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 The board also reprimanded the medical license of the psychiatrist, Dr. Dale Wallington, for performing an inadequate diagnosis of the patient and for failing to implement strategies between 2008 and 2017 to prevent the patient’s abuse of Xanax and Vyvanse, a consent order Wallington agreed to said. Vyvanse is used to treat attention deficit disorder.
The board also placed Wallington’s license on probation for 18 months, during which he must take a course in prescribing practices and hire a physician to review a portion of his medical records, the order said.
In a letter to the state Department of Public Health, the patient’s parents complained about Wallington’s care of their son and objected to the consent order. They asked that Wallington be barred from practicing medicine for an unspecified amount of time. They did not attend Tuesday’s meeting.
“Dr. Wallington’s reprehensible conduct caused immeasurable suffering for our son and family,’’ the couple wrote. “We remain hopeful that one day our son may be able to live a normal life free from the consequences of nine years of Dr. Wallington’s reckless, harmful medical practice.”
Since the DPH investigation started, Wallington has received extensive re-training in addiction diagnosis and treatment and obtained a specialty in addiction medicine with the American Board of Psychiatry and Neurology, the consent order said. By signing the order, he chose not to contest the allegations against him.
The board also imposed a $7,500 fine on and reprimanded the license of Dr. Andrew Swan, the Hamden ophthalmologist. State records show that in 2011 and 2012, he violated ethical boundaries by having a consensual relationship with a patient. Records show he has completed a course in medical ethics and boundaries. Swan chose not to contest the allegation and agreed to a consent order with the board.
Board member Jean Rexford said while the relationship could be considered consensual, “there is a disparity in power.”
“We have to be really sensitive in these cases,’’ she said.
The board also fined Dr. Mark Scanlan, an orthopedic surgeon from Hamden, $5,000 for performing an incision on the wrong site during surgery in 2017, a consent order he agreed to said. He was supposed to be operating on a patient’s left ring finger and instead made an incision on the patient’s left thumb, the order said. Scanlan chose not to contest the allegation.
Board member Michele Jacklin voted against the consent order, saying that the $5,000 fine was insufficient.
The board also reprimanded the medical license of Dr. Gayle Klein, a psychiatrist from Mansfield, and placed her license on probation for a year. A consent order she agreed to said that in 2017, Klein prescribed Xanax to an acquaintance of hers without maintaining sufficient medical records. Klein also inappropriately prescribed the same patient a cannabidiol, or marijuana, spray, the order said.
Klein, who chose not to contest the allegations, was also ordered to take courses in ethics, medical documentation and controlled substance prescribing practices within six months. During the year on probation, she must also hire a physician to provide quarterly reviews of a portion of her prescriptions for controlled substances or medical marijuana.
The board also reprimanded the medical license of Dr. Thomas Knox, a West Hartford cardiologist after finding that he violated the standard of care in 2015 when he failed to maintain appropriate treatment records for a patient. A consent order he agree to said he also improperly delegated the assessment of the patient and administration of medication to an unlicensed person.
Knox admitted no wrongdoing but chose not to contest the allegations. State records say that the patient’s daughter-in-law complained that the patient had been seen by unlicensed staff and prescribed pine bark powder without being examined by Knox. Knox maintained that pine bark powder is a non-prescription treatment option, and a DPH consultant found that Knox’s general care of the patient was appropriate, records show.
The board also issued a cease and desist order to the owner of Danielle Marie Day Spa in Stratford to have her stop practicing medicine and surgery without a license. The owner, Danielle Donfrancesco of Stratford, practiced medicine without a license in 2017 and 2018 when she medically assessed clients and performed laser hair removal, a consent order said.
While not admitting wrongdoing, Donfrancesco agreed to stop practicing medicine, the order said.
Dr. Robert Green, a board member, voted against the order, saying the penalty was too lenient and that a fine or criminal action should be considered against the spa owner.
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The board also reprimanded the license of Dr. Francis X. Walsh, placed his license on probation for six months and ordered him to take courses in medical documentation and controlled substance prescribing, a consent order he agreed to said.
In prescribing the drugs in his office practice, Walsh failed to properly document that he had examined the patients and failed to justify “potentially dangerous dosing and combinations of medications,” the order said.
