Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Informing under compulsion Allan J. Ryan To cite this article: Allan J. Ryan (1977) Informing under compulsion, Postgraduate Medicine, 62:4, 18-19, DOI: 10.1080/00325481.1977.11714628 To link to this article: http://dx.doi.org/10.1080/00325481.1977.11714628
Published online: 07 Jul 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 25 August 2017, At: 21:20
editorials - - - - - - - - - - - - - - - - - - - - - - -
• Physicians and other health professionals in New York State are now required, as the result of legislation passed this year, to report to the state office of professional medical conduct any instance of medical misconduct of which they are aware. The person may ask the office for an opinion asto whether to flle a complaint, but if the answer is Yes, a cornplaint must be filed. A physician may also flle the complaint through the county medical society. Alabama, Arizona, and Idaho have enacted similar laws, and 23 other states have provided immunity to those who come forward voluntarily with such information. The state laws which make reporting mandatory, as well.as the New York Assembly bill, specify that failure to report misconduct is itself profession al misconduct. A physician
found guilty of such a charge could lose the license to practice and conceivably be sentenced to pay a fine or serve a jail term or both. Other health care professionals, including nurses (who are required to report on the misconduct of physicians only), could also conceivably be subjected to the same penalties. Unquestionably, the immunity provisions relating to reporting professional misconduct have had a dramatic effect. There has been a sixfold increase in the past five years in the number of investigations initiated by state medical disciplinary bodies in 15 ofthe states which have this legislation, according to the American Medical Association. This compares with an average threefold increase in the same period for 4 7 of the 50 states. Wh en one considers that the cases from the 15 states contribute substantially to the overall total from the 4 7, the difference between those states with immunity and those without it is even more striking. The number of licenses revoked in the 47 states rose from 45 in 1971 to 130 in 1976, and the number ofphysicians placed on probation in the same years went from 57 to 185. Even allowing for the increase in number of practicing physicians over this period, these are big increases, although an extremely small percentage of all practicing physicians is involved. What sticks in the craw, however, is the compulsion to inform on a colleague under the threat of sustaining a charge of professional misconduct yourself. Every citizen who witnesses a crime oris aware that one has been committed is obligated to report it to the police. In the process the person must decide that what was seen or beard actually involved the commissioi:l of a crime, and as every desk officer in a police station knows, when citizen reports are investigated, many show no evidence of a crime in the legal sense. Yethere there is ordinarily sorne direct observation of the circumstance and only common sense is necessary to understand it. Where the possibility of professional misconduct is con-
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POSTORADUATE MEDICINE • October 1977 • Vol. 62 • No. 4
Downloaded by [Australian Catholic University] at 21:20 25 August 2017
be for patient care remains to be seen. As Lasagnw has said, ''The PPI is an exciting challenge. It calls for our best efforts, for deliberate progress rather th an basty gestures, for research and continuing evaluation to measure the impact of oureducational efforts, to see whether our achievements match our aspirations and to change our methods if they do not.'' • References 1. Nader R: Statement on prescription drug information for consumers (1976). Drug Info J 11:14$, 1977 2. Ryan R, McMahon FG: The patient package insert. 2. Potentia1 effects on the hea1th care system. Drug Info J 11:75S, 1977 3. Lasagna L: The patient package insert. 1. Potentia1 effects on the patient. Drug Info J 11:56S, 1977
informing under compulsion Allan J. Ryan, MD
Downloaded by [Australian Catholic University] at 21:20 25 August 2017
cemed, the situation is by no means so simple, and how much greater is the chance that the informant's assumption could be wrong. President Carter's appeals to foreign countries to respect the civil rights of their citizens have prompted many persans to observe that such rights are not al ways weil respected here
at home. Perhaps immunity for those informing on professional misconduct serves the civil rights of the putative victims of this misconduct. But legal compulsion to provide such information is only another step toward a police state, no matter what other purposes it may serve. •
introducing the editorial board One of the most important contributions made to any medical journal is that of its board of editorial consultants. ln the February issue we began to lntroduce the members of our Editorial Board. Each month we will publish brlef profiles of a few more of these distinguished physicians so that ali of you may become a little more familiar with those whose dedicated labor does so much to make this journal possible. Allan J. Ryan, MD
ing his current post, he was a Veterans Administration Distinguished Physician at the Veterans Administration Hospital in Oklahoma City. Dr Papper was ed itor of The Kidney for ten years and was on the editorial board of the Journal of Clinical and Laboratory Medicine, Clinical Nephrology, and Nephron. His textbook "Ciinical Nephrology" is widely used throughout the world. Dr Papper's major interest is in teaching general internai medicine.
