Locally, major hospital networks say they not only investigate medical staff with criminal background checks and lengthy questionnaires about their disciplinary or malpractice history, they also monitor doctors while they’re practicing and conduct periodic checkups to make sure their status hasn’t changed.
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Officials at Dayton-based Premier Health, the largest hospital system in southwest Ohio, said they updated their medical staff bylaws just this year to make it more difficult for doctors who may pose a threat to their patients or the public to slip through the screening process.
“I’ve been in the medical field now for 30 years, and it’s quite different than it used to be,’’ said Dr. Tammy Lundstrom, chief medical officer for Premier. “Doctors are people, too, and they’re going to have issues. But the days of sweeping things under the carpet are not the days we’re living in today.”
Tougher standard
Doctors applying for positions at Premier must report whether they’ve ever been convicted of any felony related to abuse or violence, which automatically disqualifies them from practicing in the hospital system, Lundstrom said. That’s an even tougher standard than Ohio state law, which bars only doctors convicted of a drug-related felonies from being licensed in the state.
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In addition, Premier queries potential new hires on whether their medical licenses have ever been revoked, suspended or restricted because of criminal behavior or professional misconduct, and whether they’ve ever voluntarily resigned while under investigation to avoid a formal reprimand.
“We have about 20 questions that we ask every practitioner coming in,” Lundstrom said. “It’s an intense process.”
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Premier, like many hospital networks, verifies the information provided by applicants by checking medical board records here and in other states, and running the names of doctors through the National Practitioner Data Bank — a confidential information clearinghouse created by Congress where hospitals are required to report certain physician behavior, including sexual misconduct.
In addition, Premier routinely checks with the the federal Office of Inspector General ‘s List of Excluded Individuals and Entities (LEIE), which contains the names of doctors and entities who have defrauded Medicare or any other federal health care program.
“We query that every time somebody comes on staff, and then every two years when they re-credential,” said Lundstrom, referring to the state’s requirement that medical doctors renew their licenses biennially.
Prospective medical staff are also extensively vetted at Dayton-baesd Kettering Health Network.
“Each physician is queried for a history of felony conviction of any kind, and confirmed against both the National Practitioner Data Bank (NPDB) and the Office of Inspector General,” said Dr. Marcus Romanello, chief medical officer at Kettering’s Fort Hamilton Hospital. “Additionally, we send queries to hospitals at which the physician has previously worked, and we perform primary source verification for licensure, medical training, and educational degrees. Any aberrant finding arising from the credentialing process is scrutinized at multiple committee levels, with ultimate discretionary authority residing with the individual hospital boards.”
Still, even with such precautions in place, sexual abuse by doctors is more common than many people might think, based on a yearlong, 50-state analysis by the Atlanta Journal Constitution, and separate investigations by the Dayton Daily News that found more than 2,400 U.S. doctors have been sanctioned for sexually abusing their patients.
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The list includes former Dayton anesthesiologist Dasharathram R. Nalabolu, whose license was revoked by the Ohio Medical Board in 2001 after he was convicted on three counts of sexual battery, stemming from an arrest in 2000.
Medical board records say Nalabolu in June 2000 gave a patient an injection for shoulder pain, then inserted his fingers into her vagina over her objections. He then rubbed “all over” the patient’s body and commented on her breasts; finally she ran out of the office and went to Centerville police.
Nalabolu had been accused of improperly touching as many as seven patients dating back to 1997 before he was arrested.
Better screening sought
In some cases, potentially dangerous doctors simply fall through the cracks of a physician oversight system that is often overworked and understaffed.
The Ohio board has about a half dozen employees who process hundreds of licensure applications each year.
To address the issue, the board — which has a reputation for being among the nation’s strictest and most transparent licensing bodies in the country — is in the process of digitizing the application process for a medical license “so that we can gain better background information on our license applicants,” according to a statement from the board’s president, Michael Gonidakis.
Tessie Pollock, a medical board spokeswoman, said electronic applications are much easier to review than applications than applications, that until recently, were sent to the medical board by mail, and processed by hand.
“First, it frees up the manpower that used to be spent chasing down all of the pieces that were missing from a paper application, and mailing them back and forth,” she said. “Now, instead of spending time gathering the information, our staff members can really focus on reviewing applications. It’s still really important to have that human review of an application for a license in the state of Ohio.”
The medical board has already converted the application process for physician assistants, anesthesiologists and other non-physician medical staff that to the electronic system, and will soon move physician applications into the electronic system, which also makes it easier to cross-check applications with national databases and medical board records in other states, Pollock said.
“If we have a physician that may have had discipline in another state, we want to make sure we’re aware of that before we even consider a license here in Ohio,” she said. “We also want to make sure the person applying is really who they say they are. We want to make sure they’ve actually gotten the training they say they’ve had. And we really want to verify any criminal history or convictions that they might have.”
Some continue to practice
While the board and hospital administrators have taken added measures to crack down on doctors who sexually abuse their patients, doctors who have been sanctioned for sexual misconduct are still allowed to practice in some cases.
Dr. Laurence I. Kleiner, a neurosurgeon at Dayton Children’s Hospital, continues to practice even after being disciplined for “conduct deemed to constitute sexual harassment” at a hospital where he previously worked in Roanoke, Va., according to medical board records.
Kleiner received a probationary medical license in Ohio in 2002 after agreeing to continue the treatment and counseling he started in Virginia as part of his agreement to continue working at the hospital there. His probation was lifted by the Ohio medical board in 2007.
Officials at Dayton Children’s were quick to point out that under state law a hospital cannot arbitrarily decide which doctors can be granted clinical privileges.
“If a physician was sanctioned by the Ohio State Medical Board but permitted to continue to practice medicine in any location, including a children’s hospital, the Hospital could not arbitrarily deny or refuse to grant clinical privileges to the physician,” the statement reads. “Ohio law provides an absolute bar only if there is a criminal conviction (or plea of guilty) to certain criminal offenses.”
The medical board notes that every license application is unique, and the board’s decision to grant or deny a license “depends on the facts of the specific case,” according to a statement: “Disciplinary action by another state’s medical regulatory agency is a basis for the Board to deny an application for an Ohio medical license, but it does not automatically disqualify the individual from obtaining a license.”
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