Magazine article Nieman Reports

Breaking the Medical Malpractice Code of Secrecy: At the Burlington Free Press, a Reporter Persists in Unearthing Stories That Doctors Don't Want Told. (Watchdog)

Magazine article Nieman Reports

Breaking the Medical Malpractice Code of Secrecy: At the Burlington Free Press, a Reporter Persists in Unearthing Stories That Doctors Don't Want Told. (Watchdog)

Article excerpt

The story began in February 2001, with a brief news item in a tiny newspaper downstate. The State of Vermont Board of Medical Practice had ruled that a local orthopedic surgeon--despite several complaints against him--was allowed to continue to practice.

At The Burlington Free Press, we'd written about the state's physician oversight panel before. A 1991 editorial slammed the board for allowing an ear, nose and throat doctor to keep his license after he was convicted of having sex with a minor in his examining room. In 1995, an editorial again criticized the board, this time for taking five years to act against a psychiatrist who counseled patients to cross-dress, ordered them to perform her office tasks, and overmedicated them to the point of seizures. In these editorial criticisms, the newspaper had treated those cases as rare instances of laxity by an otherwise diligent watchdog.

The small news story appeared to be another such anomaly. But was it?

Breaking Through the Secrecy

My editor and I decided to pursue this question. What we concluded--after eight months of reporting--was a resounding no. What had happened with this surgeon--and the other doctors we found--exemplified problems in the medical profession and in state law designed to protect the public from malpractice. The consequences of this lack of vigorous oversight, we learned, could be measured in body parts permanently damaged, in years of suffering, and in lost lives.

Nor was this only an issue of local concern. The Institute of Medicine at the National Academy of Sciences has found that throughout the nation nearly 100,000 deaths occur annually due to medical errors. The institute identifies lack of physician accountability as a major cause.

The signal that a larger story might lie beneath the surface came early in the reporting. Vermont's regulation of physicians was surrounded by secrecy. Everywhere we turned--to the courts, regulators, health insurers, even doctors themselves--the answer was the same: State law prohibited public disclosure of physicians' performance. "The public could easily misunderstand," the head of the state's health care quality improvement panel told us. "Can you imagine what would happen if people knew a certain surgeon had a high malpractice suit count?" In fact, we could imagine: Such information would probably help medical consumers make more informed choices.

Our journalistic challenge was to break through the secrecy. Although I did the reporting and writing, assembling and shaping the project was a genuine team effort with my managing editor, Geoff Gevalt. We began by filing a public records request of the board's findings against the orthopedist. In those papers, the catalog of complaints against this doctor was staggering: surgeries on the wrong body part, patients permanently marred by surgical errors, even deaths due to post-surgical complications that he allegedly ignored. However, no patients were identified and details were scant.

We then requested the rest of the doctor's records. State regulators provided minimal paperwork, with many sections redacted. Then we requested information from the medical practice board about its investigation of the case--the names of complaining patients, evidence, minutes of the board's deliberations. Again, the board's answer was an unapologetic no. Staffers at the board made little effort to conceal their indignation that we would presume to make such a request.

We also turned our attention to examining the records of other doctors and other cases. With each, our investigation pursued three themes that we saw developing through our reporting:

* Substandard doctors could practice in Vermont with impunity.

* The oversight board was unaccountable to the public.

* State laws prevented health consumers from obtaining basic information about a doctor's competence.

Soon, it became apparent that this story would not be easy to tell. …

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