During the probation, Walsh must hire a doctor to review his office practice. Walsh has surrendered his state registration to prescribe controlled substances in that practice, state records show.
He can still prescribe drugs at the Nathaniel Witherell nursing home in Greenwich, where he is the medical director, records show. In signing the consent order, Walsh chose not to contest the allegations against him.
Board members Jean Rexford and Michele Jacklin voted against the consent order, saying the fine was not high enough given the serious nature of the allegations.
“At what point do we take a bigger action” against the over-prescribing of opioids, Rexford said. “This is unacceptable.”
David Tilles, a staff attorney for the state Department of Public Health, responded that the department believes the penalty is sufficient because Walsh has made substantial improvements in his prescribing practices and because he is only prescribing controlled substances now at the nursing home, where there is oversight.
Dr. Andrew Yuan, a board member, agreed with Tilles. “I think the public is protected,’’ he said.
The board also ordered David Landi of Bristol to cease the practice of medicine without a license after DPH alleged that in April 2016, he administered a penile injection to a patient to treat erectile dysfunction, records show. Landi administered the drug at a men’s health clinic in Cromwell, records show.
Landi was the owner and operator of the clinic, which has since closed, Tilles said. Landi showed a physician who was affiliated with the clinic how to inject the medication, but the doctor cut all ties with the clinic after one day or so, Tilles told the board.
Landi agreed in a consent order with the board to stop practicing medicine without a license.
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An inspection of Hartford Hospital in 2012 found an operating room with “dust and darkened debris” on top of pumps attached to IV poles, a container of syringes “overflowing” a protective cover, and brownish stains on the floor and underside of the operating table.
These kinds of lapses, while not directly tied to patient infections, have contributed to Connecticut’s poor ratings on some federal measures of hospital-acquired infections.
Newly released data show that more than 50 percent of the state’s hospitals had rates for at least one type of hospital-acquired infection that were worse than federal benchmarks, in late 2012 and 2013. No other state had a higher percentage of its hospitals exceeding the infection standards set by the U.S. Centers for Disease Control and Prevention, and most states had fewer than 20 percent, according to the data, compiled by Kaiser Health News.
Hospital-acquired infections are caused by viral, bacterial and fungal pathogens. The most common types are bloodstream infections, urinary tract infections and surgical site infections. Adverse-event reports filed with the state Department of Public Health show hospital-acquired infections resulted in the deaths or serious injuries of 27 patients between 2005 and 2012.
Jean Rexford, executive director of the Connecticut Center for Patient Safety, an advocacy group, said that while the state’s hospitals had made good progress in reducing one kind of infection – central line-associated bloodstream infections – rates for catheter-related and surgical site infections were troubling.
“Until we have a true culture of patient safety in our hospitals, we’ll fix one infection, only to have high rates of another infection,” she said. “We’ve got to get all the administrators of our hospitals involved in this. There are known ways to deal with these infections.”
The federal government has been tracking and publishing the rates of infections that patients acquire in hospitals on Medicare’s ‘Hospital Compare’ website since 2012. Starting this fall, hospitals with the worst rates in 2012 and 2013 will lose 1 percent of their Medicare reimbursements for fiscal year 2015.
Eleven of Connecticut’s 30 hospitals are likely to face penalties, according to a preliminary list of 761 hospitals identified in April as having high infection rates. They include Hartford and Stamford hospitals, as well as: The Hospital of Central Connecticut, Bridgeport, Danbury, John Dempsey, Johnson Memorial, Norwalk, Waterbury, Windham and Yale-New Haven hospitals. The federal Centers for Medicare & Medicaid Services has not yet released final penalties.
In the first year of the penalty program, Medicare will look at three measures: the frequency of central line-associated bloodstream infections, the rate of infections from catheters inserted into the bladder to drain urine, and a composite measure that includes avoidable safety problems such as pressure sores and post-operative hip fractures. In the next two years, rates of four other infections — Clostridium difficile, known as C. diff; methicillin-resistant Staphylococcus aureus, known as MRSA; and two surgical-site infections after hysterectomies and colon operations — will be added.
