By M.D. Kittle | Wisconsin Reporter
MADISON — For physicians, a professional reprimand can be severe, carrying with it a kind of Scarlet Letter that dogs a doctor throughout his career.
But as more details come to light in the case of the doctors accused of handing out fake sick notes to Capitol protesters in February, some have questioned whether a mark on the seven physicians was nothing more than a slap on the wrist.
For some, the punishment did not fit the crime.
Last month, the state Medical Examining Board, which oversees medical licensing, approved stipulated agreements with the physicians, a move that limits their licenses, lodges fines and requires the doctors to enroll in four hours of continuing education.
The sick notes were handed out — like candy, according to media reports — in February to teachers and others who assembled at protests against proposed legislation, which has since become law, that curbed collective bargaining for most state public employees.
“There was no way to determine what kind of evaluation was actually made of an individual before these physicians issued their medical excuses,” Dr. Sujatha Kailas, chairwoman of the Medical Examining Board, said in a statement.
An earlier investigation found scores of teachers turned in sick notes from the doctors, many of the excuses signed by “Badger Doctors,” according to an open records analysis from the Wisconsin State Journal.
Following a lengthy open records request legal fight with the Madison Metropolitan School District, the newspaper this past weekend reported that at least 10 other doctors issued sick notes to district employees involved in the protest — excuses the district deemed fraudulent. Those doctors have not been named.
The State Journal also found about 570 district employees submitted sick notes during four days in February, the peak of the protests, when sickouts prompted the schools to close.
Defrauding the taxpayer
Major physicians groups have not taken a stand on the board’s disciplinary decisions, including the American Medical Association, which referred all comment to the Wisconsin Medical Society, the largest association of medical doctors in the state.
Mark Grapentine, the society’s vice president of government relations, in an email statement to Wisconsin Reporter said disciplining physicians is the domain of the Medical Examining Board and the individual physician’s employer.
The Arizona-based Association of American Physicians and Surgeons, or AAPS, however, has been very vocal on the issue.
Dr. Jane Orient, executive director of the group, said the Wisconsin doctors’ actions, ethically speaking, were tantamount to falsifying medical records.
“Putting something dishonest in the patient’s record is unethical,” Orient said. “If workers want to stay away from their job, that’s fine. But they shouldn’t expect the taxpayer to pay them for the day of work. That’s defrauding the taxpayer and the physician is an accessory to the crime.”
Orient said physicians who make false statements to licensure boards, even if they are inadvertent, often face the loss of their licenses. She said the punishment for the Wisconsin doctors seems “disproportionate to the crime.”
AAPS, which bills itself as a voice for private physicians and viewed as a fringe group by mainstream medical associations, has taken some controversial stands from criticizing peer review to opposing mandatory vaccinations.
Patricia Epstein, an attorney representing the Wisconsin physicians, in November told the Washington Post that her clients didn’t deserve such severe discipline, but agreed to the stipulations because “it was clear that was what the board wanted.”
Greg Gasper, spokesman for the Wisconsin Department of Public Safety and Professional Services, the agency that includes the Examining Board, said he could not comment on the other 10 physicians accused of writing sick notes or the severity of discipline imposed against the other physicians.
“The process is what it is,” he said.
It’s a complaint-based system, he said. If someone files a complaint, a screening board decides if the complaint merits an investigation. If so, and the charges hold, physicians face varying penalties, from warnings up to and including revocation of license.
Some have questioned whether some of the other 100-plus licensed professions monitored by the various boards that make up Public Safety and Professional Services would face similar sanctions for similar charges.
Gasper on Tuesday could only say each licensing agency follows complaint-based procedures. He said he could not speak to the discipline issues for other professional services.
William Babcock, executive director of the Wisconsin Society of Architects, doing business as AIA Wisconsin, or American Institute of Architects, said it’s hard to make an apples to apples comparison, in large part, because sick notes for protesters appear to be an unprecedented event. But Babcock said it would seem comparable to an architect signing off on plans that the professional did not review.
“These are professionals, and as professionals they can’t hide behind any corporate shield or veil,” he said. “They are putting their personal assets out anytime they provide services … The public puts a lot of faith in their ability to design buildings that are safe for occupancy.”
Lying, Babcock and others professional advocacy officials assert, no matter the reason, undermines faith in any licensed profession.
AIA Wisconsin can only take away membership, Babcock said, and in 25 years he couldn’t recall any architect losing membership status. Nationally, several architects each year are tossed from the association, many for fraudulent actions, he said.
So it goes for law enforcement officials, who face a number of sanctions, including criminal charges, for falsifying reports.
“Basically, if an officer is alleged to have done that, there would be an internal affairs investigation,” said Joel DeSpain, public information officer for the Madison Police Department. “Depending on the outcome of that investigation, the officer could receive punishment anywhere from a letter of reprimand, could be recommended for counseling, suspended or they could be terminated,” in accordance with Madison Policy and Procedure Manual 2-216 and 2-217 concerning “untruthfulness” and “false reporting.”
James Howard, president of the Madison Metropolitan School District Board of Education, told Wisconsin Reporter that the matter is a “done deal” for the district, which handed out discipline to the teachers known to have turned in sick notes the district considered fraudulent.
“I’m going to leave it to the medical community to handle it the way they see fit,” Howard said. “For me, it’s more, ‘Did our teachers do anything that was unethical. Did some of them seek out these doctors?’ I haven’t seen any information to that effect.
“I think we handled it satisfactorily, and I’m hoping this type of thing doesn’t raise its head again.”
Several physicians alleged to have handed out sick notes to protesters await public notice of discipline handed down from the University of Wisconsin School of Medicine.
Six of the seven doctors reprimanded by the state board practice at the school.
Lisa Brunette, spokeswoman for the School of Medicine and Public Health, on Tuesday said the last appeal in the case has been heard by the appeals committee and an announcement on the punishment meted to an unspecified number of physicians earlier this year will be issued in the coming weeks.
Investigators have interviewed 22 physicians in the case, Brunette said.