Connecticut’s board averaged about 13 serious disciplinary actions a year in 2017, 2018 and 2019, according to Public Citizen. The rankings are based on the number of serious disciplinary actions taken by states per 1,000 physicians. Connecticut’s rate was .65 per 1,000 physicians compared to Kentucky, which had the highest rate of serious disciplinary actions at 2.29 per 1,000 physicians, the report said. Public Citizen defines a “serious disciplinary action” as one that has a clear impact on a physician’s ability to practice.
The medical boards, which oversee the discipline of physicians in all 50 states and the District of Columbia, are largely unfunded or under-funded, are not adequately staffed, are reactive to complaints rather than initiating proactive investigations, and have little oversight by state officials or legislators, the report said.
“They are not doing what they are mandated to do,” said Dr. Sidney Wolfe, founder and senior advisor of the Public Citizen’s Health Research Group and one of the authors of the report. “So, what is happening is they are leaving tens of thousands of patients exposed to doctors who shouldn’t be practicing.”
Complaints filed against physicians in Connecticut can take months and sometimes years to investigate and adjudicate. In one recent case, a psychiatrist was allowed to practice while a 2018 complaint was investigated and discipline negotiated on allegations that he had failed to monitor a patient on Lithium and failed to keep the patient’s records during the period under review. His case was settled in June with a $10,000 fine and 18 months of probation.
Attorney Kathryn Emmett, the chair of the Connecticut board, said that the Public Citizen report doesn’t reveal the whole picture. Emmett said she couldn’t speak for the entire board but noted that comparing states by the number of disciplines issued wasn’t the best way to assess their effectiveness.
“I think that the idea that the greatest number of serious disciplines can be used is faulty,” Emmett said. “I don’t think it shows whether the board is accomplishing its goal of protecting the public.”
But at least two public members of the board share the national advocacy group’s concerns. Jean Rexford, who has been a board member for more than a decade and founded the Connecticut Center for Patient Safety, told the board during its May meeting that she wanted to look at whether it was doing enough to address the safety of the public.
“I think the legislation that chartered us was many, many years ago,” Rexford said. “Is it time to take a look at that and bring it up to 2021? Do we need to have better consideration of transparency? I’ve been feeling incredibly powerless on Zoom [where the meetings are now conducted] but also powerless in our role in protecting the public,” Rexford said before suggesting that a committee of board members examine “how we could keep current and do a better job.”
Rexford’s comments prompted the creation of a working group, which met in private for the first time on Sept. 28. The state Department of Public Health (DPH) contends that the meetings are administrative and not open to the public. The Connecticut Health Investigative Team has filed a complaint with the state’s Freedom of Information Commission on the denial of access to the working group meetings.
Med Board’s Composition And Role
The med board’s composition—which includes physicians, attorneys, and public members—and its duties are laid out in a decades-old law that has been periodically updated. The board has no funding and no staff of its own. Any fines collected from disciplined physicians go into state coffers. All staff members are DPH employees who also deal with complaints against other professions. The board has no independent investigatory or policy-making powers, according to the statute.
The DPH’s Practitioner Licensing and Investigations Section reviews complaints filed against physicians. The same investigators deal with complaints filed against dozens of other professions, including nurses, hair and nail salons, and veterinarians.
There are 18 full-time investigators within the unit who work on 1,200 to 1,500 complaints a year, said Section Chief Christian Andresen. There is also a hearing process for physicians who contest the charges. The agency receives about 450 complaints about physicians a year that result in an average of 43 disciplines a year, DPH officials said.
The DPH hires medical consultants to determine if a physician facing a complaint has met the standard of care or has participated in activities that could be harmful to patients, Andresen said. The range of complaints that come before the medical examining board includes physicians practicing while under the influence of alcohol or drugs, physicians failing to diagnose serious illness accurately, physicians practicing with a serious mental illness, or physicians prescribing to patients without adequate oversight or controls.
Michele Jacklin, a public member of the med board, said the board is “impotent and toothless” compared to medical boards in other states. “Other boards have budgets, publish newsletters and conduct seminars,” Jacklin said during an interview. “The Connecticut Medical Examining Board is totally reactive.”
Jacklin’s concerns range from no orientation process for new board members to the range of fines that can be issued as a discipline, she said.
“Other states routinely issue fines as high as $50,000,” Jacklin said. “In Connecticut, often the penalties are $1,000 to $5,000, which is a slap on the wrist for a physician.”
State statute limits the fines for physician discipline to $25,000.
There are no staff members who can monitor state or national medical issues that may arise, including checking social media for state physicians who are spreading misinformation on COVID-19 vaccines, officials said.
Although a DPH spokesperson said the agency would investigate all complaints related to misinformation about COVID-19, it took more than five weeks for Andresen to act on an anonymous tip that a retired Durham physician was issuing fraudulent exemptions for COVID-19 vaccines and masks to anyone who sent her a self-addressed stamped envelope, documents showed.
Since the complaint against Sue McIntosh was made anonymously, it took five weeks to “triage” before it was presented to Andresen to investigate, DPH officials said.
The board unanimously voted to suspend McIntosh’s medical license on Sept. 24. A few days later, the DPH alerted all long-term care facilities in the state, which require staff to be vaccinated, to review their employees’ COVID-19 vaccine exemptions to see if McIntosh had signed any.
The DPH has declined to provide any information on whether McIntosh had given exemptions to long-term care employees or any state employees, who are also mandated to be vaccinated against COVID-19. The board unanimously agreed to drop the charges against McIntosh last week after she voluntarily relinquished her medical license.
