John Oliver to US state medical boards handling malpractice: ‘Fix this mess’

John Oliver looked into state medical boards on the latest Last Week Tonight, starting with the risks of medical errors in the US. Medical errors “are more common than you might think”, he said, citing a 2016 analysis which found that they caused more than 250,000 deaths a year in the US. Most of those errors are systemic, rooted in things like poorly coordinated care or fragmented insurance networks. “And good doctors can make honest mistakes,” said Oliver. “The human body, after all, is a sloppy puzzle of wet nooks and dry crannies. Every inch of this skin sack is confusing, so let me be clear: this isn’t going to be a takedown of medicine.”

“The vast majority of doctors are dedicated professionals who strive to meet reasonable standards of care for their patients,” he added. “But a small fraction aren’t and can end up doing shit” like performing surgery on the wrong baby, as the case with one doctor in Los Angeles.

When mistakes, particularly negligent or repeated ones, occur, hospitals can fire a doctor, but only state medical boards can ensure that they don’t practice again or in other states, although “the percentage of physicians who face any sort of real consequences from medical boards can be surprisingly low”, said Oliver.

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“Medical boards can be underfunded and slow, and patients can suffer in the gaps, but the problem isn’t just one of resources,” he continued. “It’s also who is on these boards.” Most are made up heavily of doctors, and though it’s recommended a quarter of each board’s membership be composed of patient advocates, according to the Federation of State Medical Boards, less than half of state boards meet that standard.

“That can be a problem, because doctors tend to protect their own,” Oliver explained, pointing to the example of one non-physician member of California’s board who said patient care “never” came up in board meetings. “It’s not ideal if a board never thinks of patient care, since patient care is kinda doctors’ whole thing,” Oliver joked. “Without patients, doctors are really just failed urine collectors.”

Oliver illustrated a broken system – a 2016 investigation found that some doctors who sexually violated patients were returned to practice with as little as a three-day course on doctor-patient boundaries. “Which really doesn’t seem like enough,” said Oliver. “If you asked me to guess at how long they should face discipline for, I’d definitely say something longer than one Lollapalooza.”

And a recent survey found that it remains too difficult for the public to find complete information about physicians on their state medical board websites. “And what that means is that sometimes the only way people learn about a doctor’s past is if a news organization looks into it,” Oliver explained, citing the case of Jeremy Payne, who was informed by an Indiana news organization that the surgeon who left his mother paralyzed had settled numerous malpractice lawsuits. “You know, when you buy a car, it has a Car Facts. It’s almost like a doctor should have a Doctor Facts,” Payne said.

“Yeah, there probably should be!” said Oliver. “Because doctors know everything about us – if we smoke, if we’re depressed, how deep all of our holes go. But we know next to nothing about them.”

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There is a database called the National Practitioner Data Bank that’s only accessible to hospitals, medical boards, and a few select government entities. But hospitals can skirt requirements to report offending doctors, and some don’t check it. Some states, such as until recently Texas, still rely on an honor system for physician self-reporting, “but guess what, the bad doctors tend not to do that because, you know, they’re bad doctors,” said Oliver.

According to a 2018 report by the Milwaukee Journal Sentinel, at least 500 doctors who have been publicly disciplined, chastised or barred from practicing by one state medical board have been allowed practice elsewhere with a clean license. “With a trail of irreparable harm behind you, it seems that you can just hop around until you find a state that will look the other way,” said Oliver. “It’s one of the ways that doctors are like Catholic priests, along with having fun outfits that are just fancy pajamas and quietly thinking they’re God.”

When it comes to doing research on your doctor, “the best thing you can do as a patient to successfully vet your doctor might be to check TikTok to see if they’re posting videos of their surgeries online, because that seems to be the only surefire sign of disaster,” Oliver joked.

Oliver noted that due to lobbying groups, change would be difficult, but recommended that lawmakers required state boards to add more patient advocates and increase their funding, and establish public websites with transparency. “The vast majority of doctors help people, and are worthy of the value that society places in them. But this is a field that relies pretty uniquely on absolute trust,” he concluded. “It would serve everyone, including those many very good doctors, to fix this mess.”