Many Hospital and Prison Doctors Are Working In USA Without Medical Licenses

Several doctors at Larned and Osawatomie state hospitals and Kansas state prisons are working with special "institutional licenses" despite not having a full medical license, in part because the state has a severe shortage of psychiatrists, state officials said.

Nine of the 13 physicians at Larned and 10 of the 22 physicians at Osawatomie are currently on "institutional licenses," according to Kansas Department for Aging and Disability Services. And at the state's prisons, one of nine medical doctors and four of nine doctors who specialize in psychiatric medicine have the limited licenses, according to Corizon Health, the state's corrections health care contractor, The Kansas City Star reported .

The practice is not new and it is necessary because the state doesn't have enough psychiatrists, said Tim Keck, secretary of the aging and disability services.

"The agency appreciates our institutionally licensed doctors," Keck said in an emailed statement. "They are dedicated and they work hard every day to provide good care to our patients."

But Rick Cagan, executive director of the National Alliance on Mental Illness' Kansas branch, said allowing institutional licenses at state facilities means Kansans who need the most help often are cared for by doctors who, at least on paper, are less qualified.

"I am concerned that the most acutely ill individuals are receiving treatment from physicians who do not meet the highest standards for practice," Cagan said. "It's counter-intuitive that those most seriously ill have access to physicians who are denied the ability to establish a community-based practice."

Although the practice has occurred in Kansas and elsewhere for decades, Republican state Sen. Barbara Bollier, a retired physician from Mission Hills, said it might be time to discuss whether the practice should change.

"Why are we still doing this?" Bollier said. "That's the biggest question. I don't have an answer. ... If that is good enough for (state hospitals), why aren't these same things in place for the entire population of the state? Why do we have different standards?"

None of the doctors practicing on institutional licenses has been sanctioned for violating standards of care, according to Kathleen Lippert, the executive director of the Kansas Board of Healing Arts.

Kansas and about 20 other states offer limited licenses to allow doctors who aren't able to start a private practice to work in state mental institutions. After three years with institutional licenses, doctors also can practice at other public facilities like community mental health centers.

Kansas established the institutional medical license in 1969, when the nation began shifting away from long-term institutionalization for the mentally ill to community-based care. Larned and Osawatomie are the last state hospitals in Kansas and have about 300 beds between them.

Missouri, which employed a national-high 47 limited license physicians in its mental health program in 1990, has phased out the program.

Debra Walker, spokeswoman for the Missouri Department of Mental Health, said its seven state mental institutions recruit psychiatrists by working closely with medical school residency and fellowship programs. The department also allows flexible work schedules so its psychiatrists can work outside the state system for additional income.

Walker said the department currently employs 34 psychiatrists and has 6.5 openings, a vacancy rate of about 16 percent.

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