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{media_1}Earlier this year, Neha Batheja, a physician assistant, quietly signed a consent order with the New York State Board for Professional Medical Conduct in which she accepted a censure, reprimand, $5,000 fine and three years’ probation on charges of practicing medicine fraudulently. Records say she wrote improper prescriptions for Vicodin in 2006, signing a physician’s name without authorization and giving the narcotics to someone who was not a patient.

Today, Batheja practices in Bloomfield, under a state license issued in January 2007 that carries no mention of the New York charges.

The Rhode Island Board of Medical Licensure and Discipline revoked Dr. Steve Tu’s license to practice medicine in January 2009, after he was accused of bilking “numerous” patients for Lasik surgery that was never performed. The Rhode Island board reported the revocation to the state of Connecticut, where Tu also held a license.

But as Rhode Island pursued the disciplinary action, ultimately placing Tu on one year’s probation in October 2009 and ordering him to make restitution, Tu relocated his practice to Manchester, Conn., according to records.

In Massachusetts, the Board of Registration in Medicine indefinitely suspended Dr. N. Raj Birudavol’s medical license in 2004, then placed him on five years’ probation, after finding that he had rendered substandard care to four patients while practicing emergency medicine in Massachusetts. The charges included failing to prescribe the proper medications, give complete examinations or order the proper tests.

Birudavol has since been practicing in Stafford Springs, Conn., at Johnson Memorial Hospital, where he works in the emergency department, hospital officials confirmed. He has no licensure actions in Connecticut.

{media_3}Batheja, Tu and Birudavol are among more than a dozen physicians who have escaped serious licensure actions in Connecticut despite facing reprimands, censures and in some cases revocation or surrender of their licenses in three neighboring states, according to a C-HIT review of licensing records dating back three years.

The review found that Connecticut often takes no action against doctors who are disciplined in nearby Massachusetts, Rhode Island and New York, in contrast to medical boards in those other states, which are quick to impose their own reciprocal sanctions after Connecticut takes disciplinary action.

Some of the doctors who have been sanctioned in other states have promptly relocated to Connecticut, with no restrictions on their licenses.

“If a physician is found negligent or incompetent in one state, it makes perfect sense that other states where that physician is licensed should look at that action and take actions on their own, for the sake of patient safety,” said Arthur Levin, director of the non-profit Center for Medical Consumers, an advocacy group based in New York. “If that’s not happening, there’s a problem.”

State At The Bottom

A recent report shows Connecticut ranks 47th out of 50 states and the District of Columbia in the rate of serious disciplinary actions taken by state medical boards against physicians from 2007 through 2009. The analysis, by the Public Citizen Health Research Group, shows that Connecticut has consistently been in the bottom 10 states in each of the last four, three-year reporting cycles.

The Connecticut Medical Examining Board, appointed by the governor, meets monthly to hear cases that have been identified by the Department of Public Health as warranting disciplinary action. The board, composed of nine physicians, a physician’s assistant and five public members, presides over disciplinary hearings and renders final decisions.
       
A national report by the Federation of State Medical Boards reveals that Connecticut took a total of 55 disciplinary actions against its 16,557 licensed physicians, or .33 percent, in 2009. Only 28 cases involved a loss or restriction of licensing privileges – down from 36 cases during 2005.

Connecticut’s disciplinary average – the ratio of all disciplinary actions to total physicians—is far lower than that of many other states, including Alaska, Colorado, Texas, Nebraska, Arizona, North Carolina and Kentucky, the Federation’s data shows.

William Gerrish, a spokesman for the state Department of Public Health, said Connecticut takes a “wide range” of sanctions to address physician misconduct, including warnings, letters of concern and fines. Those actions “can be just as effective a tool in protecting the public,” he said.

He said that Connecticut’s board has taken “many actions” against physicians that are based on disciplinary actions taken in other states, but that such reciprocal actions are difficult and time-consuming, under existing state policy.

Because of that, he said, the state health department is now putting forward a legislative proposal that would give Connecticut explicit statutory authority to deem “as true” the findings of another state’s disciplinary proceedings, rather than having to re-examine each out-of-state case, as is done now.

“This would strengthen our ability to take action,” Gerrish said.

Officials in New York, Massachusetts and other states said they routinely conduct reviews of out-of-state disciplinary cases and have authority to base their actions on the findings of other states’ boards – measures they said were necessary for expediency and patient protection.

Connecticut receives the same out-of-state information about its physicians that other states receive, via a Disciplinary Alert Service run by the Federation of State Medical Boards [FSMB]. The system, which proactively notifies boards within 24 to 48 hours when one of their licensees has been sanctioned in another state, is intended to prevent disciplined doctors from moving from state to state undetected.