The latest CDC data show that all state hospitals are meeting benchmarks for central-line bloodstream infections, with six – Hartford Hospital, Hospital of Central Connecticut, Saint Mary’s Hospital, St. Francis Hospital and Medical Center, St. Vincent’s Medical Center and Yale-New Haven Hospital — doing better than the standard. Many hospitals worked with the Connecticut Hospital Association (CHA) on an initiative to reduce bloodstream infections.
But 11 hospitals exceed the average for urinary tract infections, five for C.diff, and five for colon surgery-site infections. Six hospitals—Hartford, Middlesex, Norwalk, St. Francis, William W. Backus and Yale-New Haven – exceed infection benchmarks in two out of the six categories.
Rexford said that while the threat of Medicare penalties may spur hospitals to make improvements, she worries that recent sales and mergers of hospitals would complicate efforts to focus on “ground-level” safety.
“I am so scared by the size of these hospital networks now. Infection control should be so basic and elementary — but it isn’t,” she said.
The CHA has been working with national groups and Qualidigm, the state’s Medicare quality-improvement consultant, to train hospital employees in reducing preventable harm and institute safety protocols. Connecticut hospitals were recognized nationally for launching the first statewide initiative to become “high reliability organizations,” a program focused on patient safety that has trained more than 10,000 staff and physicians.
Dr. Mary Cooper, vice president and chief quality officer for the CHA, acknowledged that Connecticut’s performance on federal quality and safety measures has been “worse than many other states, historically,” but said a focus on safety is “changing the culture.” She said state hospitals saw a 30-percent reduction in central line-associated bloodstream infections between 2008 and 2012, and that there are collaborative efforts underway to eliminate other infections.
Officials of Connecticut hospitals said they were taking steps to reduce surgery- and catheter-related infections, even before the threat of Medicare penalties.
At Yale-New Haven, for example, a new policy aimed at reducing urinary tract infections allows nurses to remove catheters, once a physician has given them that authority, said Dr. John Boyce, the hospital’s director of epidemiology and infection control. The hospital also is reviewing its cleaning and disinfection procedures to identify areas for improvement, using a “florescent marker” process to see how well surfaces are being cleaned, Boyce said.
“The highest level of the hospital administration is committed to getting these rates down,” he said.
In letters to the state Department of Public Health, officials of Hartford HealthCare and Stamford Hospital said they had made improvements in infection control in the last two years. Officials of Hartford HealthCare, which includes Hartford, Backus, Windham and MidState hospitals and the Hospital of Central Connecticut, said they had established an infection control council that was regularly reviewing safety procedures.
Dr. Rocco Orlando, chief medical officer for Hartford HealthCare, said the hospital network had extensively trained staff in patient safety practices and was tackling catheter-associated urinary tract infections as “one of our major system initiatives.” Noting that some of its hospitals have low rates of such infections, he said the network is “using the fact that we are a big system to our advantage” by sharing best practices and standardizing safety protocols.
Orlando said outbreaks of C.diff have dropped, due in part to an intensive hand-hygiene program that tracks hand-washing by hospital employees entering or leaving patients’ rooms by using “secret shoppers” who observe and record compliance. Rates of compliance have risen from 40 percent to 90 percent, he said, with a goal of 100 percent compliance at all hospitals. Hartford HealthCare also follows a strict room-cleaning protocol.
“There’s really been a cultural shift that extends into every safety-related function we perform,” he said.
Officials of Stamford Hospital said they had addressed a high rate of colon surgery infections by developing a “dedicated checklist” for colon procedures and making other improvements. As a result, colon infection rates have dropped nearly 70 percent since 2012, and the hospital has seen an overall 50 percent decrease in the rate of hospital-acquired infections in the last five years, Dr. Rohit Bhalla, vice president of quality for Stamford Hospital, told DPH in an April letter.
State data show all hospitals in Connecticut were meeting benchmarks for the rate of MRSA infections in 2013, and three hospitals – Hartford, St. Francis and Stamford – had rates better than expected.
Nationally, the CDC reported significant progress in reducing central-line bloodstream infections between 2008 and 2012—a 44 percent drop – but less progress in reducing rates of C.diff and MRSA.
The federal infection-reduction program is the third pay-for-performance program established under health care reform. Hospitals already are penalized for high readmissions of discharged patients and a group of quality measures.
