Nick Perencevich, MD is a semi-retired surgeon from Concord who served for 17 years on the New Hampshire Board of Medicine.
On May 1 the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetrics and Gynecology, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association – representing nearly 600,000 primary care providers – signed a joint statement opposing legislation in states, including New Hampshire, which promote interference in the doctor-patient relationship as well as criminal actions against physicians who do not comply.
In our legislature, as of 3 weeks ago, there were 6 House Bills passed, numbers 10, 232, 377, 606, 712, and 732 that have criminal directives against physicians. They range from birth control/abortion communications, breast surgery restrictions, medication directives on hormone and Covid medications, and more. They all called for criminal penalties including incarceration if providers don’t comply with the care directives of the bill. For example, HB 377 had the physician jailed if he/she does not stop hormone treatment to a child on the bill’s timetable.
When it is presumed that a physician has violated the public trust in their practice of medicine there is usually direct communication to the provider and their employer, if not self-employed. If a crime has occurred the police become involved to urgently protect the public. If there is violation of the standard of medical care or ethical guidelines, the normal action would be to report him/her to his state’s board of medicine where civil hearings have the power to fine him and restrict and/or remove his license to practice. The above house bills elevate the violation of new legislative laws around the practice of medicine to a crime.
So why not have physicians not complying with these bills be reported to the NH Board of Medicine?
The reason is that the current Board has been changed drastically by the legislature. There are still physicians and public members making the final decisions, but the investigative process, which since the NH board’s beginning in 1897 has had physicians doing the investigations in a process called peer review, barely exists. It was the 1890s when most state medical boards were formed. They allowed physicians to police themselves with state oversite to protect not physicians but the public. At the same time standard of care became based on scientific principles. For the last two years all investigations here in New Hampshire now start with attorneys looking for statute violations and criminal activity. Standard of care and medical ethical issues need initial physician review and it appears that seldom happens.
This all started in 2015 with the creation of the Office of Professional, Licensure, and Certification (the OPLC), which was then promoted as a cost savings by putting all boards under one roof. On April 16, Senate Bill 185 was discussed at an open hearing. It appears that the 15 bipartisan legislators who signed on to the bill were reacting to the complaints from their constituents in regard to the huge backlog of unanswered complaints and suits that all the boards were having, not just medicine. The bill asked the Executive Departments and Administration Committee to approve more attorney staffing to catch up on the administrative/ legislative backlog. Of all the boards, the Board of Medicine’s backlog was amongst the largest.
To me it is not coincidental that the destructions of boards of medicine and the criminalization of physicians are happening at the same time. They’re both part of the same plan. It is well established basic Libertarian and Free Stater policy to end occupational licensing and anything that limits consumer choice in health care including state or local health mandates. Former Gov. Sununu has said on several occasions that his biggest regret before leaving office was not being able to reduce or eliminate occupational boards. However, the state’s Republican Party leadership is now close to completely succeeding. Prior to 1890, when there were no boards, if you wanted to complain about your doctor, you could call the police, or hire a lawyer if you had the means, or take actions on your own… and patients often did, sometimes violently.
So what does this now mean for you, the public? It means getting used to your medical care not being science-based and now dictated by your legislature and governor. It also means if you have a complaint about your doctor, your best pathway will be to contact your legislator, not the Board of Medicine, and ask for more criminal action bills and laws. If you feel it’s hard to reach your doctor now or you’re waiting too long in the ER, plan on it getting harder since your doctor will have left the state for fear of being arrested. This is already starting here in New Hampshire and it’s happening big time in Texas because of abortion legislation. In the near future when these bills have all passed and you get really sick at 2 a.m., call the Speaker of the House, President of the Senate, or the Governor. They are the ones now practicing medicine and creating a new type of standard of care.
If you’re concerned about the pictured I’ve portrayed in the previous paragraph you will need to soon contact your senator to oppose these bills and have the governor veto them if passed. Recently, at the State House on May 6, all-day testimony from physicians and the public hopefully convinced the Senate to remove the criminal requirements in four of the bills listed above and instead refer issues to the Board of Medicine. Bill 232 was retained until fall and bill 732 was killed. However, as outlined above, the board is currently structured to focus more on the criminality of law and statute violations than standard of care violations where again physicians must be involved with the investigations. Despite the proposed change these four remaining bills interfere with the doctor-patient relationship and are still bad bills.
This problem, however, can be fixed. Last June, Sununu signed HB 322 which formed a Board of Medicine Study Committee to assure that the statute changes of two years ago, those that created the new attorney-based investigative process, were adjudicated properly. By November in their report the Committee confirmed the adjudication was proper, but they also made one important suggestion moving forward. They urged the Board of Medicine, the OPLC and the New Hampshire Medical Society to collaborate through rule making “to make necessary revisions and changes to the Board’s internal complaint review process to ensure the integration of physician/clinical review of complaints early in the investigative process.” To date the NH Medical Society has offered volunteer expert physician reviewers to help with the backlog. Please contact the governor, legislators and the board itself to urge them to accept the offer to improve and strengthen the Board of Medicine’s investigative process and also reduce the backlog and the trend towards criminalization of health care providers.