At the time Congress created the National Practitioner Data Bank (NPDB) in 1986, federal authorities acknowledged that impaired and dangerous doctors nationwide were getting off easy with informal reprimands and censures as well as poorly enforced agreements. The Federation of State Medical Boards noted that between 20,000 to 45,000 doctors were estimated to be mentally ill, drug abusers, alcoholics or criminals. Only a fraction of them ever came to light due to what then-Secretary of Health and Human Services Dr. Otis R. Bowen called “a brotherhood of silence.” In other words, the power of peer reviews was impotent. Medical boards, then and now, largely consist of doctors.
Although the NPDB continues to be questioned in terms of effectiveness and utilization, it’s at least a place for authorized entities to submit and look for infractions. Some organizations (i.e., hospitals and HMOs) and corresponding authorities are now required by law to enter reports into the NPDB about doctors violating regulations. Other entities and individuals (i.e., subjects of the reports) are entitled to review what’s posted.
The public relying on practitioners for services and guidance do not have access to this “confidential information clearinghouse” that Congress greenlighted to “improve health care quality, protect the public, and reduce health care fraud.” Fourteen years later, in March 2000, a House of Representatives Oversight and Investigations Subcommittee explored the pros and cons of such confidentiality before deciding to keep access to the content as limited as possible.
The tight lid on vetted NPDB reports coincides with physician health programs that further restrict public awareness about doctors in trouble. Medical boards, however, have added consumer- and legal-oriented positions, for example, and clearly do more than in the past to address concerning behaviors. For example, upon eligibility to have his Florida medical license reinstated in 1989, in conjunction with the state’s PRN program, Dr. Stanley Mark Dratler was required to always have a supervising physician present. The condition – and his reported diagnosis as a “sadistic sex addict” – made it difficult for him to resume practicing.
In June of 1990, a public health official for Broward County asked the Florida Board of Medicine about hiring Dratler to address the county’s profound shortage of obstetricians at the time. A media report stated that board members unanimously objected. Despite hearing arguments about the county’s “overwhelming” circumstances, with only two general practitioners and some nurses seeing pregnant patients, the board harshly criticized the proposal, which was positioned as fulfilling a public need while enabling Dratler to resume practicing.
Board members were “appalled.” Among their comments: “We’re not here to accommodate the public health service or Dr. Dratler. We’re here to protect the public.”
In September 1991, however, the Florida Board of Medicine approved a plan for Dratler to resume practicing at a Sarasota-based group of clinics – with a doctor there willing to accept the responsibility of continuously monitoring Dratler. Several months later, the board learned that he was frequently in violation of this requirement. It took two years for Dratler to be reprimanded for the offense. He was required to pay a $2,500 fine within the next 12 months of resuming practice, and admonished not to do it again while on probation for another five-year period.
Dratler ended up afterward where many doctors with disciplinary records go to practice: Prisons.
As he went to work for the Florida Department of Corrections (DOC), Dratler’s history of violations seemingly diminished. However, he became intertwined with a pharmacist in Maryland who lost his license and was sent to prison in 2010 for illegally dispensing more than 8 million doses of oxycodone in less than two years. Only eight doctors, the majority in Florida (none in Maryland), wrote the supposed prescriptions for patients across the entire country. Most of the orders were reportedly filled in four days of one month. According to public records, the Maryland Board of Pharmacy “questions the validity of the ‘sample’ prescription from Dr. Stanley Mark Dratler” that had been admitted into evidence. “The prescription is not dated, and the number of refills used and remaining is unclear.”
In addition, the board noted that the pharmacist had two weeks to submit exhibits for the hearing on his license yet failed to submit anything in advance. They mentioned that everything he entered into evidence was already on file or publicly available except Dratler’s prescription sample that the board considered unacceptable.
Lingering questions
The Maryland pharmacist and his partner were incarcerated and stripped of their licenses to practice. Did Dratler or any of the other seven physicians ostensibly involved face any questions or repercussions? Does the NPDB contain related reports?
Dratler apparently retired from Florida’s DOC in 2010, the same year as his Maryland pharmacist contact entered prison.
When Dratler applied for and received certification in 2018 to offer marijuana as part of his services, he was among the only recipients to grant a related media interview. The story focused on doctors authorized in that first year Florida legalized cannabis for medical purposes. Dratler, who remains certified to prescribe marijuana, was asked about his troubling history of sexual predation. He underscored that he had abstained from his sexual addiction for 32 years.
Perhaps it can be said Dratler paid his debt to society – or at least (indirectly) to the program and board of medicine that helped him preserve his license. Is he a better doctor because of all his travails and experiences? Tough to say,
It’s much harder to understand why medical board authorities continue to keep concerning information about doctor history from the patients who see them. Keep reading for more insight, including how we can all help drive changes that better protect the public while supporting the recovery of impaired physicians.