Substandard doctors must be reined in

No doctor would recommend that a patient wait a decade between check-ups. And yet, that's how long it's been since state watchdogs took the vital signs of the Board of Medicine.

That's too long, particularly for an agency Virginians depend on to ensure their physicians are safe and competent.

In 1999, the Joint Legislative Audit and Review Commission questioned whether the board was adequately protecting the public from deficient doctors. Four years later, the General Assembly adopted reforms that made it easier for the board to react to a single medical error, rather than waiting for a pattern of abuse to emerge.

The board also assigned less serious cases to staff supervision and instituted private consent agreements to try to focus more time and attention on the most egregious cases.

The original reform legislation, sponsored by former Norfolk Del. Winsome Sears, called for JLARC to review progress after several years, but that provision was removed from the bill. Sen. Linda "Toddy" Puller tried this year to initiate a new study, but House leaders blocked her request.

They should reconsider.

The board has improved its response time to patient complaints, but a report by the consumer group Public Citizen last year ranked Virginia 39th in the nation for its rate of serious disciplinary actions per 1,000 doctors, down from 30th the year the reforms were adopted.

The case of Dr. Stephen Plotnick suggests another review is needed. According to an investigation by Virginian-Pilot writer Bill Sizemore, 10 of the Virginia Beach doctor's patients have died since 2004, at least seven from overdoses of drugs Plotnick had prescribed. The Board of Medicine stripped him of his license in January.

Plotnick is an extreme case, but he's not the only Hampton Roads doctor whose prescriptions have attracted the board's attention. Dr. Julian D. McKenney Jr. of Suffolk was placed on indefinite probation in December after providing high-powered painkillers without proper monitoring to two patients, including a 19-year-old woman whose mother had asked him to stop giving her daughter narcotics. Dr. Mohammad Soori's license was suspended in January after the board concluded the Beach doctor had prescribed narcotics to five patients without medical cause and had inappropriate relationships with two others in Virginia and New York, in cases dating back to 2005.

JLARC previously recommended that the board adopt the standard of evidence used by 38 other states in disciplining doctors. Virginia currently requires "clear and convincing evidence," the highest legal bar possible. JLARC analysts should be tasked with considering whether that hurdle has contributed to low disciplinary rates. The agency should also consider whether alternatives exist, such as replacing existing guidelines for pain management with regulations that could be more easily enforced without requiring several experts to testify for each individual case.

JLARC also should be asked to review whether the secret consent agreements are working as intended and whether mandatory peer reviews and stepped-up reporting requirements for pharmacists could improve self-policing within the health care field.

State lawmakers can still initiate a JLARC review of the medical board, and they should do so immediately. If they put off a checkup for another year, they run the risk that a small problem could turn into an acute illness.