LICENSING; MEDICAL PERSONNEL; OCCUPATIONS (GENERAL); PHYSICIANS;

ACUPUNCTURE; PHYSICIANS;

You asked for a brief description of the Massachusetts Board of Registration in Medicine’s functions.

SUMMARY

The Board of Registration in Medicine (BORIM) is Massachusetts’ physician (and acupuncturist) licensing and disciplinary board. It receives and investigates complaints against doctors and takes disciplinary licensure actions against them when warranted. It also (1) collects and provides information to the public about physicians’ credentials and records and (2) is responsible for implementing state regulations governing health care facilities’ quality assurance and risk management systems. In Connecticut, the Department of Public Health and the Medical Examining Board perform these functions.

BORIM is a gubernatorialy appointed, independently funded agency that is currently housed in the state Department of Public Health for administrative purposes (it was moved there from the Office of Consumer Affairs and Business Regulation in 2003). It is funded by a portion of physician licensing fees. It receives 40% of the fee that was in effect on January 1, 2002, plus the entire amount of the fee increase enacted in 2002.

GOVERNANCE FUNCTIONS

The board is governed by seven gubernatorially appointed members—five physicians and two public representatives. The members serve on one or more of five committees:

• Licensing—reviews applications with legal, medical, malpractice, or competency issues, makes recommendations to the full board on granting them licenses, and then monitors the performance of those who become licensed

• Complaint—reviews complaints against physicians and recommends cases to the full board for disciplinary action or prosecution

• Data repository—reviews reports about physicians from insurers, hospitals, and state agencies and, when needed, refers them for enforcement

• Patient care assessment—works with hospitals and other institutions to improve quality assurance programs

• Acupuncture—licenses and disciplines acupuncturists.

STAFF FUNCTIONS

The board employs an executive director and a staff that includes clinicians, investigators, and attorneys grouped in four divisions: licensing, enforcement, public information, and law and policy.

Licensing

The Licensing Division performs the initial review of all applicants for a physician or acupuncturist license then refers its findings to the board’s licensing committee.

In 2002, the division handled nearly 15,000 initial and renewal license transactions. The board’s licensing committee reviewed the licenses of almost 300 license applicants with legal, medical, malpractice, or competency issues.

Discipline

The Enforcement Division investigates all consumer complaints against doctors and all reports from other entities it receives from the board’s data repository committee. (A data repository counsel unit in the Division of Law and Policy receives, processes, and, when warranted, refers to the board reports from courts, hospitals, other state agencies, and physicians, all of whom are legally required to report on malpractice settlements or awards, disciplinary actions, adverse medical events, and physician impairment allegations. )

The Enforcement Division has three units.

1. The consumer protection unit screens complaints, coordinates their initial review as part of a “triage” process that determines investigative priorities, and keeps consumers informed about the status of their complaints.

2. The clinical care unit houses clinical nurses who review allegations of substandard care and send them to outside experts for review. They analyze patient records and physician responses and coordinate remedial conferences.

3. The disciplinary unit is responsible for investigating and litigating all cases that might result in disciplinary action. It is staffed by four investigators who gather evidence, interview witnesses, and work with law enforcement agencies and by six attorneys who present cases to board’s complaint committee, the state’s Division of Administrative Law Appeals, and the full board.

If, after the disciplinary unit’s investigation the board determines discipline is appropriate, the matter is usually resolved through a negotiated settlement, such as a consent order. If this is not possible, the board refers the matter to the Division of Administrative Law Appeals, a separate state agency, for a full evidentiary hearing. When the hearing is completed, the hearing officer issues a recommended decision to the board containing findings of fact and legal conclusions. The board considers this recommendation, hears the parties’ arguments, and issues a final decision and order.

In 2002, the division investigated and took final action on nearly 700 of the 948 cases brought to the board’s complaint committee. Seventy-three (73) of those cases resulted in disciplinary action against 68 different doctors.

Public Information

This division maintains an on-line physician profile database that contains the credentials and disciplinary histories of all Massachusetts-licensed doctors. It also maintains a telephone call center whose employees answer questions about board policies, help consumers with complaints, and provide copies of physician profiles.

In 2002, the division handled over 30,000 calls from consumers and mailed nearly 25,000 profiles. Its website recorded more than 13 million “hits. ”

Physician Impairment Oversight

A physician health and compliance unit in the Division of Law and Policy advises the board on issues related to drug and alcohol abuse and mental or physical impairment that may affect a doctor’s ability to practice. Unit staff prepare and present cases to the board’s complaint and licensing committees and work with the Massachusetts Medical Society to make sure identified impaired physicians comply with the terms of any rehabilitation agreements.

Institutional Quality Assurance

The patient care assessment unit in the Division of Law and Policy is responsible for implementing regulations that require most health care facilities in the state to establish and maintain systems of quality assurance, risk management, peer review, and credentialing, collectively known as PCA programs. It reviews and approves PCA plans and monitors their operation through routine “progress” reports and “major incident” reports of serious, unexpected patient outcomes.

All hospitals in Massachusetts must have an approved PCA program as a condition of licensure, and no licensed physician can work in any facility (such as nursing homes and clinics) that does not have an approved program.

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