When Joan Dimick checked into Catholic Medical Center in Manchester, N.H., for heart valve surgery in 2014, her family had no idea that her surgeon had been disciplined the prior year for professional infractions so serious that the hospital suspended him for nearly a month.
Not only that, CMC had downgraded Dr. Yvon Baribeau’s appointment to “conditional” for the period when he operated on Dimick, a consequence of his having failed to return to the operating room after surgery when called to treat his badly bleeding patient.
The 56-year-old Hillsborough County sheriff’s office employee suffered complications during the several-hour procedure and never awoke, her family said, leaving them stunned and heartbroken. Baribeau told them the operation went smoothly, but they believe he could have been responsible for the complications that led to her death.
“We knew nothing about this,’’ said Dimick’s sister, MaryEllen McGorry, referring to Baribeau’s disciplinary record. “They were telling me this guy was the best, you don’t need to go to Boston. If any of us had known any of this, this man would never have gotten near our sister.”
They are far from the only ones kept in the dark. Patients and families in New Hampshire such as the McGorrys have no reliable way to learn crucial information about a doctor because the state’s medical board is one of the least transparent in the nation.
Doctors and hospitals are unlikely to volunteer a negative history, and the board does not make public what many health care consumers want to know, including hospital disciplinary actions, malpractice settlements, and criminal convictions, the Globe has found. That same information is available in many other states.
Baribeau’s physician profile on the N.H. medical board website implies that he has a pristine record, while his profile on the Massachusetts medical board website – where he was also licensed – lists 20 of his 21 medical malpractice settlements.
“Why is it right there on the Massachusetts page and it’s not in New Hampshire when the guy’s main business was in New Hampshire?” asked Representative Mark Pearson, Republican chairman of the Joint Legislative Department of Health and Human Services Oversight Committee in New Hampshire.
A Globe analysis also found that the New Hampshire board is one of the most poorly staffed in the country. It oversaw about 8,000 doctors last year, but had only three dedicated full-time staff, a ratio that is one of the lowest in the United States.
And Public Citizen, a nonprofit advocacy group, found that the board is slow to punish. It had the lowest rate of serious disciplinary actions against doctors of any state between 2017 and 2019, the years the organization studied. The New Hampshire board does disclose its own agency’s disciplinary actions on physician profiles, which are available to the public. But the record shows there are comparatively few of those.
Board president Dr. Emily Baker, an obstetrician at Dartmouth Hitchcock Medical Center, did not return phone calls from the Globe asking for comment on the Baribeau case and about the agency’s work.
Lindsey Courtney, executive director of the New Hampshire Office of Professional Licensure and Certification, which oversees the medical board, said state law does not allow the board to disclose malpractice settlements and hospital disciplinary actions, which are considered confidential complaints when reported to the board. Massachusetts law, on the other hand, explicitly directs that state’s board to make the information available to the public.
Dimick’s family is part of a growing chorus in New Hampshire calling on the medical board to be more transparent with the public following a Boston Globe Spotlight Team investigation into CMC and Baribeau that revealed his troubled history. Families of several of Baribeau’s patients told the Globe that when they researched the surgeon’s record they found no worrisome flags.
“Anyone who goes to a physician or surgeon should have that information. How do you make an informed decision?” McGorry said.
Dimick’s husband, Shawn Dimick, said Baribeau and the hospital never fully explained her death after she underwent much needed valve replacement surgery in March 2014. But he said an autopsy and medical records indicate she suffered severe brain swelling caused by an unexplained embolism.
Baribeau’s attorney, Beth Catenza, said last week that patient privacy laws prevent the doctor from commenting on specific cases. The hospital also said it could not comment on Dimick’s case but that “quality and patient safety guide all that we do.”
New Hampshire Governor Chris Sununu’s office said Friday that the state attorney general will launch a “review of the practices of the New Hampshire Board of Medicine, along with the rules and statutes that govern their activities,” which will be made public when it is completed.
“These important actions will not only examine the serious questions raised recently, but will inform any necessary changes to statute or rules that will improve the system going forward,” said Jayne Millerick, the governor’s chief of staff, in an e-mail.
Pearson, meanwhile, appointed a legislative subcommittee on Friday to examine why the medical board does not provide more information to consumers.
The Globe stories relied on extensive interviews with many physicians and other medical professionals at CMC who were appalled by Baribeau’s run of deadly outcomes and by the hospital’s decision to allow him to continue to operate. In 14 of his 21 settlements, he is accused of contributing to a patient’s death.
A Globe analysis of the National Practitioner Data Bank, a government-run database that tracks medical malpractice settlements, found that no other N.H. doctor has more medical malpractice settlements than Baribeau, and no US physician has more settlements involving a surgical death in the past two decades.
Baribeau, who retired in 2019, has said through his lawyer that he agreed to a large group of 17 settlements in 2020 and 2021 largely to avoid lengthy litigation and that the agreements did not include an admission of substandard medical care.
“I performed over 10,000 procedures at CMC, always with patient safety as my first priority,” he said in a statement.
The hospital’s chief executive, Alex Walker, has defended the hospital’s handling of Baribeau and denied it withheld important information from the public. But on Wednesday he promised a full review of how the hospital oversees medical care in response to the Globe stories, though the hospital provided few details.
Representative David Meuse, a Portsmouth Democrat, said he had also discussed with fellow lawmakers investigating whether the state’s medical board should play a stronger role in regulating physicians.
