BACKGROUND:

In 2010, the medical board sent with a complaint to a medical doctor a copy of a page from his website, completely irrelevant to the stated complaint, in which the doctor suggests that people with surgical needs leave the state because surgery will often be less expensive out of than in Maine. The chief complainer and now the board secretary is an ophthalmologist, who in 2010 actively campaigned for arch-liberal Elizabeth Mitchell for governor. Eye procedures, such as laser retinal attachment or blood-vessel repair, also corneal refraction adjustments, are quickly done and pay handsomely. If the board secretary was trying to intimidate the doctor into not cutting into her income by sending business to lower-cost competitors, she has violated the trust of the Maine citizenry and should be removed from office. Additional suggestions follow.

WHAT THESE CHANGES WILL DO:

Improve the morale of Maine physicians and other health-care providers

Attract the nonconforming physicians who are weary of hospital bureaucracies, increasing our primary-care physician base and especially attracting the hard-working and brilliant

Reduce health-care costs

Facilitate the creation of convalescent homes for EDTA chelation, so as to improve health of many a self-pay elderly person and provide considerable business to the hotel and hospitality industry

Tell the nation at large that Maine has a government that has a constructive attitude about health care therefore business in general so that hard-working and productive people will want to move in

Deter frivolous medical complaints so that generally disruptive people will choose to move out (therefore, when applicable, off our welfare rolls) rather than have their medical records tarnished

PROPOSED CHANGES:

A general health-care license should exist that permits any adult without a substance-abuse or domestic-violence criminal record to practice health care, upon signing an affidavit promising to pay for any medical or surgical care made necessary by his/her error, even if the victim of such an error has medical insurance.

Reason: It would allow people to take care of themselves if they know how to do so. This saves a fortune in health care expense. Also, the requirement that people pay for their mistakes protects medical insurers and the state treasury from the consequences of anything that might go wrong.

Offering a second class of health-care license might be appropriate, with slightly more stringent requirements, if federal laws that prohibit drug prescribing and ownership of various medical devices cannot otherwise be circumvented.

The health licensure board shall act as the prescriber for all preventive screening, including laboratory tests, so that everyone in Maine can pay for preventive screening of choice and get it without additional expense.

A comprehensive blood and urine screening, as I write this, costs $30 plus shipping to Illinois (total about $50). If the results are reported normal, then the screening costs any uninsured Maine resident $50. Much cheaper than seeing a physician and paying also for the lab tests. Why not? Abnormal tests need followup, true; but let's save the money if the results of the screening turn out to be normal.

All health care boards to be merged into one

Reason: What constitutes bad health care can be inferred from the bad effect on the patient, except for obvious misconduct such as showing up for work drunk, assaulting patients or co-workers, doing surgery with a tremor, etc. If a physician on the board disapproves of vitamin C as cancer therapy but a naturopath on the board considers it a legitimate treatment (and it is defensible in the medical literature), then we need the input of all disciplines to make a fair determination as to what is right. We really do need only one form of due process for all health care boards combined. Of course, the board members who pass judgment on a licensee must include some members with the same kind of license as the licensee. But other health-care approaches should be considered, too.

Keeping multiple approaches within the board helps avoid closed-mindedness and is a safeguard against elitism.

Board members 1/3 by governor, 1/3 by legislator, 1/3 by popular vote

Reason: A political bias in the board will not easily develop. Voters will have some control; dissent in the board interferes with overreaching and tyranny and a weak board makes for strong personal freedom (checks and balances).

The board should be large and should have subcommittees to do discipline and to assess credentials and to make recommendations to appropriate health organizations

Reason: Based on the assumption that health divisions in the government will not disappear as fast as we would like. Hard-to-decide issues come up, for example the ex-alcoholic, the applicant who committed obvious malpractice but since then went back to a residency to relearn, etc. How should such licensees, or licensee applicants, be handled? Individual consideration is needed, true; but subcommittees can be formed to handle such tasks.

No anonymous complaints, except that the board may react to them by inquiring without doing anything that an ordinary person does not have the authority to do and, if the facts so warrant, initiate its own complaint.

Reason: competitors of a physician will not be able to wreak revenge, and the defendant of such a complaint may be able to take legal action.