The FSMB, in its policy statement, encourages state boards to take reciprocal actions based on other states’ discipline, with “the record of the action taken by the other state” serving as sufficient evidence for bringing licensure charges.

It is not clear why Connecticut is only now seeking specific statutory authority to follow that policy.

Lisa Robin, a senior vice president of the Federation, said the sharing of information among states is intended to “close the loophole and ensure that the public is protected from physicians just picking up and moving” after they have been found guilty of misconduct.

She said some medical boards are more pro-active than others in tracking physicians.

“There are all sorts of factors – staffing levels, resources, the board’s structure and priorities – that influence the level and nature of actions,” Robin said.

{media_2}Connecticut’s relative laxity in discipline was highlighted in a recent case involving Dr. Ben Ramaley, a Greenwich ob-gyn who was cited by the state Department of Public Health in 2008 for inseminating a female patient with the wrong man’s sperm in 2002. State officials issued Ramaley a reprimand and $10,000 fine, allowing him to keep his unrestricted license. The health department declined to order a DNA test to resolve an allegation in a 2005 lawsuit filed against Ramaley by the patient and her husband that the doctor had used his own sperm in the procedure – a claim Ramaley has denied.
       
Officials in New York State saw the case differently than Connecticut. That state’s medical board, which deemed Ramaley’s actions “gross negligence,” moved to suspend his license for one year, place him on probation for three years, and also fine him $10,000. In lieu of that settlement, Ramaley voluntarily surrendered his New York license, saying he had not practiced in that state in many years and did not intend to do so. He now practices at Southport Women’s Healthcare and is affiliated with Bridgeport Hospital.
       
Ramaley’s case is among a string of similar cases in which physicians have been allowed to continue practicing in Connecticut while facing license suspension, revocation and other sanctions in neighboring states. Of two-dozen cases reviewed by C-HIT in which Connecticut physicians have faced disciplinary action in other states, 11 received no discipline at all in Connecticut. Five physicians who lost or gave up their licenses in other states have retained their licenses in Connecticut. In other cases, physicians fined or sanctioned in Connecticut but who were allowed to continue practicing have faced automatic discipline by other states.
       
Messages seeking comment from Connecticut physicians sanctioned in other states were not returned. In some cases, the doctors’ sanction histories are publicly available on the Internet from HealthGrades, a healthcare ratings organization. In one case, concerning Neha Batheja, there is a pending state investigation.
       
Among the doctors who lost licenses in other states was Dr. Laurent Brard, an ob-gyn who has held an unrestricted license in Connecticut since 2006. Brard, who has practiced in Rhode Island in recent years, previously was affiliated with Lawrence& Memorial Hospital in New London, records show.

In September 2008, Brard was sanctioned by the Rhode Island Board of Medical Licensure and Discipline for engaging in a sexual relationship with a patient. Rhode Island fined him $1,000 and suspended his license for one year – an order that was “stayed” when he agreed to participate in a counseling program.

In July 2010, Massachusetts picked up on the Rhode Island charges and indefinitely suspended Brard’s license to practice medicine.
Connecticut, meanwhile, has taken no action against Brard’s license.

Similarly, Rhode Island in January 2009 revoked the license of Tu, a doctor of ophthalmology, after receiving complaints from patients who were directed to obtain credit through a company affiliated with Tu’s Rhode Island practice for Lasik eye surgery. The surgery was never performed, Rhode Island records say.

The records show that one of Tu’s patients requested reimbursement for $2,600 in charges for surgery that was cancelled on multiple occasions. Tu was ordered to pay restitution to “each and every complainant with a valid claim for services that were paid but not provided.”

After Tu disputed the revocation, saying he did not have an adequate opportunity to respond, Rhode Island placed him on a year’s probation in October 2009, during which he was directed to “seek counseling in collaboration with the Connecticut Medical Examining Board.”

He relocated to Connecticut, where he practices at the Fichman Eye Center in Manchester under an unrestricted Connecticut license valid through 2011.

Dr. Pasquale DeMatteo, an internist, was sanctioned and fined $1,000 by the Connecticut medical board in April 2009 on charges he had prescribed benzodiazepines and narcotics to his wife. The board issued a consent order limiting his ability to prescribe controlled substances “for members of his family, friends or himself.”

In New York State, where DeMatteo also held a license, the medical board took stronger action, moving to censure, reprimand and fine him $5,000, as well as to limit his prescribing authority. DeMatteo instead surrendered his New York license in May 2010, agreeing never to practice medicine in that state. He practices in Fairfield, where he is medical director of Fairfield Family Medical Care.

