Check for a medical license before getting checked out
by Michael Schroeder
He already knew the answer, but Walt LaGraves still put the question to Reginald Phillips, who was planning to administer his wife Carol's rheumatoid arthritis treatment. "I specifically asked if he was a licensed doctor and he specifically replied that he was," Walt recalls.
After Carol had been referred to Phillips for the drug infusion therapy, she checked him out online. "We're naturally skeptical about everything," Walt says.
The LaGraveses, who both retired from the Broward County state attorney's office in Big Pine Key, Fla., insist any doctor they see must be licensed, but their habit of checking out providers isn't routine for most.
Virtually all respondents — 91 percent, according to an online Angie's List poll — say it's crucial their health care providers are licensed. Yet more than half never check, just assuming they are.
Many other members ask their providers if they're licensed, expecting an honest answer. Most are, of course. But a recent report by Medversant, a Los Angeles-based credentials verification firm, found about one in 50 health care providers — including 1.6 percent of doctors — profess to have a license, but practice without one.
One Russian-trained doctor in Ohio made headlines and landed in jail after he failed to get a license but set up practice anyway and gave improper gynecological exams and bad medical advice.
In New Jersey, authorities arrested 10 unlicensed dentists, some using rusty tools, in a 12-month period, and in Las Vegas, a pharmacist was arrested for furnishing dangerous drugs without a prescription, including horse tranquilizers.
Unlicensed and practicing
About one in 50 health care professionals are practicing without a valid license, according to an October 2009 report by Medversant, a company that verifies credentials. Here's a breakdown:
1.6% — Doctors
1.4% — Dentists
2% — Podiatrists
0.7% — Chiropractors
5.1% — Physician assistants
2.8% — Nurse practitioners
Authorities say all lacked licensure that grants an individual the privilege to practice medicine, or another discipline, within a state's jurisdiction.
By going to the Florida Department of Health website and doing a simple Google search, the LaGraveses found out Phillips was a convicted sex offender with a revoked license who'd spent time in prison.
Walt says Carol's appointment was a ruse to positively ID Phillips and confirm he was misrepresenting his credentials. Their call to local authorities eventually landed Phillips back in jail and he pleaded guilty to a misdemeanor for falsely representing himself as a licensed medical doctor.
Authorities dropped felony charges because they were unable to prove he was practicing medicine. Calls made to Phillips, who now lives in Memphis, Tenn., went unreturned.
Health care professionals practicing without a license generally fall into one of three camps, says Medversant CEO Matt Haddad: They've never had a license, they've had their license suspended or revoked, or they let their license lapse. The latter is the most common reason. In any case, Haddad says you're better off seeing a properly credentialed provider.
Lisa Robin, senior vice president of advocacy and member services for the Federation of State Medical Boards, concurs. "The purpose of professional licensure is to ensure that a minimum standard of training and education is met," she says.
According to Medversant's 2009 findings — drawn from a sample of about 30,000 practitioners concentrated mostly in 10 states across the country — the percentage of health care practitioners practicing without a state-required license ranged from 0.7 percent for chiropractors to 5 percent for physician assistants.
Ann Davis, director of state government advocacy and outreach for the American Academy of Physician Assistants, says she's perplexed by Medversant's numbers.
"We just don't see this," Davis says of P.A.'s practicing without a license. Because P.A.'s are part of a physician-led team, she says they may be more reliant on administrative staff to handle renewal paperwork. But she adds, it's ultimately the responsibility of the P.A. to make sure he or she has an active, current license.
Licensed by state
Doctors and nurses must be licensed in every state, but that's not true of all health care practitioners. A snapshot of practitioners — including offbeat ones — and some states that license them.
Illinois, South Dakota, Utah, Oklahoma, Tennessee
Arizona, Connecticut, Nevada
Professional art therapist
Kentucky, New York
At the highly rated American Health Network in Avon, Ind., one of about 70 of these practices in Ohio and Indiana, office manager Judy Clark keeps track of license renewal for staff. She speculates that some providers responsible for renewing their own license might just forget to do it.
"That's why I keep records," says Clark, who adds it's quick and easy to do, costing about $269 for doctors.
Hospitals, HMOs and other large health organizations like American Health Network check licensing credentials when they hire and generally every two to three years thereafter, Haddad says. Some check more often, but a corporate banner isn't a guarantee.
Rather than simply taking the provider's word, consumer experts recommend getting licensing verified through a state agency such as a medical board.
Brian Buckelew, San Francisco's assistant district attorney, has handled numerous cases involving unlicensed doctors, including one who performed fake exams and administered bogus vaccines to bilk more than 1,400 immigrants out of about $250,000 in fees.