If the health board, while seeking legal assistance from any person or organization for which the primary mission is to assist health boards, licensure boards, hospital administrators, or any group of people other than the licensees themselves, or an attorney or other person with an affiliation with such an organization, in order to prosecute or complain against an alleged wrongdoing health-care licensee, then all communications between the board and such a person or organization must be disclosed in full to the licensee against which the prosecution or complaint is being considered or is in effect.

Reason: A medical board is free to use whatever legal representation it prefers, as can its members acting individually. But if the board seeks legal assistance to further it own interests, as opposed to merely deterring bad health care practice that can be identified as bad by ordinary criteria, then it may be trying to increase its own power rather than simply enforcing reasonable standards of practice. To protect against misuse of power, such communications should be made public or at least disclosed to any defendant whenever it occurs.

I am thinking of the Federation of State Medical Boards as I write this paragraph. It is an organization dedicated to the increase of power of state medical boards. It is an enemy of freedom. Its communications should never be secret.

If a complaint by a patient or on behalf of a patient is found to be without basis, then the complaint and the findings that the complaint is without merit may be attached to the medical record of the patient and, whenever any portion of such record is released, the complaint and findings may also be released. The right to release all or part of the medical record may be granted and withheld from time to time by the patient, but the right to release the complaint and findings will always be present whenever any right to release any part of the record is in effect.

Reason: if patients are disruptive, they can be described as such. Allowing threats against patients to exist may scare off the abusive patients and also encourage primary care physicians to enter the state if they know that they have some recourse against such nonsense. Physicians may decide not to accept a problem patient, or may insist on being paid extra for the risk.

If a licensee does something illegal, and it would also be illegal if a non-licensee did it, then the board may not initiate a license-related complaint. But it may turn the matter over to law enforcement and, if law enforcement does not pursue it, then initiate a license complaint. Restrictions on medical practice resulting from such illegal actions may be imposed as necessary to assure patient safety, but they may not be recorded as discipline or reported to any data bank as discipline unless there is no prosecution by ordinary law enforcement.

Reason: penalties for wrongdoings exist apart from any medical licensure laws; they are adequate. There should be no code of conduct that is separate from the actual administration of treatment that is under the board's jurisdiction. Licenses are not above the law, entitled to a more lenient treatment for smoking marijuana or other misconduct. Conversely, the board should not punish licensees more vigorously than through ordinary criminal-law proceedings so as to create an elite subculture among health-care workers.

The opinion of the board, and all of its recommendations and actions, shall be in full compliance with the principle that the federal government has no jurisdiction over health care. Any board member disagreeing with that principle may not use government letterhead, mailings or e-mail, or other communication methods that are expected to be interpreted as issued by the board. Any board member disagreeing with that principle may so state only with a disclaimer that it is a difference of opinion from that of the board. If there is a hearing or other meeting in which a board member announces a disagreement, then he must do so in his capacity as an ordinary citizen and the hearing or meeting must be open to the public, public citizens get the same opportunity to speak as do board members, and proper notice in the press must be given in advance.

Reason: the federal government must stay out of health care. The Tenth Amendment is in full force.

The medical board may not establish and maintain communication with any organization outside the state of Maine if by doing so there is any implicit forfeiture of power, including by forming the habit of accepting recommendations from such organization with a significant probability.

Reason: to the extent there is power it belongs with the state citizenry, not the outside. The state government and the state licensure board do not have the right to surrender it to a national or foreign government. Habitually accepting recommendations from an "advisory" body such as the Federation of State Medical Boards is essentially equivalent to surrendering power to it. Same for giving rubber-stamp approval for continuing medical education to various accrediting agencies instead of directly accepting the burden of deciding what health-care information people need to know.

A board member with a conflict of interest when there is a matter of licensure approval or of discipline must recuse himself and may not participate in any relevant proceedings unless the defendant requests him to do so, in which case he may participate as a witness but may not vote. Loss of income to a competitor or a competing treatment process is a conflict of interest.

Reason: no conflict of interest. See for example the sending of the Internet site printout with a meidcla-board complaint under implicit orders from a practitioner with (I presume) a high percentage of her income from procedures of which most of the cost is fixed.

No discipline may be imposed unless there is actual or probable cause of harm to a patient. Preventably high health-care cost due to failure to inform a patient of low-cost alternatives including competitors is grounds for discipline.

