Annually, the Medical Board of California alone receives over 8,000 complaints concerning physicians.
For medical boards throughout the United States, a complaint is a starting point for an investigation that could lead to disciplinary actions, potentially as severe as license revocation. If you receive a request for a medical board interview, certified medical records, or a summary of patient care from your practice, it’s a grave matter that could threaten your professional practice.
We have put together a list of guidelines, insights, and recommendations for the medical board interview and entire complaint processing, equipping you to handle any issue that may arise.
Why Did the Medical Board Contact You?
The Minnesota Board of Medical Practice includes an interview as part of its licensing process. This step allows the board to engage directly with candidates, assessing their understanding of medical principles and their professional experiences. Minnesota’s approach, requiring a formal interview, is somewhat unique compared to other states that may not include this step, opting instead to focus on credential verification, background checks, and the review of detailed applications.
More often, when a medical board reaches out to a physician, it’s because there’s a concern that needs addressing.
The reason for contact from a board usually stems from a complaint—be it from a patient, a family member, a pharmacy, a colleague, or through reports such as those from insurers required to notify the California Medical Board of settlements over $30,000. Furthermore, all settlements, regardless of size, are reported to the National Practitioner Data Bank, which communicates these to the relevant medical board.
In 2022 alone, the FSMB’s Physician Data Center was queried over 150,000 times for practitioner profiles. This sharing of disciplinary data is crucial, as it helps prevent physicians who have been disciplined from moving undetected between states. Last year, this system led to 6,584 disciplinary actions against 3,062 physicians, marking some of their first encounters with such proceedings.
Overview of the Complaint Process
Annually, with thousands of complaints to handle, the board diligently navigates the complexities of these issues, relying heavily on the pivotal roles of its members. Each member’s responsibility is critical in shaping the outcomes of these procedures.
The composition and size of the board vary by state, typically comprising licensed medical professionals and public members. This diverse makeup ensures a balanced perspective between medical expertise and consumer advocacy. The board meets multiple times a year to deliberate on cases presented by the Investigative Committee, ultimately making final decisions. Interestingly, the details of their deliberations are kept confidential, not requiring public disclosure.
The Investigative Committee, which often includes board staff and may involve the Medical Director, meets more frequently than the full board. This committee is tasked with reviewing cases and crafting preliminary judgments or recommendations. These are then escalated to the full Medical Board for final decisions.
The Executive Director, serving as the chief administrator and Public Information Officer, bridges the gap between the public and the medical community. This role is vital for maintaining transparency and facilitating effective communication. The Executive Director participates in all board meetings and manages the board’s administrative functions.
The Medical Director’s role, although not present in all state boards, is crucial, especially in complex cases that require detailed medical scrutiny. This individual may coordinate with medical specialists to thoroughly examine the specifics of a case.
Not every board has an in-house Department of Justice Attorney. Where one is available, this attorney advises on various legal aspects of board operations, helping to maneuver through legal intricacies. In jurisdictions without a dedicated attorney, the board might lean on the state’s attorney general’s office or external legal advisors for support.
With this structured understanding of how the board operates, we are better positioned to delve into the usual triggers for investigations and how these roles influence the process.
Causes of Medical Board Complaints
According to the Federation of State Medical Boards (FSMB), medical boards meticulously organize and prioritize complaints, especially those that might involve immediate risk to patients. Such urgent cases often involve serious allegations, such as sexual misconduct with patients, deviations from standard medical practices, or substance abuse while practicing medicine.
Common complaints related to standard-of-care issues include:
- Misdiagnoses, which are frequently cited in medical malpractice claims;
- Inappropriate prescribing and management of opioids and other controlled substances;
- Mistakes in prescribing medications;
- Breaches in physician-patient confidentiality;
- Unprofessional conduct that disrupts patient care, including problematic interactions with other healthcare professionals;
- Neglect in providing necessary postoperative care;
- Ignoring urgent calls from hospitals needing immediate physician intervention.
To proactively monitor potential issues, some medical boards conduct daily checks of arrest records within their state to identify any matches with licensed physicians. If a match is discovered, an investigation is initiated. However, the typical protocol in most states is for physicians to self-report any legal troubles, with significant repercussions possible if the board discovers these issues independently. In such criminal or ethical cases, it’s wise for physicians to seek legal representation and engage transparently with the board. Typically, a specialized committee within the board handles these types of issues, and their responses are guided by the board’s established regulations.
