- Email: [email protected]
Towards a global partnership to prevent misconduct
EDITORIAL
THE LANCET Volume 356, Number 9227
Towards a global partnership to prevent misconduct A US federal grand jury has charged a US physician with serial murder—he is alleged to have killed patients in the USA and abroad as he moved from post to post. The indictment alleges that Michael Swango gave lethal injections to three patients in a Veterans Affairs hospital in 1993, while he was a resident at the Stony Brook Health Sciences Center on Long Island in New York state. The indictment also charges that in 1984 Swango, while he was an intern at Ohio State University Hospital, killed a 19-year-old woman, who had been struck by a car, by giving her a lethal injection of potassium chloride. Swango, who if convicted could face the death penalty, has entered a plea of not guilty. One of the many troubling aspects of this case is that despite the fact that he had been convicted of a felony for giving arsenic to five emergency medical technicians with whom he worked, a crime for which he served 2 years, and that he had been investigated for suspicious deaths of patients at Ohio State University Hospitals, Swango was able to obtain hospital positions in the states of South Dakota and New York, and abroad, in Zimbabwe, Zambia, and Saudi Arabia. In Zimbabwe, warrants have been issued for Swango’s arrest for the murder of five patients and the attempted murder of three more individuals. Swango’s success at finding work despite his record highlights just how easily physicians who have been found guilty of incompetence or misconduct can continue to practise by moving from jurisdiction to jurisdiction. Aspects of Swango’s case are echoed in that of Richard Neale, a UK gynaecologist, who on July 25 was struck off the medical register, having been found guilty of more than 30 charges of malpractice (see p 398). The findings are disturbing given that they were the result of Neale’s work after he returned to the UK in 1985, having had his licence to practise removed in two provinces in Canada. The UK General Medical Council was alerted to Neale’s censure by the Canadian authorities, yet the matter was not pursued. With globalisation and the relaxation of barriers, it is likely that more and more medical professionals who have been disciplined for incompetence or misconduct in one country will attempt to resume THE LANCET • Vol 356 • July 29, 2000
practice by moving to another. In the USA, it has long been common for disciplined doctors to move across state lines in often successful attempts to resume practice. This has become more difficult since 1990 when the USA set up the National Practitioner Data Bank, which collects information on “adverse action reports” involving physicians and dentists who have lost privileges for more than 30 days because of incompetence or professional misconduct, on malpractice-liability payments made on behalf of a health-care practitioner, on disciplinary actions resulting in suspension or revocation of a physician’s or dentist’s licence, and other such sanctions. But the effectiveness of the databank has been limited in part because of various loopholes that allow many disciplinary actions to go unreported, since credentialing officials often fail to use the system to screen applicants, and perhaps most of all because medical professionals remain reluctant to aggressively investigate and punish colleagues. The problems seen with the US model are likely to be multiplied by any international system established to share information between nations with different medical, legal, and political arrangements. Nevertheless, the Swango and Neale cases illustrate the need for some mechanism by which officials can easily conduct background checks on physicians from other nations seeking permission to practise in their countries. A possible first step towards setting up such a system is a proposal that has been drawn up by medical licensing organisations representing Australia, Canada, New Zealand, South Africa, Sweden, UK, and the USA calling for the establishment of an International Association of Medical Licensing Authorities. The goal of the association will be to promote high standards of physician licensure and registration around the world, an effort that would include the establishment of a “network for the regular exchange of medical licensing and disciplining data”. The proposal, which will be presented at the Fourth International Conference on Medical Regulation being held in Oxford, UK, in late September, merits serious consideration. The Lancet 351
For personal use only. Not to be reproduced without permission of The Lancet.
THE LANCET Volume 356, Number 9227
Towards a global partnership to prevent misconduct A US federal grand jury has charged a US physician with serial murder—he is alleged to have killed patients in the USA and abroad as he moved from post to post. The indictment alleges that Michael Swango gave lethal injections to three patients in a Veterans Affairs hospital in 1993, while he was a resident at the Stony Brook Health Sciences Center on Long Island in New York state. The indictment also charges that in 1984 Swango, while he was an intern at Ohio State University Hospital, killed a 19-year-old woman, who had been struck by a car, by giving her a lethal injection of potassium chloride. Swango, who if convicted could face the death penalty, has entered a plea of not guilty. One of the many troubling aspects of this case is that despite the fact that he had been convicted of a felony for giving arsenic to five emergency medical technicians with whom he worked, a crime for which he served 2 years, and that he had been investigated for suspicious deaths of patients at Ohio State University Hospitals, Swango was able to obtain hospital positions in the states of South Dakota and New York, and abroad, in Zimbabwe, Zambia, and Saudi Arabia. In Zimbabwe, warrants have been issued for Swango’s arrest for the murder of five patients and the attempted murder of three more individuals. Swango’s success at finding work despite his record highlights just how easily physicians who have been found guilty of incompetence or misconduct can continue to practise by moving from jurisdiction to jurisdiction. Aspects of Swango’s case are echoed in that of Richard Neale, a UK gynaecologist, who on July 25 was struck off the medical register, having been found guilty of more than 30 charges of malpractice (see p 398). The findings are disturbing given that they were the result of Neale’s work after he returned to the UK in 1985, having had his licence to practise removed in two provinces in Canada. The UK General Medical Council was alerted to Neale’s censure by the Canadian authorities, yet the matter was not pursued. With globalisation and the relaxation of barriers, it is likely that more and more medical professionals who have been disciplined for incompetence or misconduct in one country will attempt to resume THE LANCET • Vol 356 • July 29, 2000
practice by moving to another. In the USA, it has long been common for disciplined doctors to move across state lines in often successful attempts to resume practice. This has become more difficult since 1990 when the USA set up the National Practitioner Data Bank, which collects information on “adverse action reports” involving physicians and dentists who have lost privileges for more than 30 days because of incompetence or professional misconduct, on malpractice-liability payments made on behalf of a health-care practitioner, on disciplinary actions resulting in suspension or revocation of a physician’s or dentist’s licence, and other such sanctions. But the effectiveness of the databank has been limited in part because of various loopholes that allow many disciplinary actions to go unreported, since credentialing officials often fail to use the system to screen applicants, and perhaps most of all because medical professionals remain reluctant to aggressively investigate and punish colleagues. The problems seen with the US model are likely to be multiplied by any international system established to share information between nations with different medical, legal, and political arrangements. Nevertheless, the Swango and Neale cases illustrate the need for some mechanism by which officials can easily conduct background checks on physicians from other nations seeking permission to practise in their countries. A possible first step towards setting up such a system is a proposal that has been drawn up by medical licensing organisations representing Australia, Canada, New Zealand, South Africa, Sweden, UK, and the USA calling for the establishment of an International Association of Medical Licensing Authorities. The goal of the association will be to promote high standards of physician licensure and registration around the world, an effort that would include the establishment of a “network for the regular exchange of medical licensing and disciplining data”. The proposal, which will be presented at the Fourth International Conference on Medical Regulation being held in Oxford, UK, in late September, merits serious consideration. The Lancet 351
For personal use only. Not to be reproduced without permission of The Lancet.