Iowa doctors accused of serious offenses admonished in secret by state board

In the past six months, the state board that oversees physicians has issued dozens of confidential letters of warning to doctors accused of criminal assault, patient neglect, sexual misconduct and other serious offenses.

Every year, the Iowa Board of Medicine, which oversees physician licensing, issues about 100 confidential letters to practitioners. Some of those letters are characterized as warnings, while others are described as letters of education intended to encourage doctors to brush up on their medical knowledge.

In some cases, doctors are sent confidential letters ordering them to undergo a mental or physical assessment of some kind. Last November, for example, the board confidentially ordered an evaluation for an Iowa-licensed physician due to concerns that he “inappropriately touched a female patient’s breasts during an examination.”

Three other confidential evaluation orders were issued that same month due to concerns over the doctors’ professional competency, and a confidential letter of warning was sent in response to a physician being charged with domestic assault of his or her spouse.

Also in November, letters of warning were sent in response to concerns with the hip replacement surgery an Iowa doctor performed on a patient, and unspecified concerns with another doctor’s surgical care for “multiple patients.”

Kent Nebel, executive director of the Iowa Board of Medicine, said the confidential letters are sent out when the board determines that formal disciplinary action, which would be made public, isn’t warranted.

“If the board believes (the offense) is a threat to the public, or part of a pattern, or something egregious, then they will take formal disciplinary action.” he said. “If it appears to be an error or just a poor decision, frequently that will end up with a letter.”

He said there’s typically no question as to the validity of the allegation in cases where a letter is sent out, so that’s not a factor when the board chooses to send a confidential letter rather than impose public, formal disciplinary action. “It’s usually not about whether we can prove the conduct,” he said. “It’s about how severe the conduct is.”

In recent years, Nebel said, the board has handled roughly 675 investigations per year. Of those, about 100 cases are resolved with a confidential letter, he said.

Although the recipients of such letters are not publicly disclosed by the board, a few details about the nature of each allegation is. State records show that some letters of warning are issued in response to serious offenses.

For example:

• Last December, the board issued confidential letters in response to concerns that a physician was criminally charged with domestic assault of his or her spouse; that a physician failed to inform a patient about an abnormal x-ray result; and that a physician allowed the sale of cannabidiol, or CBD, products at her medical office.
• In February, nine confidential letters of warning or education were sent out by the board. Among the alleged offenses: failure to address a patient’s abnormal CT scan, resulting in the delayed diagnosis and treatment of lung cancer; failure to personally assess a psychiatric patient in the emergency department; failure to document the need for an early induction of delivery of a baby; mistakenly switching two patients’ pathology reports, resulting in an unnecessary surgery for one patient and the delayed diagnosis and treatment of cancer for the other; and being sanctioned by another state’s licensing board for alcohol abuse.
• In March, nine confidential letters were sent in response to allegations that a doctor injured a patient’s left eye while attempting to cut into a lump on the patient’s eyelid; and that another doctor failed to examine a patient who was subsequently diagnosed with bacterial meningitis and then lied under oath while giving testimony in a civil lawsuit. Other issues related to a doctor making an “unprofessional comment” to a child patient, and to a doctor who failed to adequately diagnose an ovarian cyst or inform the patient of the problem.
• In May, the board issued what it calls a “confidential evaluation order” – which typically requires a practitioner to undergo some form of medical assessment – out of concern that he or she was suffering from a health condition that might impair their ability to practice medicine with reasonable skill and safety, and out of concern that the doctor was “engaged in a pattern of substance abuse and/or sexual misconduct.” That same month, confidential letter were sent in response to concerns that a physician failed to diagnose a patient who was suffering from a heart attack and that a physician prescribed opioids to a female co-worker without performing the appropriate exams and without maintaining the appropriate medical records.
• In July, the board issued seven confidential letters in response to concerns that a physician failed to provide appropriate supervision to an assistant who prescribed excessive amounts of opioids to patients without the proper patient evaluation and monitoring; that a physician had been criminally charged with a domestic violence offense; that a physician removed a patient’s gallbladder in a manner that resulted in serious complications; that a physician failed to perform a biopsy on a patient who was suffering from bladder cancer; and that a physician failed to provide the proper examinations and medical treatment for “multiple patients.” That same month, confidential letters were also sent to a physician who was disciplined in another state for engaging in substance abuse, and to a physician who failed to report his academic probation on an application for an Iowa medical license.

The eight-member Board of Medicine consists of five physicians and three public members. The public members are Diane Cortese of Urbandale, an employee of Principal Global Investors; Mary Jo Romanco, a registered nurse from Pleasantville; and Trudy Caviness of Ottumwa, who has served as chair of the Wapello County Republican Party.