By Christopher Guadagnino, Ph.D.

Published August 2001

• React to this article in the Discussion Forum.

Albert H. Masland is Commissioner of Pennsylvania Department of State’s Bureau of Professional and Occupational Affairs.

PND: What is the purpose of Pennsylvania’s new website reporting disciplinary actions against licensed professionals?

AHM: We have an Internet site that permits the licensees and the public to verify the license status of any licensee, not just physicians, and determine if there were disciplinary actions against the individual. Our old system had basically been in place with one minor upgrade for over 20 years and was an internally created system which we knew we had to upgrade. The Bureau oversees 27 boards that meet on a regular basis with approximately 800,000 licensees from over 40 professions. We deal with every professional who’s licensed in the state except for lawyers, bankers and insurance salesman and will have approximately two million licenses of record on the website. That has been a major challenge—to convert the data from our old system to this new system. The web address for the site is www.licensepa.state.pa.us, and you will also be able to access it from the Pennsylvania home page.

PND: How can physicians and consumers use the site?

AHM: The medical community will be able to log on to make sure that their license number and status are accurate—that they have an active license that is in good standing. They’ll be able to verify that they don’t have any disciplinary actions lodged against them, unless that it is case, and then they’ll be able to verify that what is in there is accurate. The public, too, will be able to check to see that their physician is in good standing with the Bureau and either does or does not have any disciplinary actions. We have not put on the website an extensive description of every disciplinary action. This is a first step, and some may complain that we don’t have enough information on there, but others will probably complain we have too much. Some states, I believe Florida for instance, list every malpractice claim above $5,000. To put that information on would be quite time consuming. It’s probably required by their statute. It’s not required by ours. Everything that’s on our website is public information. If someone wants more information, for instance, if they see there has been a disciplinary action and a professional has had their license revoked, we will not have the full adjudication on the website. We won’t have the decision by the board or by the hearing examiner on there for someone to read. Eventually, we may be able to do that—to provide the consumer and the physician the opportunity to click on a button and see exactly what the disciplinary order stated. At this point, though, we’re just giving the bare bones that there was disciplinary action, that it was a revocation or a suspension, that it was for a certain number of months, that there was a fine of $1,000—information of that sort.

PND: What constitutes a disciplinary action for physicians?

AHM: With respect to any profession, it can be a public reprimand, which amounts to a board saying, "You did something wrong but it’s not serious enough to take your license away." It can be probation, suspension of anywhere from one month to five years, or revocation. You could also have the denial of an application.

PND: Are there other data besides the disciplinary actions on the website?

AHM: It will have basic employment information. We will not have the address of the licensee on the website. We decided that, although that is public information, for privacy reasons we would refrain from doing that at the outset. We heard of other states having attempted to put the address on and then having to retract that information after hue and cry from the public and from the licensees. Also, by the time physicians are next scheduled to renew their license, they will be able to do so online. They will not have to fill out a form, sign a check, put it in the mail and hope it gets here. This service will be available this fall.

PND: Will information about malpractice history appear on the website?

AHM: We will not have malpractice history on the site initially. We’ll see what kind of feedback we get from the public and from the licensees about the data we have on the site. Based on that feedback and our assessment of public demand and public need, along with the needs of our licensees, we’ll add information down the road. I do not know at this point whether we’ll determine that malpractice information is essential.

PND: Is any information on this website new, or has all of it been available previously to the public?

AHM: All this information has been available to the public, but the public would have to call or write to request the information, and that was not only time-consuming to them, but frankly was very time consuming for us. This new system is going to streamline our internal operation incredibly. We will be able to process applications much easier. Our staff will be able to concentrate on other activities instead of spending 90 percent of their time on the phone, especially during the renewal periods, when clerical staff can’t get off the phone because people are calling in to check on the status of their license.

PND: Medical boards in some other states have provided more information about physicians to consumers, such as a physician’s educational background, malpractice insurance coverage, malpractice claims and settlement amounts. Why aren’t you including this type of information?

AHM: For the website vendor which we’re dealing with, System Automation, this is the largest project they’ve ever been involved in. It has been quite ambitious to accomplish what we’re doing within about a year from the time the contract was finalized and frankly, it’s taken a lot of work just to get the information we have onto the system. There’s no question that we could make more information available, and we will make more information available. But, initially we wanted to make sure we at least got the bare facts out there to the public so they can verify that someone has a license in good standing. We’ll have to see what kind of feedback we get from the public. Once we get the bare bones out there we’ll be able to analyze how much more flesh we put on them and when it goes on.