Reason: if it does not hurt the patient, don't prevent it. Meanwhile, offering comparison-shopping to the patient is good for health care cost control and prevents corruption or other dishonest alliances between powerful health-care organizations and the health-care board.

Any disciplinary or credentialing proceedings may, at the option of the defendant/applicant, be audiorecorded or recorded by a stenographer. Audio recordings and stenographer reports shall be admissible as evidence in any subsequent proceedings. Board members agree to waiving the right to testify against themselves, if such recordings and reports are later used to sue them, or if they are submitted to professional associations including hospitals with intent to induce disciplinary action, by accepting their positions on the board.

Reason: Absolute defense against bullying by board members. Yes, it has been a problem in Texas. There is no way to know for sure in Maine unless recording devices are consistently used.

Any disciplinary action and any refusal to grant a license shall, if it is reportable to any data bank that is customarily used to assess licensees' competence or if it leads to an unfavorable answer on a question generally asked on a liability insurance application, be subject to appeal to a jury.

Reason: safeguards against unreasonable board action

Board members may use expert witnesses to explain complicated issues to them during proceedings as appropriate. Such witnesses, if they review medical records, must have the defendant's name redacted. They must either be actively practicing and derive a small percentage of their income from expert-witness work or be physically impaired so that they cannot practice in their specialty.

Reason: no fake expert witnesses who say what they are told to say and are not current with real medical practice, unless they can't work in the operating room any longer because of some physical infirmity (tremor, bad leg/can't stand for a long time, etc.).

Consensus is not a defense. Nonstandard practice method is not grounds for an attack. Board members must assess any nonstandard process on its merits and must learn what is needed; they may not merely insist that their licensees be like everybody else.

Reason: the board is not to defend tradition and homogeneity and role playing; it is to get out of the way and allow natural scientific progress to occur.

Actions by a licensee that relate to health care, if observed and reported to the board and the board does not issue a cease-and-desist order or otherwise penalize or induce to stop, shall be an absolute defense against substantially identical actions by other licensees that have the same kind of license; and the board shall, if such actions are observed and not prosecuted, be required to establish regulations that explicitly permit it if so demanded by the person who reported them to the board.

Reason: if one practitioner, a favored or politically influential one, breaks the law and gets away with it, then the law has to be repealed. Favoritism is thereby made impossible.

When investigating credentials and complaints, the board may not demand anything not directly related to the allegations of the complaint or the evidence that an applicant may be incompetent.

Reason: prevents harassment. An appeals procedure needs to be in place so that a defendant harassed by irrelevant demands can insist on having the complaint transferred to a judge.

An applicant or a defendant may have any proceedings transferred to administrative court and petition the court for a ruling that sufficient evidence is present for the board to make a decision. If approved, then the board must stop the investigation and make the decision.

Reason: prevents harassment.

If a licensee is in a union, then the licensee must be told periodically of the proportion or absolute dollar amount of any union dues that he has paid that are used to defend any other union members against board actions.

Reason: if the board is constrained to enforce competence only when appropriate (correct genuine incompetence not merely harassing people), then such defense expense pertains to incompetent licensees. If the union takes money without direct permission from one licensee and spends it to defend another, then the first one is being taxed (not really ethical) and deserves to know what is going on.

Board members who violate these terms go to jail.

Reason: that's where bad people should go.

Health care boards may include certifications on Internet licensee lookup screens and other information sources for licensees as they see fit. But if the certifications are derived from normed examinations (in which the score, or the pass-fail cutoff, is calculated from the percentile raw scores of the people who took the test at the same time), then the certification must be labeled as based on normed criteria and a simple and clear definition of normed criteria must be supplied also. If the certifications are derived from examinations or assessments in which the material tested is secret, then the certification must be labeled as based on deliberately undisclosed criteria. If the certifications, as renewed or otherwise, are based on anything that does not directly relate to competence, then the distinction between certification and competence must be shown. Engaging in a practice-improvement process is by way of example and precedent not directly related to competence; it shows improvement and therefore relative competence and not absolute competence.

Reason: Specialty board certifications are coming under fire nowadays for being based on irrelevant criteria. Patients deserve to know the truth; but if the truth is that the specialty board uses a poor test for certification or renewal of certification, then the board should say so.

