Report: Arizona Medical Board's slow response endangers patients

More than three-fourths of complaints were not resolved within six months, the study of the Arizona Medical Board performed for the state by the accounting firm of Walker and Armstrong found.

That is the amount of time that the state Auditor General's Office, which commissioned the new examination, says it should take healthcare regulatory boards such as this to investigate and resolve complaints.

That's critical because of the harm that can occur to patients if doctors are not properly regulated, the report says.

And this isn't just about low-level complaints over billing or a doctor's failure to turn over a patient's medical records.

The report found that the board was out of compliance with the 180-day standard even in what it calls Priority 1 complaints. Those include complaints about sexual misconduct, a doctor's drug or alcohol abuse, and what auditors consider a "severe quality of care violation, such as inappropriate prescribing of medications resulting in death.''

The auditors also said none of this is new — or news to the Medical Board.

"Board performance audits conducted by the Arizona Auditor General as far back as 1981 all found that the board has not investigated and resolved complaints in a timely manner,'' the new report says. "Additionally, although the board made some improvements to address the recommendations made in the previous audits, some improvements were not sustained.''

'Leaving the public at risk'

The auditors said the key issue is the delay in resolving cases — and what that can mean to patients.

They cited one instance where it took more than three years to resolve a complaint that a doctor failed to comply with the standard of care by not obtaining consent from a patient prior to conducting a procedure that was not medically necessary.

Almost nine months after the first complaint, the board got another one against the same provider alleging that the doctor performed surgery on a patient who had a recent infection at the surgical site, did not inform the patient of the associated risks, failed to obtain consent before the procedure, and provided inadequate post-operative care, treatment and communication.

And even as the board was investigating those complaints, it received two more.

The board eventually concluded the allegations were true, placed the doctor on probation, and imposed some restrictions on practice.

"However, the licensee was allowed to continue practicing for more than three years while under investigation, and therefore, may have continued to provide patient services that fell below the standard of care during that time, leaving the public at risk,'' the auditors said.

Another case cited took 1,653 days to resolve against a radiologist who allowed an assistant to independently perform procedures on at least four patients while the doctor was out of state, as well as charging patients for services not provided.

The auditors also said patients are not the only ones affected by the delays: The report cites a case in which it took the board 1,101 days to dismiss a complaint that a doctor had failed to oversee a patient.

The auditors found there were multiple reasons the board takes so long.

They pointed out the board is authorized to issue subpoenas to medical providers and others who have information such as medical records. But the report says the board was slow in issuing those subpoenas or using its authority to have the demands enforced by courts.

The report also was critical of the various executive directors the board has had over the years, saying they failed to establish oversight for delegated responsibilities. The auditors said that resulted in "potentially inefficient and ineffective board operations and waste of public resources, poor performance, and noncompliance with statute and board policies.''

Director: Benchmark unreasonable, funding inadequate

In her response, Raquel Rivera, the board's executive director, said many of those deficiencies "originated under the direction of prior staff that are no longer with the Arizona Medical Board.''

"Improving oversight and accountability mechanisms has been a priority for the Arizona Medical Board's current executive director,'' she said.

Rivera, while acknowledging the data cited by auditors in completing cases, also questioned whether the board should be judged by the 180-day benchmark.

She pointed out that the board could not meet that standard as far back as the audit conducted in 1981. And back then it regulated fewer than 5,900 professionals.

Now, she said, the board regulates more than 35,000 doctors and also is charged with oversight of about 5,600 physician assistants.

"This more than six-fold growth in licensee population, without a corresponding adjustment to the 180-day benchmark, indicates that a uniform 180-day goal is no longer a reasonable or reliable benchmark,'' Rivera wrote in her response.

She acknowledged that the board is self-funded from fees from the professionals it regulates.

But Rivera told Capitol Media Services that more doctors — and more fees — do not automatically translate to the ability to hire more staff to handle the increased caseload.

"The board does not have unrestricted access to the revenue it generates,'' she said, with the ultimate authority up to the Legislature, which authorizes not only what it can spend but the number of staffers it can hire.

"Even as licensee volume and associated fee revenue has increased, the board must request legislative approval for new positions and salary adjustments through the normal budget process,'' Rivera said.

Related to those money issues, she said, is hiring and keeping qualified staff.

"State salary ranges for several positions have not kept pace with comparable roles in the private sector and broader public sector,'' Rivera said. "The board has raised this in its budget requests as a contributing factor to both turnover and capacity challenges.''

Rivera said the board is asking state lawmakers for more authority to spend money for the new fiscal year that begins July 1, 2027.

Legislature's role in funding issues

The auditors acknowledged the role of lawmakers in funding issues.

Under normal circumstances, the board keeps 90% of what it collects, giving the remaining 10% to the state general fund. But in 2024, as lawmakers sought to balance the overall state budget, they ordered the board to remit 15% of all collections — and do so through June 2028.

The auditors noted that lawmakers also mandated the board to transfer $9.3 million in its fund balance to the general fund to balance the 2025 state budget.