A study last year in JAMA Internal Medicine found that hospital-acquired infections cost $9.8 billion a year nationally, with surgical-site infections accounting for about a third of those costs.
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During Nakouzi’s treatment of Mary, her husband racked up over $40,000 in charges. The treatment — which involved a variety of pills and supplements and “bioresonance” therapy, a technique that measures electrical activity at the skin—failed. In early 2007, Mary passed away at the age of 42.
When he sought Nakouzi’s help, Nedlouf’s wife was “in and out of consciousness,” he said in a recent interview. Desperate for a cure at the time, he “didn’t think much. I wanted to help her. She was dying.”
Nedlouf said that, in the end, he believed he was “taken for a ride.” So he filed a complaint with the Connecticut Department of Public Health (DPH), in hopes the board would punish Nakouzi for his misrepresentations.
Although the complaint was filed in 2007, it wasn’t until September of 2011 that Nakouzi was disciplined with a $5,000 fine, two years’ probation on his medical license, and practice restrictions.
The delay that Nedlouf experienced is not unusual in Connecticut, where it can take two years or longer for complaints against physicians to result in license suspensions, revocations and other disciplinary actions by the state Medical Examining Board, working with the DPH.
A review of disciplinary decisions in the past 18 months shows that the medical board rarely acts within a year of an incident occurring – and sometimes the process takes as long as four years, with physicians still practicing freely in the interim.
Reasons for the delays vary. In some cases, it takes time for the DPH to prepare charges against physicians, allow for responses and schedule hearings. In other cases, there is a lag between the alleged lapse in care and a complaint to the DPH that triggers an investigation.
Last month, for example, the medical board imposed six months’ probation on Dr. David Wilterdink, who has a family practice in Danielson, for giving a patient, who was also an employee, early refills of Ativan and Fioricet without an adequate review of the patient’s medical record or proper documentation. The violation dated back to 2011.
Similarly, in July 2012, the medical board imposed a civil fine on East Hartford physician Mahmood Yekta for ordering numerous unnecessary diagnostic tests on a patient without documenting the reasons. The charges stemmed from a 2007 complaint.
DPH spokesman William Gerrish maintained that such cases are unusual, explaining that lengthy cases, such as Nakouzi’s, are sometimes caused by “the time required to locate a physician expert to review a case.” He added that DPH recently reviewed its processes and is “continually working to improve the timeliness of its investigations.”
Anne Doremus, outgoing chair of the medical board, said that delays can be frustrating for board members, as well as patients. She said some of the delays stem from a protracted hearing process, noting that Connecticut is one of a few states in which the medical board lacks its own staff of investigators and lawyers and instead relies on DPH to staff the panel.
“Certainly, we would like to see any case completed within at least 18 months,” Doremus said. “But remember, the board is made up of volunteers, most of them working people. And DPH has (15 licensing) boards to work with.”
Over the last decade, Connecticut has consistently ranked in the bottom fifth of states in the rate of serious disciplinary actions taken against physicians, according to the watchdog group Public Citizen.
The membership of the medical board was recently expanded from 15 to 21 members, which Doremus said may help to speed up dispositions of cases.
Meanwhile, the process can be grueling for patients and physicians alike.
Nedlouf was told that in his case, the length of the investigative process was largely based on the lack of standards for homeopathic physicians in Connecticut. He said outside experts in homeopathic medicine had to be called in, and finding a suitable expert took time.
Nakouzi declined to comment on the case.
According to a Connecticut DPH consumer guide, the average length of an investigation is six months. However, the investigation itself is only one part of the disciplinary process and does not reflect the length of time between the reporting of an incident and the board’s final decision.
Recent cases adjudicated by the board after a significant delay include:
• Dr. Michael Waldman, a former New Milford Hospital radiologist, was investigated by the DPH for an April 2010 incident in which he perforated a patient’s spleen during a procedure. DPH records say that Waldman “recognized that he had perforated the spleen,” but sent the patient home without telling him what happened or undertaking proper monitoring. The 74-year-old patient died three days after the procedure. Not until April 2012 did the medical board impose discipline: a one-year probation, a reprimand and practice restrictions.
