Medical schools in doubt


A HANDFUL of medical schools in the United States and abroad graduate troubled doctors at about 10 times the rate of the best schools, an eight-month Hartford Courant investigation found.  

Four medical schools – the Autonomous University of Guadalajara in Mexico, Howard University in Washington, Manila Central University in the Philippines and Meharry Medical College in Nashville, Tennessee – ranked at the bottom in separate analyses of three databases containing records of disciplinary actions against thousands of physicians across the United States.  

Other medical schools also fared poorly in The Courant's review, but only Guadalajara, Howard, Manila Central and Meharry appeared in the bottom 5% of roughly 200 schools ranked by rates of disciplinary actions against graduates in each analysis.  

Together, these large, well-established schools have produced more than 600 doctors cited by licensing boards for negligence, incompetence, sexual assault, drug abuse or fraud.  


Eyed with concern 

Within the medical profession, some of these schools have long been eyed with concern. Howard and Meharry ranked at the bottom of a National Science Foundation-funded survey of US medical school quality in 1977, and questions have been raised about Guadalajara for years.  

While it is difficult to draw conclusions about individual doctors based on where they went to school, The Courant's findings, for the first time, point to a link between medical schools that have raised red flags in various settings and troubling behaviour by some of their graduates. 

“This is incredible information,'' said Dr Rebecca Patchin, chairwoman of the American Medical Association's council on medical education. “This could shake up the whole community and force people to take another look at the licensing criteria.''  

The precise reasons for the poor showing of these schools is unclear, but most have one thing in common: a practice of admitting students with lower grades or scores on standardised tests who might have trouble being accepted in many other places.  

At least one school, Guadalajara, has accepted would-be doctors who never completed college.  

“There is no excuse for students being allowed into medical school if they aren't adequately prepared,'' said Dr Sidney Wolfe, director of health research for Public Citizen, a Washington-based consumer group.  

“Maybe this means that it's worth requiring that anyone practising medicine in the United States had adequate preparation before medical school.''  

The newspaper's findings drew a sharp response from the head of the trade group representing US medical schools, who said it was impossible to pin the performance of physicians on the schools they graduated from because too many other variables determine success or failure.  

“I think it's kind of an irrational approach to analysing a very complex set of issues,'' said Dr Jordan Cohen, president of the American Association of Medical Colleges, who also characterised the effort as “simplistic'' and “foolish.''  

“I don't think there are any bad medical schools'' in the United States, Cohen said. “That's a null set.''  


Physician profile databases 

The Courant analysed US national and state-level databases containing the type of disciplinary information consumers can get through “physician profile'' websites run by state licensing boards.  

The broadest database, compiled by Public Citizen, contained information on more than 19,000 physicians disciplined between 1990 and 1999 by state licensing boards, the federal Medicare and Medicaid programmes, the Food and Drug Administration and the Drug Enforcement Administration.  

In addition to the national data, The Courant also obtained “physician profile'' databases from two large, geographically distinct states, California and Ohio, which together contain the records for some 240,000 doctors who have held licences over the last 50 years. The California database also contains some malpractice payments made by physicians.  

The schools represented were then ranked according to rates of disciplined graduates. After eliminating small schools with statistically insignificant numbers of graduates, only Guadalajara, Howard, Manila and Meharry consistently stood out with the highest rates of disciplined doctors in all three databases.  

In California, approximately one of every 10 graduates from each school has faced disciplinary action. For most schools, less than half that many graduates have been disciplined.  

The schools differ in many ways, but the clearest common denominator is that most accept candidates unable to get into other schools. For a variety of reasons – some noble, others more pragmatic – the schools have more flexible admissions standards than other institutions. 


Flexible admission standards 

The two US schools, Howard and Meharry, have played a critical role in the history of American medical education, training generations of black physicians when the doors to most schools were largely open only to whites.  

Doctors trained at these schools have gone on to provide care for many who were being turned away by all-white hospitals, or by physicians who refused to treat minorities.  

They are also among a handful of historically black institutions that attract students who often come from underprivileged backgrounds and may score lower on standardised tests.  

“Many, although not all, of our students come from disadvantaged backgrounds and therefore have not had the same educational advantages as other students in their formative years,'' Meharry spokeswoman Jill Scoggins said in a statement.  

Howard officials declined to comment.  

Howard and Meharry refused The Courant's requests to meet with school officials and explain to them the analysis in detail. Instead, The Courant provided the schools with a written summary and a list of questions.  

Officials at Manila Central did not respond to questions about the newspaper's findings.  

The Autonomous University of Guadalajara also has more flexible admissions standards, but for a different reason. The school draws US citizens south of the border by catering to college students who do not have the grades, or the Medical College Admission Test scores, to get into a medical school in the United States.  

“We don't frown on someone with a 'B' average,'' said Peter Himonidis, a Guadalajara dean. “We provide an opportunity for people who are determined to become doctors but are denied that opportunity at home.''  

While the vast majority of Guadalajara's graduates go on to practise without tarnished records, others – such as Dr Jose Nabut of Florida – have dismayed courts and regulators across the country with their lack of preparation for the safe practice of medicine.  

Nabut seriously injured at least five patients using a surgical technique that plaintiffs' lawyers said he learned by practising – only once – on a pig at a weekend seminar after graduation.  

One of those patients, Glenn O'Loughlin, required eight corrective surgeries after Nabut mistakenly stapled shut his bile duct during what should have been a routine gallbladder removal.  

O'Loughlin said he was stunned to discover, much later, that Nabut had been accepted at Guadalajara without first earning a college degree.  

“If I had known any of that, I never would have gone to him,'' O'Loughlin said. “But when your insurance company refers you to a doctor, you just trust that they know what they're doing.'' – LAT-WP 

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