What Other States Do

The review of records shows that New York is quick to follow-up on disciplinary actions taken in Connecticut, with at least 10 cases in the last three years in which the New York board has acted against the licenses of doctors sanctioned in Connecticut. In all of those cases, New York has taken either identical or stronger disciplinary actions than Connecticut.

In one case in December 2007, Connecticut officials reprimanded Dr. Richard Glisson of Southington for prescribing Hydrocodone, a narcotic, for himself and his wife, then abruptly removed restrictions from his license, saying he had satisfied the conditions of the order penalizing him. But in May 2008, the New York board issued its own censure and reprimand against Glisson’s license, charging him with two counts of professional misconduct.

Jeffrey Hammond, a spokesman for the New York State Department of Health, said state officials actively monitor disciplinary actions in other jurisdictions.

“It’s really based on patient safety. We don’t want a doctor who’s been disciplined in Connecticut or California or Michigan to fall back on their New York license and say, ‘OK, I’ll just relocate to New York,’” Hammond said.

Similarly, in Massachusetts, the Board of Registration in Medicine routinely tracks sanctions imposed by other states and is authorized to discipline physicians whose out-of-state conduct would be prohibited in Massachusetts, board spokesman Russell Aims said.

In some cases, the Massachusetts board has imposed stronger sanctions than those imposed in the physician’s home state. In a ruling defending its right to indefinitely suspend Brard’s license, based on the Rhode Island charges, Massachusetts officials maintained that “the Board may impose any sanction consistent with its policies and precedent and based on the out-of-state facts, not the out-of-state sanction.”

Aims said that while some out-of-state offenses may not warrant reciprocal discipline, the Massachusetts board is “unforgiving” on cases involving sexual misconduct and other violations of the doctor-patient relationship.

Widespread use of the state-to-state Disciplinary Alert Service has led to sharp increases in the number of reciprocal actions taken by medical boards nationwide.  From 2003 to 2006, the number of reciprocal actions taken by boards increased by 37 percent, according to the FSMB.
State medical boards also are required to report adverse licensure actions to the National Practitioner Data Bank, which then makes that information available to state licensing boards, hospitals and other healthcare entities, who can query the database.
{media_4}Among the cases reviewed by C-HIT in which physicians were sanctioned by New York, Massachusetts or Rhode Island and remained licensed in Connecticut, without restriction, are:

•Dr. Jaydutt Patel, an internist, was reprimanded by the Massachusetts board in October 2009 for lying on his licensing application that he had no criminal arrests, when he had, in fact, been arrested in 2008 for soliciting prostitution. He obtained a license to practice in Connecticut in January 2010, three months later. His license is no longer active.
•Dr. Patrick J. Dean, a pathologist, was disciplined by the North Carolina Medical Board in 2006 for practicing medicine in that state without a license – an action that was followed by sanctions and fines by a number of other states in which he held licenses, including Arizona, Virginia and Massachusetts. Connecticut informed him in an October 2006 letter that it would not pursue any action against him, records show.
•Dr. Payton D. Turpin, an emergency medicine physician, was sanctioned and fined by New York’s board in November 2009 for failing to abide by a 2005 order that he maintain active registration of his license. “The only explanation that the respondent could offer was that he was not very good at long documents,” records of New York’s disciplinary order say. Turpin told the board that he had not practiced in New York for years and had no intention of doing so; “He testified that he practiced in Maine and after that in Connecticut, where he got in trouble with alcohol and was monitored by Connecticut.” He then moved to North Carolina, he said. He holds an unrestricted Connecticut license, valid through August 2011.
•Dr. Dmitry Mironov, an anesthesiologist and pain management specialist, was censured, reprimanded and fined by New York in February 2010 after being found guilty in 2008 of driving while intoxicated and falsely answering ‘no’ to a question on his registration application regarding his misdemeanor conviction. He practices at Norwalk Hospital, under a Connecticut license with no disciplinary action.
•Dr. Robert Todd Spector, an ophthalmologist, was reprimanded and fined by Florida in 2008, followed by New York in 2009, on charges he failed to practice medicine within acceptable standards, after two botched Lasik surgical procedures. He had been practicing in Meriden until earlier this year, under a Connecticut license that carries no mention of the disciplinary action.
•Dr. Henri LaMothe, an internal and emergency medicine physician, was reprimanded and fined $5,000 by Massachusetts in January 2009 for failing to report two malpractice cases on his physician registration renewal. He holds a license in Connecticut that carries no mention of sanctions.

Lisa Chedekel can be reached .(JavaScript must be enabled to view this email address).
Margaret Lohmiller and Michael Billera, both Quinnipiac University graduate students, assisted with research for this story.

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