Who checks up on the doctors?
Most Americans would do just about anything their doctors told them to, or at least feel guilty when they disobeyed. But doctors, like any other professionals, have flaws. Doctors occasionally find themselves in trouble, but those instances are rare in Minnesota and North Dakota.
Just under 2 percent of actively licensed North Dakota physicians have been disciplined by the North Dakota Board of Medicine in the last five years, a Herald review found. Fewer than 1 percent of the licensed physicians have experienced some form of punishment from the Minnesota Board of Medical Practice.
Americans put more faith in doctors than they do in cops, pastors, professors or politicians. A 2016 Gallup Poll found health care providers to be the most trustworthy professionals in the U.S. Eighty-four percent of Americans rate nurses as highly ethical; 67 percent say the same of pharmacists; and 65 percent find their medical doctors to be very honest and ethical.
So, who checks up on the doctors?
In North Dakota and Minnesota, and across the U.S., it's mostly doctors themselves. Both states have medical review boards with a majority of practicing doctors from varying specializations and a small civilian section. The medical boards are independent government organizations solely charged with reviewing complaints and dishing out punishments or revoking licenses if necessary.
Doctors are punished for an eclectic collection of wrongdoing: insurance issues; failing to maintain records; poor billing practices; malpractice; improper prescription practices; personal criminal activity; substance abuse; and sexual relations with clients.
Minnesota has 23,642 licensed doctors and surgeons, 17,903 of whom reside in the North Star State. In the past five years, just 168 have received some form of discipline from the board. From 2012 to July 2017, 61 Minnesota doctors have had their licenses suspended; 18 have surrendered their licenses or had them revoked, according to data from the Minnesota Board of Medical Practice.
There are 4,022 actively licensed physicians in the state of North Dakota, 78 of whom have been disciplined by the board of medicine. In the past five years, 15 physicians have been indefinitely suspended and 20 more suspensions have been stayed, according to the North Dakota Board of Medicine.
North Dakota has received 81 complaints so far in 2017, 78 against physicians and three against physicians assistants, according to the board of medicine.
Devils Lake has 17 actively licensed physicians, two of whom have been disciplined by the medical board at some point. Both currently have licenses in good standing. None of Grafton's five active doctors have been disciplined.
The North Dakota board meets three times a year, in March, July and November. The board has 13 members: nine medical doctors, two doctors of osteopathy, one physician assistant and two members of the public.
The Minnesota board has 16 members: 11 physicians and five members of the public. The board meets six times each year, in January, March, May, July, September and November.
Seven doctors actively licensed to practice medicine in Grand Forks have been disciplined by the board, records show.
Two were not properly monitoring prescriptions for opioid drugs such as OxyContin and oxycodone. Two were punished for alcoholism, one of whom has been reinstated and another, Dr. Gerardo Lantoria, signed a non-practice agreement on Aug. 10.
One doctor, former UND chairman of Family and Community Medicine Dr. Robert William Beattie, lost his license to practice medicine in Minnesota and North Dakota after being convicted of child porn possession.
Dr. Thomas Lohstreter of Hallock, Minn. was reprimanded by the Minnesota board in 2013 for improper prescribing practices, the only northern Red River Valley doctor besides Beattie punished in Minnesota in the past five years.
Opioid abuse has swept across the U.S. and the Grand Forks region in the past five years, leading many medical boards to re-evaluate best practice procedures when it comes to prescribing opioid medications.
A Herald review found of the 168 physicians who were disciplined by the Minnesota Board of Medical Practice since 2012, 29 were cited for improper prescribing practices. Doctors typically received a reprimand, and many were required to read a model policy for pain by the Federation of State Medical Boards and a book on responsible opioid prescribing.
In 2014, Grand Forks doctor and part-time UND School of Medicine instructor Charles Christianson was reprimanded by the board after an investigative complaint ruled that on at least eight occasions between 2008 and 2011 he overprescribed opioids.
One patient was allowed to obtain 400 extra Endocet tablets and more than 400 extra OxyContin tablets because Christianson failed to adequately monitor the number of early refills he prescribed to the patient between March and June 2009, according to a report from a investigative panel from the state board.
Christianson signed documents admitting to the findings and received a one-year ban from prescribing prescription drugs with a high potential for addiction and abuse.
Reached by the Herald, Christianson said he stands by the decisions he made in his family health practice.
"I felt I could explain it, the board did not think that," he said.
The board felt he over-prescribed patients, but Christianson believes he was following standards of care at the time.
"There's been a huge change in how we look at this," he said.
In the 1990s and 2000s, he said physicians were trained to aggressively treat chronic pain, and opioid medications were a recognized form of that treatment. Many patients in Grand Forks suffer from chronic pain, he said, adding he looked closely at standards of care for such patients.
"For 20 years we were told we needed to be diagnosing and treating more, and that would include, in selected circumstances, using opioids," he said. "As you know, that led to a huge unanticipated problem."
Now retired apart from occasional instruction at UND, Christianson said he and the board disagreed on his work. His license is now in good standing.
Another Grand Forks doctor, internal medicine specialist William Zaks, was also issued a one-year prohibition from prescribing opioids after the board found he failed to properly monitor prescriptions for two patients in 2011 and 2012. His license is now in good standing.
In November 2016, Grand Forks gynecologist Laura K. Andreson received a two-year stay from having her license suspended for one year by a Board of Medicine investigative panel, which found from June to September 2013 she saw a patient for pelvic pain three times and did not order a Pap test, which resulted in an unnecessary delay in a cervical cancer diagnosis.
She was ordered to complete a Physician Competency Assessment and was ordered to pay legal fees for the board of medicine.
Andreson and Zaks work for the Altru Health System, which declined to comment when reached by the Herald. Altru added that for both doctors, it is their only instance of discipline.
While most Americans trust and appreciate their medical care, any resident of Minnesota or North Dakota who feels they received poor care can submit a complaint to their respective medical boards at any time that will be reviewed.
"We receive complaints, and then we evaluate each complaint based on our current rule structures," North Dakota Board of Medicine executive secretary Bonnie Storbakken said.