“A lot of the time, especially in emergency situations, you have to put a lot of trust in the people who are taking care of you and in the institution those people work for. What we have here looks like a violation of that trust over a very long time,” Meuse said.
Medical boards consist mostly of physicians and don’t include many public members who work outside the health care system, explained Lori Nerbonne, a nurse who co-founded the patient advocacy group New England Patient Voices. As a result, she said, they tend to “protect physicians who they license to the detriment of patients.’’
The N.H. board, which is appointed by the governor and the Executive Council, currently includes six doctors, one physician’s assistant, and two public members. Two of the doctors have strong connections to Catholic Medical Center: Baker, the obstetrician, conducts telehealth visits for CMC, and Dr. Jonathan Eddinger is a cardiologist who works at CMC. He also did not respond to a request for comment.
The medical board has investigated Baribeau’s care of patients at least twice over the past decade, according to Baribeau’s New Hampshire and Michigan license renewal applications and a CMC statement to the Globe. But the board has declined to discipline him, according to the board’s website and the hospital statement.
Several current and former board members interviewed over the past few months insisted that the board is diligent in its investigation of complaints, including those against Baribeau. They said the details and results of those investigations are confidential.
Nina Gardner, a board member since 2017, was a member of the subcommittee that oversees investigations when it conducted a probe of Baribeau surgeries related to the 28-day suspension.
The hospital suspended Baribeau in June 2013 following two cases in which he allegedly failed to return to CMC when called to care for two patients experiencing emergencies.
“A lot of work went into the investigation because there was concern,’’ she said. “We struggled to get information from the people we needed to talk to. But the information we got did not indicate a problem.”
Gardner, however, said she was surprised by some of the Globe’s findings, including that Baribeau had settled 21 malpractice claims, raising questions about how much information the board has access to. “We did not know all that,” she said.
The Globe examined the work of the N.H. Board of Medicine as part of its investigation into Baribeau, who colleagues say was responsible for a string of patient injuries and deaths that hospital executives largely swept under the rug because he was a top revenue generator.
Each state medical board or its legislature decides for itself what information to publicly reveal on a doctor’s online profile. But as consumers and patient advocates press for more openness in the health care system, a growing number of states are revealing key details about doctors.
The Federation of State Medical Boards, a nonprofit advocacy organization, believes all states should disclose hospital disciplinary actions and malpractice settlements; at last count, 15 states and the District of Columbia reveal the former, 22, the later. Massachusetts discloses both.
Dr. Tom Sherman, a N.H. senator who is running for governor as a Democrat against Sununu, said that his state’s political culture is worlds away from that of Massachusetts, which has a long history of vocal patient advocacy groups and was the first state to publicly post physician profiles. New Hampshire is “very protective of privacy,” including that of physicians, said Sherman, a member of the Legislature’s health and human services committee and a former gastroenterologist.
The New Hampshire board does not see its role as “a clearinghouse for information about doctors,’’ he said. Sherman said he favors a legislative committee to study the issue, saying it’s important to strike the right balance between the privacy of the professional and the public’s right to know.
“It does not appear that there is sufficient transparency in our state law,” he said. But when it comes to posting malpractice settlements, Sherman pointed out that they are not necessarily indicative of poor medical care. “The place where I get a little uncomfortable is where otherwise confidential information is released by the board to the public,” such as sealed court proceedings, he said.
Reluctance to make medical information public doesn’t surprise Representative Mary Beth Walz, a Bow Democrat.
“New Hampshire is such an anti-government state, such a libertarian state,” she said. “The average person would want to know [about settlements], but people in a position of power would be inclined to protect the profession.”
In its analysis of board staffing, the Globe found that, because it is so lightly staffed, the N.H. board relies heavily on volunteer doctors to investigate peers accused of wrongdoing. The Globe found that the board had only a single dedicated employee for every 2,763 licensed physicians compared to 69 employees at the Massachusetts medical board, or 1 for every 530 doctors.
Courtney said that the medical board also has access to employees in the licensing office and that she has advocated for more resources for the medical board. The governor and council recently approved money for another physician investigator, she said.
Still, the board is dependent on a slate of unpaid physicians to help investigate complaints, review thousands of pages of patient medical records, and make recommendations on whether a surgeon committed an error or behaved inappropriately. Some observers feel it is unwise to rely so heavily on volunteer physicians to investigate the actions of peers in their profession.
“You are not going to get transparency unless you have enough staffing,” said Representative William Marsh, a retired ophthalmologist who serves on a legislative committee that oversees bills pertaining to the state’s licensing boards. “You need staff to verify this information before it goes up.”
Nerbonne, who founded her patient advocacy group after her mother died from an alleged anticoagulant overdose at CMC in 2004, said there may be a silver lining to the revelations about CMC and Baribeau. The fallout should focus the attention of regulators on problems that threaten patient safety everywhere, including the lack of transparency about doctors records and oversight of hospital administrators.
“Whatever is done has to have real teeth, when you’re talking about people’s lives.”
Liz Kowalczyk can be reached at firstname.lastname@example.org. Jonathan Saltzman can be reached at email@example.com. Deirdre Fernandes can be reached at firstname.lastname@example.org. Follow her on Twitter @fernandesglobe. Rebecca Ostriker can be reached at email@example.com. Follow her on Twitter @GlobeOstriker.