How medical boards often fail patients with deadly results

The Ballard Clinic sits crossed the thoroughfare from the Greyhound autobus presumption successful the hollowed-out downtown of Jackson, Tenn., a tiny metropolis astir an hr from Memphis. After Dr. Thomas Ballard III took it implicit from his father, helium turned the household medicine signifier into a symptom clinic. By 2015, it had go a pill mill.

That’s what national prosecutors alleged erstwhile they indicted Dr. Ballard III successful 2019 for prescribing 4.2 cardinal pills of opioids retired of the Ballard Clinic. They claimed that Dr. Ballard doled retired opioids successful unsafe combinations with musculus relaxants and benzodiazepines known to abusers arsenic the “holy trinity.”

The feds said helium traded drugs for sex. Prosecutors claimed Ballard prescribed opioids to 1 patient, A.L. — a young pistillate helium had known since she was a miss — earlier and aft she was successful cause rehab and adjacent portion she was pregnant. She died connected May 28, 2015, from an overdose of hydrocodone, which Dr. Ballard had prescribed the time before.

And wherever successful each this was the state’s aesculapian board, the regulatory entity that decides who gets a aesculapian licence and who gets to support it? Two weeks earlier A.L. overdosed, committee investigators had inspected the Ballard Clinic, astir apt successful effect to a complaint.

They recovered 10 violations, including that helium was taking currency and wealth orders for “pain absorption treatment” and that helium was repackaging unused medicine to beryllium dispensed to different patients. They asked Ballard for charts and the doc refused to afloat comply. But nary enactment was taken.

The pursuing year, erstwhile implicit 42,000 Americans died of opioid-related overdoses, committee investigators came back. They recovered the aforesaid violations. And again the aesculapian committee waited.

The twelvemonth aft that, erstwhile much than 47,000 much Americans died of overdoses, the Ballard Clinic yet mislaid its “pain clinic” designation based connected the failed inspections. Not having the designation made it technically unlawful for the doc to spot mostly symptom patients. But the aesculapian committee — the lone authorities regulatory entity capable to halt Dr. Ballard’s prescribing — again did nothing. 

In 2018 (another 46,000 dead), the aesculapian committee yet placed Dr. Ballard’s licence connected probation. They asked him to wage a fine, be classes, and instrumentality to the state’s pain-prescribing guidelines. But they did not instrumentality distant his quality to prescribe controlled substances.

By 2019 — the twelvemonth astir 50,000 Americans died from opioid overdoses — it was wide that the committee wasn’t going to halt Dr. Ballard. Only a national indictment could region the powerfulness of his medicine pad. He was yet arrested successful April 2019, 4 years aft licensing committee investigators archetypal visited the clinic.

At his pretrial merchandise hearing, a national justice did what the licensing committee couldn’t oregon wouldn’t do: Revoke his authorization to prescribe controlled substances. In 2021, Ballard pled blameworthy to distributing controlled substances not for a morganatic aesculapian purpose, resulting successful death. He was sentenced to 20 years successful prison.  

How did we get here, wherever it’s easier to spell to situation for nonrecreational misconduct than suffer your licence erstwhile your patients upwind up dead? Medical boards, similar each nonrecreational licensing boards, are comprised mostly of members of the assemblage — chap doctors, lawyers, oregon nurses.

They are busy, moving afloat time, taking conscionable a fewer days each twelvemonth to moonlight arsenic their ain regulators. Board seats often spell to erstwhile leaders of nonrecreational associations, wherever the instinct to ellipse the wagons is ingrained. 

Board members bash their champion to “change hats” erstwhile they spell from relation to almighty licensing board, but existent alteration is acold harder than it seems. Licensing boards’ mediocre show successful nonrecreational subject bears this out. For example, I recovered that the Tennessee Medical Board kept successful signifier much than two-thirds of prescribers recovered to person engaged successful over-prescribing controlled substances, adjacent astatine the tallness of the opioid crisis.

In caller years, the transgression justness strategy has picked up the slack. It took an indictment and condemnation to halt Christopher Duntsch, besides known arsenic Dr. Death, the Dallas neurosurgeon who killed oregon maimed 33 of his patients a decennary ago. The Texas aesculapian committee knew astir his ineptitude, yet did thing to halt him.

Far much regular examples of malpractice person besides been the taxable of transgression indictment, specified arsenic the Nashville caregiver RaDonda Vaught who was found guilty successful 2022 of negligent homicide for a aesculapian error, aft the nursing committee declined to prosecute discipline. 

Professionals should beryllium prosecuted for misconduct erstwhile it meets the elements of a crime. However, we should not presumption the transgression justness strategy arsenic an due substitute for meaningful nonrecreational discipline. For 1 thing, transgression laws bash not screen each unsafe nonrecreational practices.

For another, prosecutors and judges are inexpert astir harmless nonrecreational signifier — the constituent of licensing is to springiness professionals a accidental successful who gets to support their license. Finally, the transgression justness strategy tin beryllium imprecise.

In the cases of Dr. Duntsch and Dr. Ballard, it was excessively little, excessively late. And successful the lawsuit of Ms. Vaught, many person claimed it was the other — excessively draconian. 

The nonrecreational licensing strategy needs an overhaul. Self-regulation done authorities boards has (among different problems) made subject acold excessively light, slow, and collegial to beryllium safe. 

States request to alteration who sits connected nonrecreational licensing boards, marque them advisory to an accountable authorities official, oregon both. Our information and nationalist wellness beryllium connected it.

Rebecca Haw Allensworth is simply a prof astatine Vanderbilt Law and writer of “The Licensing Racket.”