CORRECTION

A story on Page 1B of the City & State section Wednesday did not give a complete title for Polly Johnson. She is executive director of the N.C. Board of Nursing and president and chairwoman of the board of the Foundation for Nursing Excellence.

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The N.C. Medical Board, widely criticized for slack oversight of the state's 21,000 physicians, is seeking broader legal authority to discipline doctors.

The board has proposed draft legislation that would greatly increase its ability to publicly censure errant doctors.

Today, physician misconduct is publicly disclosed in two ways: Either the doctor acknowledges it and agrees to be disciplined, or the medical board holds a public hearing and imposes punishment. Other actions by the medical board, such as letters of warning sent to physicians under review, are kept private. Patients have no way to know a doctor has been cautioned, let alone for what reason.

Critics say that system allows problem doctors to practice under the radar in North Carolina, resulting in harm to patients.

Last year, for example, The News & Observer and other news media reported extensively on Dr. Steven Olchowski, a Wilmington surgeon who performed risky weight loss surgery on dozens of patients who had agreed to a safer procedure. Olchowski, who surrendered his license and no longer lives in the state, maintained a spotless record and unrestricted license to practice medicine in North Carolina, even as the medical board conducted its more than two-year investigation of him.

Currently, state law provides the medical board with two main remedies for punishing misconduct: It can suspend a doctor's license or revoke it. The board estimates it gets 1,000 complaints in a given year, including accusations of fraud, substance abuse and sexual misconduct as well as allegations of poor quality care.

Dr. Jesse Roberts, the board's medical director, said that very few cases involve misconduct that warrants yanking a physician's license, even temporarily.

"[Revoking or suspending the medical license] is like killing a fly with an atomic bomb, or at least a sledgehammer," he said.

Lawyers want more

Under the proposed legislation, the medical board would gain sweeping powers to publicly sanction doctors. And it could use all of them without first having to get the physician's consent.

Under the proposed changes, the board could impose public reprimands and public letters of concern. It could place doctors on probation, order them to provide free medical services and require them to complete treatment programs or remedial or educational training. It could also levy fines, place providers on probation or limit the scope of their practice.

If the board took any of those actions against a physician, it would be publicly disclosed to anyone who contacted the board about that doctor or looked up the doctor on the board's Web site.

"It's definitely going to move more actions from non-public to public," said Thomas Mansfield, the medical board's chief prosecutor and legislative liaison.

He discussed the draft legislation last week at a meeting of a House subcommittee.

"The clear message I got was that the medical board needs to step up and put forward recommendations, or we might get mandates [the board] doesn't like and might not be as effective," Mansfield said.

The proposed changes are winning early support from trial lawyers, a group more accustomed to battling doctors over medical malpractice awards. Mansfield said the medical board hopes to enlist the help of the N.C. Academy of Trial Lawyers in urging lawmakers to adopt the proposed reforms.

Burton Craige, a Raleigh medical malpractice plaintiffs lawyer and past president of the trial lawyers academy, said the medical board's changes are a good start.

"But they need to go a lot farther," he said.

Craige is on the board of the Coalition for Patients Rights, a patient advocacy organization established by the trial lawyers that is also pushing for medical board reform. Among other things, the coalition wants the N.C. Medical Board to do as some other states, including Virginia, have done and provide information about licensees' past malpractice payments and disciplinary history, including actions taken by medical boards in other states.

"I don't see any reason we can't do that in North Carolina," Craige said.

Rep. Bill Faison, a Democrat who represents Orange and Caswell counties and is a partner in a firm handling medical malpractice cases, said broader disciplinary powers would be a "dramatic improvement" -- if the board would be aggressive about applying them.

"It's movement in the right direction," he said. "But if they have the option to continue operating as the good old boys club, which they have done up until now, I'm not sure the public has gained any ground."

Not everyone is enamored of the idea of a medical board with sharper teeth.

The N.C. Board of Nursing and the N.C. Board of Pharmacy are preparing to fend off some of the board's proposed changes, specifically one that would authorize the board to use its broadened powers to go after nurse practitioners and clinical practitioner pharmacists.

Mansfield said those types of providers essentially practice medicine and therefore should be subject to the medical board's authority.

Jay Campbell, executive director of the N.C. Board of Pharmacy, noted that existing rules governing clinical practitioner pharmacists already allow the medical board to restrict, deny or terminate such pharmacists ability to direct medication therapy.

"This is a solution in search of a problem," Campbell said.

Polly Johnson, chairwoman of the N.C. Board of Nursing, was similarly nonplused by the medical board's bid. She said nurse practitioners are advanced-practice nurses, not medical doctors. Johnson said the nursing board does just fine monitoring its 123,000 licensees -- about 3,000 of whom are nurse practitioners -- and ordering appropriate punishment when needed.