"Traditionally in cases like this where people are masquerading as a doctor there's just this inherent trust placed in a person," Buckelew says.
The physician — Stephen Brian Turner, a convicted sex offender who'd lost his medical license previously — went to prison in 2006 and is now on parole.
Most states offer an online lookup option to verify a license. Some states have centralized locations online for health care professional licensing, while others have information scattered across many different regulatory agency sites.
The Center for the Health Professions at University of California San Francisco estimates there are more than 200 health care professions requiring licensure in the U.S., says Catherine Dower, director of research, but each state only licenses about 30 to 60. Massage therapists, for example, must be licensed in most states but not all, with exceptions including Vermont and Alaska. "Nobody has the same exact list," Dower says.
Boards that regulate licensed health care providers, such as doctors, rely heavily on complaints from patients to police problems. The most egregious offenses such as criminal behavior, sexual misconduct or drug-related offenses can result in a provider's license being suspended or revoked.
But many doctors plagued by malpractice problems go on practicing without facing sanctions and disciplinary rates vary considerably by state, says Sidney Wolfe, director of consumer watchdog Public Citizen's Health Research Group. "You get a tiny fraction [of providers] that are disciplined, which understates the problem," Wolfe says.
State board officials say comparing serious disciplinary rates is like comparing apples and oranges because of differing laws and other factors. They also say comparisons don't consider drug rehab programs and other corrective measures taken.
Wolfe says because so few physicians are ever formally disciplined by medical boards, an active, clear license doesn't say much in and of itself.
One report by Public Citizen found that two-thirds of doctors who made 10 or more malpractice payments between 1990 and 2005, didn't face serious disciplinary consequences, such as having their license suspended or revoked. Some who do lose their license just go on to practice in another state. "Lack of standard, national licensure is a problem," Dower says.
Public Citizen, a consumer watchdog group, annually ranks medical boards by the amount of serious disciplinary actions they take, such as revoking or suspending a license. Here are the numbers per 1,000 doctors:
States with lowest rates
1. Minnesota — 0.95
2. South Carolina — 1.23
3. Wisconsin — 1.64
States with highest rates
1. Alaska — 6.54
2. Kentucky — 5.87
3. Ohio — 5.33
In extreme cases, the federal government can put doctors on a list of "excluded providers," which prevents them from charging Medicare or Medicaid for services. States may also discipline doctors, withhold a license or forego renewal based on disciplinary action taken in other states. But it can take years.
Since 2006, at least 19 patients have filed malpractice suits against Dr. Lawrence Rothstein, a licensed physician practicing in Dayton, Ohio. Two cases, one involving a woman who suffered permanent brain damage after taking pain drugs prescribed by Rothstein following a back procedure he performed, resulted in jury awards totaling more than $7 million last year. Both are under appeal.
"He needs to be stopped," says attorney Greg C. Gibson, who'd filed seven suits against Rothstein, five pending and two that resulted in confidential settlements, as of press time.
His clients blame Rothstein, who performs a 30-minute laser procedure to repair the spine, for permanent nerve damage, partial paralysis and drop foot — a symptom of an underlying spinal condition that leaves one unable to lift the front part of their foot. "The state board is investigating, but they don't do anything," Gibson says.
Benton Taylor, assistant to the executive director of the State Medical Board of Ohio, says the state medical board investigates every complaint — and his office receives more than 4,000 of them a year. He adds that the law prohibits him from commenting on or acknowledging ongoing investigations.
Rothstein previously had his license suspended over a cocaine addiction, according to state records, but he currently faces no license restrictions. His brother and attorney, Steven Rothstein, says he's been drug-free for years and the fact that he's performing a relatively new procedure makes him an easy target for plaintiffs' attorneys.
Former patient Andy Glaser, who filed a complaint with the state in March, says he isn't after monetary compensation. "I'm just trying to prevent someone else from having to go through what we've gone through — or worse," says Glaser who spent three months off work following what he says was a botched procedure.
He required a second back surgery performed by another doctor. Steven Rothstein declined to comment on Glaser's allegations, citing patient confidentiality, but says any surgery carries risks and every patient's experience is different.
Robin, of the Federation of State Medical Boards, concedes differences in how state boards discipline and strains on resources — money and people — in a bad economy can slow response time to patient complaints. But, she says, a license in good standing is still the first thing she thinks a patient should look for in a doctor.
It's advice not lost on the LaGraveses. "Frankly, it should be routine for everybody who's seeing a new physician or professional," Walt says.