Under the current system, board members have no idea how many complaints have been filed, the substance of the complaints, or how many complaints have been dismissed, Jacklin said. “The discipline is negotiated by DPH attorneys and then what comes to us is a consent order,” she said. “We basically can’t ask any questions or get any other information other than what is in the consent order. All we can do is reject the consent order or rubber-stamp it.”
In general, the board focuses on approving disciplines that educate and monitor physicians so that they improve and provide better care, Emmett said. “I don’t think there’s good data to support that more discipline results in better care for the community,” Emmett added.
But the board could be doing more to protect the public by providing orientation for all board members and by being kept up to date on state legislative happenings and national policy changes, Rexford and Jacklin said.
Rexford said other state boards moved to pass legislation based on a national workgroup report on physician sexual misconduct. “I just feel as if we are missing the boat when I hear that and when I see what other groups are doing,” Rexford said. “At the very least, I would like Chris [Andresen] to attend meetings, I would like everybody to attend an orientation and I would like to feel that we were all working as a team.”
Read the Public Citizen report below.
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Open in new tab New HIV/AIDS cases are falling in Connecticut, especially among injection drug users, but men who have sex with men make up a growing proportion of diagnoses in the state. They are also the largest group affected by HIV nationally.
Getting these men tested and into treatment is key, as medication now drastically reduces the risk of infected people passing on the virus. AIDS workers say that “men who have sex with men’’ includes gay and bisexual men and men who identify themselves as heterosexual, despite having sexual relations with other men.
It’s this group of men that AIDS Project New Haven is particularly trying to reach because they are “more disenfranchised and stigmatized,” and therefore may not be aware of their HIV status and may not be practicing safe sex, explained Executive Director Christopher Cole. The organization is now sending outreach workers to public parks, rest stops and other places where men in the target group meet sexual partners.
The number of HIV/AIDS cases diagnosed in Connecticut has decreased from 851 in 2002 to 407 in 2010, according to the latest figures from the state Department of Public Health (DPH).
About 10,500 people in Connecticut are living with HIV/AIDS and nearly one-half live in Hartford, Bridgeport and New Haven.
Between 2006 and 2010, Hartford had 312 newly diagnosed HIV cases, Bridgeport had 256 and New Haven had 224, according to DPH. The statewide total for the same period was 2,055.
More than 9,000 have died of AIDS in Connecticut since 1981.
In 2010, 36 percent of newly diagnosed cases were men who have sex with men, making that the leading risk factor in the state, and 11 percent were injection drug users. In 2002, injection drug use was the leading risk factor for infection.
Connecticut is seeing a drop in federal HIV prevention funding. Last year the state received $6.1 million in federal funding. This year only $4.7 million was allocated, and state officials say federal funds will continue to decline. Better national data collection revealed that some areas of the country with the highest number of HIV/AIDS cases were underfunded and led to a redistribution of federal resources, according to Christian Andresen, chief of the TB, HIV, STD and Viral Hepatitis Section at DPH.
The national AIDS strategy is emphasizing testing more people and moving them into treatment, said Andresen. An estimated one in five people infected with HIV do not know it. Younger people are especially likely to go undiagnosed.
Among people 13 to 24 with HIV, 60 percent are unaware of their infection, according to a report released this week by the Centers for Disease Control and Prevention. Getting people on medication and reducing their viral loads (the amount of HIV in the blood) can decrease risk of transmission by up to 96 percent, said Andresen.
Connecticut has a large number of “late testers,” according to DPH’s 2010 epidemiological report, which finds that 30 to 40 percent of people already have AIDS when they first test positive for HIV, the virus that causes AIDS. National rates of late testing are similar.
Late testing is evidence that doctors are not following the CDC guidelines on HIV testing, which since 2006 have suggested testing for anyone aged 13 to 64 as part of routine medical care, according to Shawn Lang, director of public policy at the Connecticut AIDS Resource Coalition. “People don’t think they’re at risk,” she said, and so don’t get tested until symptoms occur.”
The state is encouraging routine AIDS testing in local health centers in order to get more people tested and, if needed, in a treatment program. Andresen said that medications work effectively to prevent virus transmission and to reduce the risk of infection after exposure.
While injection drug use transmission is dropping, Andresen said that the state would continue to support some projects that do prevention work with drug users.
Federal funding cannot be used for needle exchange programs; however, such programs in the three cities with the highest AIDS burden –Hartford, Bridgeport and New Haven – receive state money. About $455,000 is spent on the needle exchange program, according to Lang.
Danbury will lose its needle exchange funding next year, but will continue to operate its program, which serves more than 120 people, according to Roberta Stewart, executive director of AIDS Project Greater Danbury.
Stewart realizes that her decreased funding is the result of successful efforts to contain the virus. “I get that intellectually,” she said. But she worries that funding cuts could make it harder to maintain low transmission rates. “It’s much harder for us out there,” she said.
As the emphasis moves from needle to sexual transmission, how best to reach men at risk is “the million dollar question,” said Andresen.
AIDS clinicians and policymakers are meeting in December, said Lang, and will be looking at data in an attempt to understand why prevention has been so much more effective with some groups than others.
Cole said that interviews AIDS Project New Haven did with a small group of men who have sex with men offered some clues. “We learned that stigma was an issue in sharing their HIV status,” he said.
New infections are falling and people live longer thanks to improved medications, but problems persist in some communities. Blacks and Hispanics represent 65 percent of people living with HIV in Connecticut. Nationally, the CDC estimates that women comprise 24 percent of people living with HIV, but in Connecticut that number is 34 percent.
“Not a lot of people are paying attention to AIDS anymore and it’s still a problem,” said Lang. “We’ve got a lot of work to do still.”
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