• Dr. Gerald Micalizzi of Bridgeport was charged with improperly accessing the records of hundreds of patients at Griffin Hospital in 2010. He used the passwords of other radiologists to access the hospital’s system and download patient information, records say. The medical board disciplined him with a civil penalty, license reprimand and six months’ probation in June 2012.
• Dr. Marc Aronson, a Middletown psychiatrist, was found to have given a patient a high dose of an anti-seizure and mood-stabilizing drug in 2009 without proper justification, records show. An investigation was opened in 2010. The board disciplined him with a license reprimand in January 2013.
• Dr. Leslie Domalik was charged in 2010 with prescribing an excessive dose of an anti-diabetic drug over the phone to a patient in 2009, while working at William Backus Hospital in Norwich. The board fined her $7,500 in January 2013.
Four recent cases of wrong-site medical procedures each took more than a year to adjudicate after cases were opened.
Jean Rexford, a patient-safety advocate who serves on the medical board, said cases can take “easily two years” from complaint to board action. She blamed the delays on bureaucratic inertia. She said the commissioner of DPH, Dr. Jewel Mullen, has been supportive of improving the effectiveness and transparency of the disciplinary process.
Dr. Jeffrey Lane, a gynecologist and cosmetic surgeon practicing in East Lyme, recently went through the process. He was accused of prescribing controlled substances to family members and an employee without accurate records; instructing unlicensed assistants to help him with procedures; and failing to adequately document sterilization practices. The investigation took two years from the initial complaint in early 2011 to the board’s action in January 2013.
“I’ve been through hell, despite the fact that not a single patient of mine was injured, we never had any serious complications, and no patient ever filed a complaint,” Lane said of the disciplinary process. “The system is broken.”
Lane took issue with several aspects of the investigation. He said that after he signed a consent order in 2011 to try to settle his case and avoid the threat of a license suspension, the DPH proceeded with a lengthy investigation. The medical board fined him $2,000, imposed a one-year probation and placed restrictions on his practice.
Lane described the process as “totally devastating — financially, professionally and emotionally.”
Lane’s hearing, before a three-member panel, lasted two days. But because of scheduling issues, his hearing days were a month apart. After the second hearing on April 17, 2012, Lane said it took six months for the decision to be reached.
“Why it took six months, I have no idea,” he said, speculating that the DPH “may have a big backlog.” He also said he was concerned that the medical board’s decision would not be objective because the panel is so closely linked to the DPH.
“I felt like my head was in the guillotine. It’s only a matter of time until it’s going to drop,” Lane said.
Under Connecticut’s system, the DPH is responsible for investigating complaints against doctors, including obtaining records, interviewing witnesses and seeking expert opinions from physicians with the same specialty, when appropriate. In many cases, the DPH will not act until it has retained a physician reviewer.
DPH investigators confer with attorneys to draft charges. In some cases, the department tries to negotiate a settlement with the physician; in others, the case goes to a hearing before a three-person panel, which makes a recommendation to the full board.
Gerrish said the DPH and the board have distinct roles, with the panel’s gubernatorial appointees acting independently. He said the DPH is focused on “conducting fair and timely investigations, and prosecuting physicians when we have determined that their conduct has deviated from the standard of care in Connecticut.” In some cases in which physicians are found to pose a clear threat to patient safety, the board takes immediate action by suspending their licenses.
Public Citizen, a consumer advocacy group, takes the position that more physician discipline leads to better patient protection. In its 2012 report on the rate of state medical boards’ serious disciplinary actions against physicians from 2009-2011, Connecticut ranked fifth-lowest. The advocacy group cites adequate funding, strong leadership, and independence from other state agencies as keys to expediting and improving the work of medical boards.
In Nedlouf’s case, Connecticut officials initially told him that his complaint about Dr. Nakouzi’s treatment of his wife did not have much of a chance because of the lack of standards for homeopathy, he recalled. He said there were “so many steps” in the process, as the DPH had to find probable cause to investigate and then extensively examine Nakouzi’s files.
While the delays were frustrating, he said he was relieved that some action eventually was taken.
“To get to that point, after we thought we had no chance, it was symbolic in ways,” Nedlouf said. “It sheds a light, brings it to public attention.”
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