve Georgia citizens.
But parts of the report weren’t fair, she said, such as its portrayal of the high proportion of non-discipline cases as a shortcoming.
“It doesn’t mean that those cases warranted public sanctions,” she said. “They may not have been to that level … It could be anything, like, ‘I didn’t get my records in a timely manner.’ It’s stuff like that. All of them aren’t sexual misconduct cases or egregious cases.”
More lax than others
State auditors, however, found Georgia’s rate of discipline stacks up poorly to that of other state regulatory boards they examined. Maryland, Virginia, Tennessee, Florida, North Carolina and Ohio all had higher rates of discipline for doctors, ranging from three to nearly six times higher.
The AJC has reported extensively on the medical board’s habit of forgiving doctors, a practice that continues. In a national investigation four years ago of doctors who sexually violate patients, the AJC found that two-thirds of Georgia doctors found to have sexually violated patients still were permitted to practice.
In a 2017 national investigation into the opioid crisis, the AJC found that the Georgia board had taken public action against only a handful of doctors per year for improper opioid prescribing. Even doctors who recklessly prescribed painkillers or had been arrested on drug charges were able to keep practicing.
Other findings in the audit also echo AJC findings.
The audit noted that consumers are underrepresented on the medical board. State law stipulates that two of the board’s 16 members represent the public. Like the AJC, the auditors reported that the public members are more likely than physician members to act when violations occur.
Colbert, of Georgians for a Healthy Future, pointed out that one of the board’s current consumer members is a pharmacist. “Not to pick on that individual, but I don’t know that that qualifies as a consumer,” she said.
The state Audits and Accounts department also noted the board closes some cases with confidential actions.
In the last fiscal year, the medical board closed 17% of cases by sending doctors a confidential “letter of concern,” which is not considered disciplinary action.
Only 18 cases last year resulted in actual discipline, including suspending or revoking medical licenses. The board took minor actions in four of those cases, such as imposing fines, reprimands, license restrictions or educational requirements.
Two other cases resulted in private actions, state auditors found, meaning the complaints were settled quietly between the board and accused doctors, with the records closed to the public.
The board took no public action against Dr. James Lanier Heaton after he was indicted in 2018 in a federal drug-trafficking case. It still didn’t act in October 2019, when Heaton was convicted on multiple counts. This past March, five months after his conviction, the board allowed the former nursing home medical director and family medicine doctor to voluntarily surrender his license.
There is no hint in the 2020 document that the surrender was anything but his desire, and no information about the reasons. Heaton’s attorney in the federal case did not immediately return a call for comment.
The state audit explores why discipline may be so rare, attributing a culture of leniency to both internal and external factors. The board may be hamstrung by a state Legislature that seizes licensing revenues each year that could go toward more investigative resources, the audit says.
Credit: Illustration by Richard Watkins / AJC
Credit: Illustration by Richard Watkins / AJC
Dragged out for years
In examining the board’s investigative process, the auditors found that its guidance to staff is more limited compared with other states and management can’t easily track the progress due to data system limitations. That can result in some lengthy delays.
The audit said that prescribing complaints can take one month to eight years to close.
Such delays can pose risks to the public, the audit says. It described one case where the board received a sexual misconduct complaint in 2016, against a doctor with a history of complaints and prior discipline, yet the board took a year to issue a summary license suspension.
In a recent case reviewed by the AJC, the board did discipline Dr. Basil Lamont Anderson, a family medicine doctor in Oakwood – but three years after he was first reported to police for sexually harassing and improperly touching an employee.
After her December 2015 report to police, investigators unearthed a series of other complaints. He was arrested in February 2016 and in January 2017 pleaded no contest to one count of misdemeanor sexual battery.
The board in July 2017 issued a confidential order for Anderson to get a mental and physical examination after it said it had received information that he had engaged in “acts of sexual intimacy, misconduct, assault, battery and other boundary violations with his patients, former patients and employees.”
The board revoked his license in July 2018 — one year after it ordered the examination — saying Anderson had offered no indication he would comply with recommendations from the examination.
Anderson could not be reached for comment.
Another audit to follow
Leslie McGuire, the director of Audits and Accounts’ performance audits division, said the review of the medical board was prompted by reporting by the AJC and other national news outlets, as well as a recent review of the Department of Community Health, which the medical board falls under.
There will be a follow-up audit within the next two years, McGuire said.
Among the recommendations for reforms, the audit said the medical board should engage in more public outreach so the public knows how to complain about an offending physician, and how to go about it.
The board should consider issuing press releases about disciplined doctors and having a presence on social media. Hughes, the executive director, said the board’s public outreach committee has been working on that, as well a sign for doctors to post in offices about the complaint process.
“Some things, we were already working on before,” Hughes said.
About the Georgia Composite Medical Board:
The medical licensing board regulates 38,000 doctors, along with 16,000 licensees in other professions including physician assistants, orthotists and prosthetists, and acupuncturists.
The board has 16 members, 13 of them physicians, two consumer members and one a non-voting physician assistant. They have an executive director, a medical director, an assistant medical director, and a support staff of 29 people involved in investigations, licensing and operations. Five are criminal investigators.
Among the recommendations by the Georgia Department of Audits and Accounts:
· The Georgia General Assembly should consider requiring additional public members.
· The General Assembly should consider directing all fee revenue to purposes related to licensure, discipline and board administration.
· The General Assembly should consider requiring violation reporting from additional entities such as hospitals, healthcare organizations and other doctors, and consider imposing civil penalties for failure to report.
· The medical board should consider establishing comprehensive checklists for routine case reviews and investigative plans for complex investigations.
· The medical board for internal purposes should consider documenting the reason for closing cases without discipline.
· The medical board should establish sanctioning guidelines that outline criteria for determining appropriate disciplinary action. The guidelines should address the use of private orders and non-disciplinary letters of concern.
· On physicians’ profiles on the board website, the medical board should provide a narrative summary of any violations and disciplinary actions. Links to the full board orders should be included in the discipline section.
· The medical board should consider low-cost public outreach initiatives, such as monthly press releases on disciplinary actions and utilizing social media accounts.
Four years ago, a groundbreaking investigation by The Atlanta Journal-Constitution exposed a nationwide scourge of doctors raping, molesting and seducing patients, yet being allowed by their peers to continue seeing patients. The newspaper discovered that of the 2,400 doctors publicly sanctioned for sexual misconduct against patients from 1999 to 2015, half still had active medical licenses.
In another national investigation in 2017 involving the opioid crisis, the AJC found that the Georgia medical board rarely yanks the licenses of physicians who behave more like dealers than healers. The board allowed errant doctors to keep seeing patients even if they recklessly prescribed pain killers or had been arrested on drug charges.