The United States' medical licensing system does not always preclude a doctor who surrenders a license in one state from practicing in another—potentially allowing physicians with a problematic past to continue seeing patients, according to an investigation by the Milwaukee Journal Sentinel, USA Today and MedPage Today.

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About the investigation

In the United States, doctors must be licensed by an individual state's medical board to practice medicine in that state.

Doctors who face disciplinary actions for unprofessional conduct—such as repeatedly committing surgical errors, improperly prescribing opioids, or having intimate relations with patients—may in some cases voluntarily surrender their license, John Fauber and Matt Wynn write report for the Milwaukee Journal Sentinel and USA Today.

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In doing so, doctors may avoid the financial burden and reputational harm that can come from formal charges and a state medical board hearing. But because of the decentralized nature of the U.S. medical licensing system, surrendering a medical license in one state does not always prevent a doctor from getting a license in another, Fauber and Wynn report.

For many doctors, they write, surrendering a license "amounts to a get-out-of-jail-free card."

For the investigation, Fauber and Wynn write, the publications sought to determine how often physicians who have faced disciplinary action are able to continue practicing in another state. To do so, they analyzed data compiled by TruthMD, a private company that gathers doctors' information from thousands of sources, including state medical boards and local courts.

The investigation focused on cases dating back to 2013 in which a state medical board recorded some action regarding a doctor.

Hundreds of doctors who've had licenses revoked are practicing elsewhere

The investigation identified more than 250 doctors who, after surrendering their medical licenses in one state, were allowed to practice in another. In about one-third of those cases, the doctors were allowed to practice in another state with no restrictions or public disclosure.

One such doctor is Larry Mitchell Isaacs, who over the course of several years surrendered his license in California, Louisiana, and New York, according to state medical records, before joining a practice in Ohio.

In 2013, Isaacs surrendered his Louisiana medical license after the state's medical board accused him of failing to recognize he had removed a healthy kidney from a patient during a colon surgery. Isaacs denied this and said the kidney's removal was necessary, but elected to surrender his license.

In California, the state medical board in December 2014 began looking into Isaacs following complaints of gross negligence, repeated negligent acts, and incompetence, particularly regarding one patient, referred to as G.G., whom Isaacs operated on several times. Isaacs allegedly removed her fallopian tube when he'd intended to remove her appendix, which it turned out had already been removed, and allegedly forgot to reconnect her intestine. Isaacs admitted only to inadequate recordkeeping and surrendered his California medical license in 2016.

Then, New York's Office of Professional Medical Conduct cited Isaacs' license surrender in California as evidence of professional misconduct, Fauber and Wynn write. Isaacs surrendered his New York medical license in 2017.

But Ohio allowed Isaacs to practice with an unblemished medical record, Fauber and Wynn write. Tessie Pollock, a spokesperson for the Ohio medical board, said she couldn't comment on why the board decided not to take action against Isaacs, but said the board takes allegations of "compromised patient safety and actions by other states very seriously."

For his part, Isaacs maintains his innocence in all three states and said he surrendered his licenses to avoid expensive legal battles. "I didn't do anything wrong anywhere," he said, adding that he "always went by the textbook. Sadly some doctors don't know what is in it."

For example, Isaacs said that, in California, he didn't leave G.G.'s intestine unconnected, but rather that sutures had broken down, which allowed the intestine to leak.

Isaacs also claimed that the licensing system is rigged. He alleged that the California state medical board often goes after doctors in order to make money off of fines. However, a spokesperson for the board said only 450 actions were taken last year in a state that licenses 113,000 doctors, Fauber and Wynn write.

According to Isaacs, Ohio is the only state that fully investigated every case against him, and it concluded he could practice. Regardless, Isaacs said he's no longer doing surgeries. "This was my last stop," he said. "I'm going to be 64 years old. I am just working as a physician and trying to live out my last years in peace."

Should physicians who surrender their licenses be barred from practicing elsewhere?

While there's wide variation in how states approach medical license surrenders, there's also debate about whether providers who do so should be allowed to practice in different states, Fauber and Wynn report.

John Harris, an assistant professor of medicine at the University of Pittsburgh Medical Center, said, "It is very concerning to think a physician surrenders in one state and doesn't surrender in another. There seems to be an inconsistency and danger. As a physician, I want our patients to be safe and I want these people not practicing."

Michael Carome, a physician with Public Citizen, which has studied the variations in doctor discipline by state, said, "All of those cases are troubling. Actions should have been taken against them in the states where they remained licensed."

However, some argue that there are cases in which a license surrender shouldn't prevent a doctor from continuing to practice medicine, Fauber and Wynn write. Eli Stutsman, an attorney who specializes in representing doctors and other medical professionals, said he's represented at least two people who received the help they needed and went back to practicing medicine without any new problems.

"Do they have some history? Yes. Did they make some compromises to return to work? Yes. Are they reinstated? Yes, and I wouldn't be afraid to see either of them," he said. "Good practitioners have been caught up in this. I'd be careful to not paint with such broad strokes" (Fauber/Wynn, Milwaukee Journal Sentinel, 11/30/18).

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