PND: What data do you think is appropriate and not appropriate to gather and disclose?

AHM: I think it’s not so much a question of what data is appropriate because we have most of this data. Whatever we have is public information. If someone asks for it, we will give it to them. The issue is not, "What’s appropriate to put out there?," but rather, "What can your system handle and how soon do you need to get it out there—how crucial is it?" Not all malpractice claims are public information. Some settlements are sealed when the court determines that it will not be made public. But, to the extent that settlements are public information and that malpractice claims are not sealed by the court, that’s something that could be put on the website. One of the concerns we have is to balance the need to protect the public with the need to not do any harm with respect to the licensees. If you put out every malpractice claim that’s paid over $5,000, as they do in Florida, I think you have to be careful that’s it’s done with 100 percent accuracy and that it is not done in an inflammatory fashion. My belief is that it would be important to say whether something is a jury verdict or a settlement. The website’s current information, though, is pretty straightforward: you find the physician and you find out if they have any disciplinary actions. If you want to get more details, we don’t have a button to click on so you can get the full adjudication and order, but you can contact the Bureau and we can send that to you in written form.

PND: Who determines what information and context for that information will be put on the website?

AHM: We will review the feedback that we get from the public, from the boards, and the licensees and a determination will be made about what data should be added. It’s not going to be done in a vacuum. There will be input from board members, which includes public members of the boards. We will also have input from the governor’s policy office and from the Secretary of State. We’ll make a thorough and a conscientious review of the feedback we get to determine what information is appropriate. I don’t foresee the need for any legislative action to put on the website things that are already in the public record. The only issue is in what form you make it public. I don’t think there would be any requirement of the Independent Regulatory Review Commission to act with respect to the information that we put on the website. There’s nothing that requires us to put everything on a website because there’s nothing that requires us to have a website. Someone can access the information by writing us or calling us. I don’t think we’re depriving them if we don’t put every jot and tittle on the website itself. That’s not to say someone in the General Assembly won’t introduce a bill to require the information to be made public on the website.

PND: The Medical Board’s role in reducing medical errors has gained a lot more attention in wake of the current medical malpractice crisis in Pa., with even the Pennsylvania Medical Society stating that the Board does not have sufficient resources to fulfill its mission adequately. The state’s trial lawyers point to the small number of physicians receiving disciplinary actions and the relative lack of disciplinary data disclosure as reasons fueling the need for so many malpractice lawsuits. Is there anything that the Board could be doing to play a greater role in reducing medical errors and ameliorating the medical malpractice crisis?

AHM: In my six months in the Bureau I can say that the Medical Board has not shirked its responsibility to protect the public with respect to any case that has come before it. Does that mean that we could have more cases brought before it? That’s possible, but ultimately we are a complaint-driven body. If the complaints aren’t raised by the public initially, there’s nothing we can do. There may be a need, as is mentioned by many of the professional boards, to hire more investigators. Everybody wants to increase the budget at the Bureau of Enforcement and Investigation astronomically and exponentially. But from my perspective, I don’t think the Medical Board has shirked its duties to appropriately discipline the cases that come before it. If there is a serious complaint against a physician, it goes to the top of the stack and is given priority status, especially if there is any allegation that the public has been harmed by that physician. For me to say that having more investigators will automatically lead to a greater number of disciplinary actions is probably too simplistic. If we had more staff, we might be able to move some of those issues through faster, but the Bureau of Enforcement and Investigations looks into every complaint. I don’t know of any cases out there that have not been investigated because of a lack of investigators. If we receive a complaint we investigate it.

We’re working with the Department of Health in collecting data on a number of things, including the shortage of health care practitioners, and data on errors in hospital settings so we can do something with it. I imagine, as a result of the attention given to medical errors over the past year, that referrals to us from the Department of Health will go up significantly. Error data is nice to look at from an academic perspective, but we don’t need data—we need specific complaints. We can’t just send an investigator to a hospital without giving that person direction as to who he is supposed to investigate. We need names and addresses—not percentages, medians and means.