Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


Medical boards are responsible for disciplining physicians who inflict egregious harm on their patients, yet they often fail to do so. This Article develops a cultural and organizational framework for explaining why boards so often fail to discipline physicians. The framework highlights three types of barriers that impede board action: (1) input barriers that prevent hospitals and clinics from reporting harm to boards, (2) processing barriers that prevent boards from taking sufficient action against physicians who do harm, and (3) output barriers that prevent boards from sharing information about physicians who do harm with other disciplinary agencies like other medical boards and law enforcement. The Article demonstrates how the interplay between these barriers reduces the likelihood that boards will discipline physicians who harm patients and also shows how boards behave like other kinds of organizations in similar situations. The Article concludes with a set of solutions to overcoming each type of barrier and explains why an organizational and cultural perspective is essential for identifying gaps between boards’ stated goals and their actions and for developing effective solutions.