The process of approving or denying a license, or a license renewal, shall not be affected by lack of knowledge relating only to billing, insurance, paperwork, or other matter not directly related to patient care.

Reason: Hospitals, insurance companies, and such can impose whatever regulations they wish. Meanwhile, licenses who do not submit claims to a specified insurer or who otherwise don't need to bother with such information do not need to waste their time learning it.

Health care licensees are, from time to time, asked to review a licensee for improper conduct, perhaps in connection with medical practice at a hospital. The Health Care Quality Improvement Act (federal) provides immunity from retaliation if a hospital reviews a physician and the physician is penalized but the grounds for the penalty are frivolous or fictitious. The health licensure board shall establish protocols for physicians wrongly disciplined by such review proceedings (sham peer review) so that they can file complaints against such reviewers. By accepting a health-care license, all licensees waive immunity conferred by HCQIA.

Reason: Many a good physician has has his career ruined by sham peer review. It's a BIG problem.

Regulations imposed by the board against the sale of medical supplies, supplements, drugs, etc. in licensees' offices shall apply also to prescribed substances administered to patients.

Reason: It's blatant hypocrisy for the medical licensure board to stop physicians from selling drugs in their offices while at the same time not requiring physicians to let patients buy the material infused during cancer chemotherapy sessions at discount pharmacies. (It's a BIG markup, perhaps hundreds of dollars per dose. Ever wonder why many a physician opposes discussion of alternatives to cancer chemotherapy? Now you know.)

If physicians are under contractual obligations to confine their referrals to specified hospital staffs or are otherwise restricted in their referral patterns, or are required to bring in a specified amount of business to a medical complex, then they must so disclose to their patients.

Reason: patients otherwise assume falsely that the physician is acting in their best interest. The conflict of interest must be disclosed. I have been told (rumor) that Penobscot Bay Medical Center demands referrals from its affiliated physician offices. If true, then a major scandal is about to erupt if you can prove it.

A physician who purchases a prescription-required substance for dispensing or administering to a patient, unless the substance is controlled by the Drug Enforcement Administration, is free to do so without stating the patient's name or otherwise incurring the cost of a formal prescription.

Reason: This ruse is used by the medical board to increase the cost of ethylene diamine tetra-acetate (EDTA), which is used to remove lead and which also removes arterial deposits and reverses coronary and cerebral and other artery disease. In Florida, no such prescription formality is needed for EDTA and everyone gets along well. EDTA works. The Florida Board of Medicine lost an important case several years ago and was told not to interfere with its use. The medical board here is using a prescription technicality to increase medical cost to the uninsured, an abhorrent practice.

Professional liability (malpractice) insurance policies may not charge a higher premium of those clients who practice EDTA chelation than they charge other clients.

Reason: EDTA chelation patients essentially never sue. Physicians doing EDTA chelation are, therefore, a very good risk to a malpractice insurer. This fact is independent of the actual benefit of such chelation. But malpractice underwriters shake down chelation physicians with too-high premiums. They must be stopped. Similar prohibitions need to be placed on price discrimination of other malpractice-rate-friendly procedures.

No continuing medical education requirement except for special training, ordered by the governor or legislature, due to an unpredictable event such as an epidemic or a credible threat of war.

Reason: Medical care changes over the years, due to improved surgical techniques, better drugs, and various research breakthroughs. But the underlying issues, human physiology, methods of examining a patient and arriving at a diagnostic algorithm before ordering various lab and radiology tests, are timeless. Refresher courses on history-physical examination may be be useful, but they are never offered--and they would be if the need for continuing education were genuine instead of a racket for the educators. (Considerable money could be saved if detailed physical findings were generally known; check the syllabus for the licensure examination of the Professional Linguistics Assessment Board of London, England, if you don't believe me.)

Patients may ask about recent training in one therapeutic modality or another, and hospitals may require competence in various processes from time to time. But for the license itself, it is superfluous.

No license or license renewal application may call for material irrelevant to the assessment process. By way of example and precedent, the health care board may not ask about Internet sites (except for probable cause of false and deceptive advertising) or hospital affiliations.

Reason: Blanket permission to ask all imaginable questions permits harassment by the board.