Leonard O. Hudson, MD Seattle Pulmonary Disease
Solomon Papper, MD Oklahoma City Internai Medicine Dr Papper is Distinguished Professer and head of the department of medicine at the University of Oklahoma Health Sciences Center, Oklahoma City. He is a graduate of New York University School of Medicine, New York, and completed his residency under Dr Maurice B. Strauss. He was later a fellow in medicine at the Thorndike Memorial Laboratory and Harvard Medical School, Boston. After many years on Dr Strauss' staff, Dr Papper held several academie positions, including protessor and chairman, department of medicine, University of New Mexico School of Medicine, Albuquerke, and professer and cochairman, department of medicine, University of Miami School of Medicine, Miami. For several years before assum-
Vol. 62 • No. 4 • October 1977 • POSTGRADUATE MEDICINE
Dr Hudson is associate professer of medicine at the University of Washington School of Medicine and chief of the respiratory disease division at Harborview Medical Center, Seattle. A graduate of the University of Washington School of Medicine, Dr Hudson interned at the Cornell Division of Bellevue Hospital Center, New York, took one year of residency training at the New York Hospitai-Cornell Medical Center, New York, and completed his residency at the University of Washington, including a year as chief resident in medicine at Harborview Medical Center. He received his training in pulmonary disease at the University of Colorado Medical Center, Denver, where he remained on the faculty for two years before returning to Seattle. Dr Hudson's research interests include gas exchange and hemodynamic aspects of the adult respiratory distress syndrome, pulmonary effects of smoke inhalation, and pulmonary effects of trauma. His outside interests include pottery, jogging (bordering on running), and "very amateur" basketball (his ability togo to his left has been questioned). Dr Hudson and his wife have three children, Sean, Sherry, and Kevin.~
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ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Informing under compulsion Allan J. Ryan To cite this article: Allan J. Ryan (1977) Informing under compulsion, Postgraduate Medicine, 62:4, 18-19, DOI: 10.1080/00325481.1977.11714628 To link to this article: http://dx.doi.org/10.1080/00325481.1977.11714628
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [Australian Catholic University]
Date: 25 August 2017, At: 21:20
editorials - - - - - - - - - - - - - - - - - - - - - - -
• Physicians and other health professionals in New York State are now required, as the result of legislation passed this year, to report to the state office of professional medical conduct any instance of medical misconduct of which they are aware. The person may ask the office for an opinion asto whether to flle a complaint, but if the answer is Yes, a cornplaint must be filed. A physician may also flle the complaint through the county medical society. Alabama, Arizona, and Idaho have enacted similar laws, and 23 other states have provided immunity to those who come forward voluntarily with such information. The state laws which make reporting mandatory, as well.as the New York Assembly bill, specify that failure to report misconduct is itself profession al misconduct. A physician
found guilty of such a charge could lose the license to practice and conceivably be sentenced to pay a fine or serve a jail term or both. Other health care professionals, including nurses (who are required to report on the misconduct of physicians only), could also conceivably be subjected to the same penalties. Unquestionably, the immunity provisions relating to reporting professional misconduct have had a dramatic effect. There has been a sixfold increase in the past five years in the number of investigations initiated by state medical disciplinary bodies in 15 ofthe states which have this legislation, according to the American Medical Association. This compares with an average threefold increase in the same period for 4 7 of the 50 states. Wh en one considers that the cases from the 15 states contribute substantially to the overall total from the 4 7, the difference between those states with immunity and those without it is even more striking. The number of licenses revoked in the 47 states rose from 45 in 1971 to 130 in 1976, and the number ofphysicians placed on probation in the same years went from 57 to 185. Even allowing for the increase in number of practicing physicians over this period, these are big increases, although an extremely small percentage of all practicing physicians is involved. What sticks in the craw, however, is the compulsion to inform on a colleague under the threat of sustaining a charge of professional misconduct yourself. Every citizen who witnesses a crime oris aware that one has been committed is obligated to report it to the police. In the process the person must decide that what was seen or beard actually involved the commissioi:l of a crime, and as every desk officer in a police station knows, when citizen reports are investigated, many show no evidence of a crime in the legal sense. Yethere there is ordinarily sorne direct observation of the circumstance and only common sense is necessary to understand it. Where the possibility of professional misconduct is con-
