The watchdog group, Public Citizen, has alerted California Gov. Jerry Brown that the state’s medical board has failed to take action against more than 700 health care providers that were disciplined for wrongdoing between September 1990 and the end of 2009.

Violations include wrongly diagnosing surgical patients, delivering substandard care, leaving surgical equipment in a patient and alcohol or substance abuse. Peer reviewers called more than 100 of these clinicians “an immediate threat to health and safety of patients,” the organization wrote in a letter to the governor.

In 2010, California ranked 41st of all states in terms of disciplining physicians, data from the National Practitioner Data Bank indicated, which includes state disciplinary actions, malpractice payments and clinical privilege actions taken against health care providers. But recently the state’s ranking has been dropping.

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Nationally, there were 220 physicians designated by peer reviewers as an “immediate threat” to patients, and California doctors made up almost half of that number. Public Citizen has reached out to the California medical board, but the board reported that understaffing and lack of resources might affect its ability to follow up on these physicians.

Public Citizen urged Gov. Brown to order an independent investigation and address the performance of the state medical board in it’s letter.