It’s also crucial to recognize that anyone can file a complaint against a physician to a state medical board—this includes patients, their family members, nurses, pharmacists, colleagues, and even hospital committees. While some jurisdictions refuse anonymous complaints, an increasing number are beginning to accept or even encourage them to ensure broader oversight and protection.
Medical Board Complaint Processing
Navigating a medical board investigation can be an intricate and lengthy process, often necessitating legal representation. The time and extent of a case depend on the precise processes needed to settle it. The procedure commences when a complaint is submitted. Next steps include:
- Preliminary Review. The board examines whether the complaint is justified.
- Investigation Initiated. If deemed valid, a full investigation starts.
- Field Investigation. Investigators gather facts on the ground.
- Review by the Investigative Committee. The collected information is analyzed. This committee may also interview the physician.
- Deliberation by Medical Board Members. They review the facts and decide whether to dismiss the case or escalate it by issuing a notice.
- Notice to Physician. The physician receives a formal notification and must respond.
- Response by Physician. The physician can either agree to settle or contest the findings by presenting supporting facts.
- Final Decision. The Medical Board makes a conclusive decision.
- Appeals Process. If dissatisfied, the physician can appeal the decision.
During any stage, if the medical director determines that no violation occurred, the complaint may be dismissed outright. The Investigative Committee would then discuss and recommend dismissal to the board, all without the physician’s involvement.
Upon receiving a complaint, physicians are typically notified via phone or letter, providing them with an opportunity to respond directly through written correspondence, a call, or a teleconference. Some states may conclude the investigation based solely on the physician’s initial response.
The majority of complaints are dismissed without a formal investigation. However, if the case proceeds, it undergoes peer review, where relevant medical records and the physician’s account are examined. Reviewers primarily assess whether there was a deviation from standard care, if that deviation harmed the patient, and if the physician’s documentation met state medical standards.
Following the review, the board’s complaints committee considers the findings and decides the course of action: a formal complaint that leads to legal proceedings, a letter of caution (either public or confidential), or dismissal of the complaint. While dismissals go unrecorded, letters of caution are noted, and a formal complaint could lead to disciplinary measures like mandatory education, fines, or more severe actions such as suspension or revocation of the medical license.
In the event of serious charges, a panel hearing might be convened, consisting mainly of physician peers, to adjudicate the case. Depending on the outcome, the physician might have to follow the board’s directives or challenge the decision in a formal board hearing.
For medical malpractice cases, any settlements or judgments typically need to be reported to the state medical board once civil proceedings conclude. Disclosure standards vary by state, with some demanding immediate notice when mentioned in a lawsuit and others requiring notification only after settlement or verdict.
Physicians must be familiar with their state’s medical board procedures in order to successfully navigate any investigations or disciplinary measures.
The Medical Board Interview Process
Board investigators may contact you to arrange a live medical board interview, which can take place over the phone, via written request, or in person. If you are officially notified of a complaint, you will be invited to respond in writing. While the board loves to hear from you personally, it is best not to do this on your own. Engaging an attorney who can help draft or review your response is highly recommended.
Your attorney will guide you in structuring your response effectively. Following a brief introduction, you should answer each issue mentioned in the complaint, clarifying your actions and reasons.
It’s vital to note that, while the board has permission to use the information supplied in the inquiry, you must follow HIPAA guidelines. Ensure that all of your interactions are secure, regardless of whether they are transmitted via mail, fax, or e-mail, and avoid transmitting unencrypted emails containing critical patient information.
If requested, attending a medical board interview with a board investigator is mandatory. Missing this medical board interview without a valid reason could lead to charges of unprofessional conduct. You have the legal right to have your lawyer present throughout these medical board interviews, and you should inform the investigator that you intend to take part in his presence.
Medical board interviews are typically attended by the investigator who handles your case, an expert consultant, and, on occasion, a Deputy Attorney General.
At the start of the medical board interview, you will be asked to verify your identification, and the entire medical board interview will be recorded. You can bring your personal recording equipment or obtain an electronic copy of the conversation on tape.
Before the medical board interview, prepare thoroughly by reviewing patient records and the care you provided. If you do not have access to those records, you may study them at the Board’s office.
During the course of the medical board interview, you may be asked about several subjects, including:
- The specifics of the complaint,
- Your use of alcohol or drugs,
- Your mental health history,
- Any criminal history,
- Your past and current hospital credentialing and employment,
- Any psychiatric or substance abuse-related hospitalizations,
- Your disciplinary history.
Following the medical board interview, the recordings, along with additional material, are examined by an experienced consultant in your field. This consultant will provide a recommendation on whether the matter should be submitted to the Office of the Attorney General or closed. Typically, you will get a letter informing you of the decision to close the inquiry or proceed with the referral.
