Seven of 15 members on California’s state medical board are not physicians. That’s 47 percent.

On Rhode Island’s panel, 46 percent are nonphysicians, or public members.

Delaware’s not far behind at 44 percent.

Hawaii: 18 percent.

That Hawaii is among the states with the lowest proportion of public members on their medical boards is not surprising, given what the Honolulu Star-Advertiser found in examining the state’s regulatory system for physicians.

The system frequently tilts in favor of physicians.

By law, two of the 11 members on the Hawaii Medical Board must be nonphysicians, bringing nonmedical, independent voices to a panel dominated by physicians. The idea is to guard against any tendency of physicians to protect their own.

The board’s main responsibilities are to decide whether to grant licenses for physician applicants and to decide whether to discipline a licensee charged with misconduct.

Of Hawaii’s two public members, one has close ties to physicians.

Maria Chun, who has a doctoral degree in psychology and once served as deputy to former state Auditor Marion Higa, is an administrator with the department of surgery at the University of Hawaii John A. Burns School of Medicine. The previous medical board chairman comes from the same department.

Sam Puletasi, a former special agent with Immigration and Customs Enforcement, is the other public member.

Chun, who has served on the board less than two years, said she takes the panel’s job of protecting the public seriously and has sometimes voted against the majority if she believed that was the correct decision. Despite her close ties to the medical profession, "I feel I can be independent," she said.

Chun, who stressed that she was not speaking for the board, said she believes the public is adequately represented on the panel but that adding more public members would help. "It would give more balance," she said.

Puletasi, who describes himself as an advocate for patient rights, likewise said he believes the public is sufficiently represented, but favors more public members to provide a better balance of voices.

Despite the heavy physician membership, Dr. Niraj Desai, a Kauai nephrologist and chairman of the medical board, said the group is able to make decisions based on protecting the public.

"I haven’t really had a sense of doctors protecting their own," said Desai, who stressed he was voicing his opinion, not speaking for the board. "I just haven’t seen that as a driver."

If the state Legislature decides to introduce a bill increasing public representation on the board, "I think that would be a worthy effort," Desai said.

Dr. Sidney Wolfe of the national advocacy group Public Citizen said public members need to have three characteristics: be properly trained, have no close ties to physicians and be able to speak up when warranted. Without all three, he added, "they are really not in a position to wage battle if that’s necessary."

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