18
POSTORADUATE MEDICINE • October 1977 • Vol. 62 • No. 4
Downloaded by [Australian Catholic University] at 21:20 25 August 2017
be for patient care remains to be seen. As Lasagnw has said, ''The PPI is an exciting challenge. It calls for our best efforts, for deliberate progress rather th an basty gestures, for research and continuing evaluation to measure the impact of oureducational efforts, to see whether our achievements match our aspirations and to change our methods if they do not.'' • References 1. Nader R: Statement on prescription drug information for consumers (1976). Drug Info J 11:14$, 1977 2. Ryan R, McMahon FG: The patient package insert. 2. Potentia1 effects on the hea1th care system. Drug Info J 11:75S, 1977 3. Lasagna L: The patient package insert. 1. Potentia1 effects on the patient. Drug Info J 11:56S, 1977
informing under compulsion Allan J. Ryan, MD
Downloaded by [Australian Catholic University] at 21:20 25 August 2017
cemed, the situation is by no means so simple, and how much greater is the chance that the informant's assumption could be wrong. President Carter's appeals to foreign countries to respect the civil rights of their citizens have prompted many persans to observe that such rights are not al ways weil respected here
at home. Perhaps immunity for those informing on professional misconduct serves the civil rights of the putative victims of this misconduct. But legal compulsion to provide such information is only another step toward a police state, no matter what other purposes it may serve. •
introducing the editorial board One of the most important contributions made to any medical journal is that of its board of editorial consultants. ln the February issue we began to lntroduce the members of our Editorial Board. Each month we will publish brlef profiles of a few more of these distinguished physicians so that ali of you may become a little more familiar with those whose dedicated labor does so much to make this journal possible. Allan J. Ryan, MD
ing his current post, he was a Veterans Administration Distinguished Physician at the Veterans Administration Hospital in Oklahoma City. Dr Papper was ed itor of The Kidney for ten years and was on the editorial board of the Journal of Clinical and Laboratory Medicine, Clinical Nephrology, and Nephron. His textbook "Ciinical Nephrology" is widely used throughout the world. Dr Papper's major interest is in teaching general internai medicine.
Leonard O. Hudson, MD Seattle Pulmonary Disease
Solomon Papper, MD Oklahoma City Internai Medicine Dr Papper is Distinguished Professer and head of the department of medicine at the University of Oklahoma Health Sciences Center, Oklahoma City. He is a graduate of New York University School of Medicine, New York, and completed his residency under Dr Maurice B. Strauss. He was later a fellow in medicine at the Thorndike Memorial Laboratory and Harvard Medical School, Boston. After many years on Dr Strauss' staff, Dr Papper held several academie positions, including protessor and chairman, department of medicine, University of New Mexico School of Medicine, Albuquerke, and professer and cochairman, department of medicine, University of Miami School of Medicine, Miami. For several years before assum-
Vol. 62 • No. 4 • October 1977 • POSTGRADUATE MEDICINE
Dr Hudson is associate professer of medicine at the University of Washington School of Medicine and chief of the respiratory disease division at Harborview Medical Center, Seattle. A graduate of the University of Washington School of Medicine, Dr Hudson interned at the Cornell Division of Bellevue Hospital Center, New York, took one year of residency training at the New York Hospitai-Cornell Medical Center, New York, and completed his residency at the University of Washington, including a year as chief resident in medicine at Harborview Medical Center. He received his training in pulmonary disease at the University of Colorado Medical Center, Denver, where he remained on the faculty for two years before returning to Seattle. Dr Hudson's research interests include gas exchange and hemodynamic aspects of the adult respiratory distress syndrome, pulmonary effects of smoke inhalation, and pulmonary effects of trauma. His outside interests include pottery, jogging (bordering on running), and "very amateur" basketball (his ability togo to his left has been questioned). Dr Hudson and his wife have three children, Sean, Sherry, and Kevin.~
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