Wednesday, January 13, 2010


A recent Associated Press article told the story of a Dover, Delaware pediatrician who had been arrested and charged with more than 50 felonies related to sexual abuse of his patients. The arrest followed a mother’s report to police of the doctor’s abuse of her 2-year old daughter.

The story indicated that there had been complaints about this doctor dating back almost a decade. The state’s medical board suspended his medical license, but not until after he had been arrested.

Police had tried to deal with the matter in 2005, but were told that they could only investigate if there was a formal complaint by a patient or a parent.

Governor Jack Markell was quoted as saying that the system had failed and that there was a need to find out where and how.

What the governor could learn without bothering with a formal investigation is that a health care system that includes independent private practice is unable to deal satisfactorily with this type of situation. In his private office, a physician is effectively accountable only to the state medical board, which can only act if a complaint is filed and then, as a branch of government, has to grant the full panoply of constitutional protections to the person complained against..

Had the doctor been employed by a properly functioning group practice or hospital, chances are the problem would have been dealt with a long time ago. Once his behavior became clear, he would have been called on the carpet, following which he would either have ceased to offend or have been fired.

There is talk these days of developing entities called Accountable Care Organizations (ACOs) of which doctors like the Dover pediatrician would be a part. The ACO would then be ‘accountable’ for all aspects of care, including that of dealing with physician misbehavior.

If Governor Markell wants Delaware to have a system that works, he can promote the development of ACO’s and the requirement that every doctor be part of one.

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