One doctor, two states: Comparing Texas and North Carolina transparency

AUSTIN (KXAN) — We put our lives in their hands, but how can we know we're in good ones?

If patients want to research their doctor or surgeon ahead of time, what they find could be determined by where they live, a KXAN investigation found.

A three-month KXAN investigation found nearly 50 doctors licensed in Texas with "clean" records — even though they faced discipline in other states. For these physicians, patients searching the Texas Medical Board's license lookup page would not find any mention of disciplinary actions taken in other states including licenses suspended, surrendered and revoked — information doctors are required to report to the TMB but failed to do so. Instead, KXAN uncovered those discrepancies.

"We're trying to provide transparency to patients," TMB Executive Director Stephen Carlton told KXAN.

While Texas promises transparency, our investigation found it lacking compared to other states. KXAN looked at one doctor who is licensed in both Texas and North Carolina — a state that one recent study found was among the most transparent states in the country when it comes to health care. On the TMB website, there are no records of any out-of-state disciplinary actions or medical malpractice claims, leading patients to think this doctor has a squeaky clean record.

We found that isn't the case.

Looking up that same doctor on the North Carolina Medical Board reveals a 2018 "public letter of concern," reciprocal letters of reprimand from four other states and two medical malpractice settlements. The NCMB issued the letter of concern after finding he misinterpreted a five-centimeter mass — which is the size of a lime — on an MRI as "normal" when, in fact, it was cancer. The missed diagnosis prevented the patient from being treated earlier for his illness, the TMB wrote.

North Carolina patients have access to all these records and can read the reports directly.

KXAN is focusing on greater accountability within the system rather than specific doctors, which is why we have not named individuals.

"If we are aware of an action, then we post it on our website," NCMB spokesperson Jean Fisher Brinkley said. "And it never goes away."

Brinkley said the NCMB began posting disciplinary actions online back in 2000. The state's transparency efforts continued even further in 2007 after a law was passed making hospital privilege actions and malpractice settlements — which are often settled in secret — public. She said there was fierce opposition to that.

"It's a big emotional topic," she said. "Clinicians really feel strongly that sometimes those things are settled for business reasons and not because their care was insufficient."

The state ultimately sided with transparency, believing more information, and easy access to records, are the best way to serve patients. Another obstacle the state had to overcome was building a massive database and getting the public to use it. Brinkley acknowledges the way North Carolina operates is not necessarily the norm but says it's a model other states should consider.

In Texas, doctors have to report disciplinary actions and most criminal offenses to the TMB when they renew their license every two years. In North Carolina, they have 60 days to report that information. KXAN asked the TMB if it would consider changing that but was told it would require a change to state law.

"Most of the time there's nothing to find" when researching a doctor, Brinkley said. "But if there is something to find, wouldn't you want to know about it before?"

Is the fix fixing much?

After KXAN started asking questions, the TMB promised a fix. The board said starting this year it will now post new out-of-state disciplinary actions it finds out about online with a note that it was not reported by the doctor.

Under the Texas Occupations Code Sec. 154.006, however, a "description" of that information should already be public by law — something our investigation found isn't routinely happening.

"As far as 'Does the [Texas] Medical Board go and review all, you know, 154,000 of our licensees to make sure that they've disclosed everything that's come in?' That's something that's a little more time-intensive that the medical board has not, in the past, done," Carlton said in an interview with KXAN.

More than a month after the TMB said it would start posting disciplinary actions that were not self-reported by doctors, KXAN asked for examples. We were sent a doctor whose public profile was updated to say "action taken in Michigan" in 2019 with reciprocal discipline in three other states, reported by the Federation of State Medical Boards.

So, what was that "action?" Texas doesn't say. It turns out, though, that the doctor given to us as an example of Texas' increased transparency is also licensed in North Carolina. In checking the NCMB website, we saw the doctor's full disciplinary history. That included links to official documents showing he was placed on probation and fined $5,000 for multiple violations, including improperly dispensing medications without conducting an exam.

KXAN followed up with the TMB to ask if it would consider adopting a model similar to North Carolina's as a way to increase transparency. We will update this story when we receive a response. The TMB also never addressed why it isn't fully following the law. Instead, it said it has "historically" relied on doctors to self-report out-of-state disciplinary actions due to limited staff and time resources.

Brinkley says patients and state leaders collectively have to answer one question.

"What is the standard of transparency that Texans deserve?" Brinkley asked.

Graphic Artist Rachel Gale, Director of Investigations & Innovation Josh Hinkle, Photojournalist Chris Nelson, Digital Special Projects Developer Robert Sims, Digital Director Kate Winkle and Graphic Artist Jeffrey Wright contributed to this report.