What Comes After a Medical Board Interview?
If the Medical Board concludes that a breach of the Medical Practice Act took place, the board members will consult internally to determine the proper disciplinary action.
This phase is formally known as the “Complaint & Notice” process. During this stage, the Medical Board issues its disciplinary actions in writing to the affected physician. At this juncture, the physician has two primary options:
Accepting Disciplinary Action
The physician may choose to fully accept the board’s decision. This acceptance is formalized through what is known as a ‘Stipulated Order.’ You might have read about such orders in medical board newsletters. Possible outcomes under a Stipulated Order include:
- License revocation
- License suspension
- License restriction
- Monetary fines
- Referral to a Diversion Program
- Public reprimand
- Requirement for further training
- Surrender of license
- Forced retirement of license
Appealing the Final Decision
Engaging in a disputed hearing might be one of the most intimidating experiences a licensee can have. It entails giving sworn evidence before a subcommittee as a defense to the charges. However, with proper preparation and a smart approach, this hearing may be used to successfully conclude the issue. If the healthcare provider and their attorney disagree with the board’s recommended disciplinary sanctions, they will request a contested hearing.
During the proceedings, both the physician’s and the board’s lawyers, who are usually Department of Justice attorneys, submit their arguments to an Impartial Hearing Officer. The specifics of the dispute are reviewed from both sides. Following the hearing, all considerations and conclusions are collated and given to the members of the board, who subsequently issue the final order. If the physician is dissatisfied with the final verdict, they can appeal to the state’s Court of Appeals. If the appellate court’s ruling is still not in the physician’s favor, the next step is to appeal to the state Supreme Court.
Understanding these processes and being well-prepared for each stage of the procedure can have a major impact on the result of a physician’s disciplinary action.
Best Practices for Responding to Licensing Board Complaints
To effectively respond to licensing board concerns and handle medical board interview, rigorous preparation and planning are required. If you happen to find yourself in such a circumstance, consider these best practices:
- Preparation is Crucial
When preparing to go before the board, whether it is the entire board or simply a subcommittee, diligence is your greatest defense. Ensure that you properly evaluate all investigation-related documents, including any previous board submissions. Conducting mock sessions with your legal counsel can help you anticipate potential inquiries and rehearse your replies.
- Develop a Clear Narrative
During the hearing, the prosecution Deputy Attorney General (DAG) and members of the board will examine you on many elements of patient care and professional behavior. It is critical to offer a well-organized narrative that immediately addresses the issues revealed throughout the inquiry. Consistency in your account is essential; any discrepancy or avoidance in your replies may be interpreted as dishonesty, perhaps leading to disciplinary action.
- Respond Promptly and Thoughtfully
When responding to an inquiry, subpoena, or patient complaint, it is impossible to be too prompt. Gather all the necessary papers and information to create a thorough and accurate answer. Be mindful of over-disclosure; offering too much information may unintentionally open up fresh points of investigation for the board.
- Maintain Professionalism in Your Responses
Always have a professional attitude in your comments. Avoid any resentment toward the complainant, since the board values empathy and professionalism, even if the concerns appear unfounded.
- Work Closely with Experienced Legal Counsel
Hiring an attorney with expertise in board investigations is quite beneficial. They can guide you through the procedure and safeguard your interests. Competent lawyers understand the complexities of the law and can communicate effectively with DAGs as well as other legal organizations engaged in your case. They’ll make sure you fulfill all deadlines and suggest proactive methods to address and perhaps resolve the challenges at hand.
By following these recommended practices, you may better handle the complexity of licensing board complaints and protect your professional reputation.
Bottom Line
A medical board investigation is a serious matter that demands cautious management and a thorough grasp of the procedures involved. This book attempts to provide you with a thorough understanding of why and how a medical board may contact you, the stages involved in processing complaints, and best practices when preparing for and responding to medical board interviews. By becoming acquainted with the board’s structure and activities, you may better prepare for any interviews or disciplinary proceedings that may occur.
Whether you’re dealing with a simple license review or an intricate disciplinary matter, understanding how to handle these processes may make a big difference in the outcome. With proper preparation, a thorough grasp of the expected processes, and the assistance of expert legal counsel, you may face these problems with confidence and protect your professional standing.
Remember, the key to managing medical board inquiries is comprehensive preparation, an unambiguous explanation of facts, prompt and measured replies, and retaining professionalism throughout the process. By following the tactics provided in this guide, you will be well-prepared to deal with the difficulties of medical board interviews and defend your career in the healthcare business.
