New York State Office of Professional Medical Conduct: Are its policies and performance becoming a political liability?

Townsend Letter for Doctors and Patients,  Feb-March, 2002  by Marcus A. Cohen

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The institution of medicine has a great deal invested in the perpetuation of the myth of objective evaluation. It underpins the cognitive and social authority of its practitioners and legitimates powerful vested interests, not only in medicine, but in society at large.

-Evelleen Richards,

The Politics of Therapeutic Evaluation:

The Vitamin C and Cancer Controversy

Part Three: Medical Politics and the Reform of the OPMC

This is the third installment of an article, on state regulation of medical practice published by the Townsend Letter, the first and second installments having appeared in September and October, 2001. As it did in the previous installments, the Office of Professional Medical Conduct (OPMC), New York State Department of Health, exemplifies how state medical boards discipline physicians for misconduct.

Briefly reviewing the other installments: The first centered on physicians providing conventional medical care, the second on physicians specializing in complementary and alternative medicine (CAM). Both dealt with problems in the disciplinary process, documenting them and probing for their likely causes. Both made a distinction between the OPMC's handling of minority treatment approaches (CAM and mainstream), and the agency's prosecution of physicians who bungle standard procedures, misread diagnostic tests, and so forth.

Focusing on minority approaches, this installment 1) examines, competition between physicians and other health care providers, as well as competition among physicians; and 2) analyzes the political elements in state medical board actions against physicians whose treatment approaches, though deviating from practice norms, help patients. It closes with pragmatic steps for political activists to follow in lobbying for limitations on OPMC prosecutions of such CAM and mainstream physicians.

Readers of the Townsend Letter who've been following its coverage of the OPMC's attempt to revoke Dr. Serafina Corsello's license, may wish to consider these steps, then take one (or more), to broaden the support she's receiving from her patients and New York consumers of CAM. (The second installment of this article, published in October, closes with an interim report on this watershed case.)

The hearing has recommended revocation of Dr. Corsello's license. Her attorney has asked the appellate court in Albany for a stay -- a necessary intervention, since a change in the law several years ago forbids revoked doctors from practicing while the health department deliberates over their appeals.

Note that Corsello's case has never gone to trial. When her attomey filed an answer late, the administrative law judge (ALJ), declared her in default, which moved the proceeding into the penalty phase. Her attorney is arguing that the law does not mandate a default for lateness; it leaves the ALJ the power to weigh the circumstances and waive the default.

Meanwhile, the OPMC gives out to anyone protesting or merely inquiring that it found Dr. Corsello guilty of providing inappropriate and illegitimate tests and studies -- guilty, in effect, of fraud. (1) And while she's been willing and eager to defend her practice, the OPMC is holding fast to the technicality it seized on to dispense with an evidentiary hearing -- a right that the law affords respondents in all administrative proceedings. (2)

The last installment of this article, proposes reforms that would allow patients greater access to necessary treatment options. Effective reform of the OPMC will depend on how clearly doctors and health care consumers understand the influence competition and politics have in state regulation of clinical practice. The reforms proposed should benefit mainstream as well as CAM physicians. History suggests, though, that parochial interests on both sides are likely to impede change, perpetuating contentiousness instead of cooperation.

OPMC and Competition Between Mainstream and Other Kinds of Care

The mainstream physicians and their confederates, the government agencies that regulate medicine, the pharmaceutical and insurance industries, are at it again -- conspiring to oust alternatives from the health care business. And confronting deep inroads into their markets and profits by CAM providers, they're employing every means at their disposal to succeed. Or so it seems, sampling CAM periodicals, particularly letters to the editors and talk shows hosted by CAM doctors railing against the medical establishment.

Competition in medicine can be healthy, spurring improvements in care, or harmful, limiting choices in care. CAM supporters tend to dwell on the traumatic prosecutions of high profile CAM physicians by state medical boards over the years. (And they suspect hostile elements in mainstream medicine of instigating these attacks). But they must have some notion that the nasty side of competition has cropped up between men and women skilled in healing throughout history.

References to bloodletting between different medical traditions appear in the remnants of literature from early Mediterranean and Middle Eastern civilizations. Galen, a Greek physician famous for anatomical discoveries made through dissections of gladiators, moved to Rome in 164 AD and quickly earned high repute for his medical care and lectures to the populace. He lasted three years in that imperial seat of murderous jealousies and intrigues before rivals drove him out. (3)