I’ve only known 2 colleagues who were investigated by their respective medical boards. One was for domestic violence and the other for drunk driving. Each state outlines their own Medical Board investigation process. I thought I would share the process and that should help me understand my own recent dealings with the medical board.
Each state follows the Medical Practice Act (MPA) which they will have modified to uniquely fit their state. Potential violations of the state MPA are investigated by the medical board and criminal charges filed by the district attorney if necessary.
1. Initiating The Complaint
Anyone can initiate the complaint. Once the complaint is received, it’s first decided whether the matter is worth investigating or whether no further action is needed.
In case of bogus complaints, these matters are closed and a letter is sent to the person/group who filed the complaint and that’s the end of it.
If the matter risks the health, safety and wellbeing of the state’s citizens then an individual investigator is assigned to the case in order to gather more information.
2. Gathering Information By The Investigator
In order for an investigator to be involved it’s assumed that there was a violation of state law. The investigator will collect statements from the complainant and the licensee, as well as any other involved individuals.
This is the stage when you as a healthcare professional will receive a letter or phone call, along with a case ID number. The investigator will ask you certain questions which you need to answer.
You’ll get an “investigative summary” but likely won’t know the exact details such as the identity of the complainant or reason for the complaint.
In rare circumstances, the healthcare professional may be asked to temporarily withdraw from practice until the investigation is settled or at least until further information is gathered.
3. Review By The Investigative Committee
So far an individual investigator was tasked with gathering the information, talking to the involved parties, and putting together a dossier to present to the Investigative Committee. The IC is a subsection of the medical board in charge of hearing such cases.
At this stage the Investigative Committee may require further information or simply present the case to the Board. Often, the IC will make the recommendation to the Board and that’s what the Board will enact.
4. Violating The Medical Practice Act
This is the stage when the Medical Board finally gets involved. They are the ones who can issue a Board Order. In rare circumstances, if you are posing a danger to the public, your license will be temporarily but immediately suspended.
Your state Medical Board will only take action if the Medical Practice Act has been violated. In Oregon, they will issue a “Complaint and Notice of Proposed Disciplinary Action”.
This is when you’ll finally get all the facts and also when you’ll be given instructions on how to arrange a hearing in case disciplinary action is required.
More often (90%), the Board will simply tell you what you did wrong and tell you what you can do in order to prevent it in the future and that’s the end of the medical board investigation process.
5. The Medical Board Hearing
If you did in fact violate the Medical Practice Act then the Board will take an action such as a revocation, suspension, reprimand, probation, remedial education, monitoring, practice limitation, chaperoning, or fine.
You’ll be given the option of a hearing (aka interview) and that’s when you can negotiate with the Board to reach a mutually accepted settlement. This is called the “Settlement Discussions” and it’s the end for most of such cases.
If you cannot reach a settlement agreement with the Board then you’ll take your case to an actual hearing with an Administrative Law Judge.
6. Stipulated Order by the Medical Board
Because you went through the investigation process, there will always be a Board Issued Order. Obviously, if it’s something really minor then you don’t need to take any further action.
Unfortunately, moving forward you’ll have to answer “Yes” when asked whether you were under investigation by a medical board. And then you get to fill that extra-fun page where it says “Please explain here if you answered “yes” to any of the above”.
Do You Need An Attorney?
The above concludes the 6 main steps involved in the medical board investigation process. Next, I’ll address a few other issues which I’ve discovered while researching my own case.
The consensus is that you should have an attorney for any medical board investigation, even if it seems minor. And you should do so as early as possible. Ideally, you want to let your attorney respond to the initial investigation letter instead of yourself.
Your malpractice insurance may offer you an attorney for the medical board investigation process. You still want to make sure that the attorney who is representing you is competent. And he/she has experience dealing with medical boards. Not all policies offer this rider but it’s worth finding out.
Time frame of resolution
The medical board investigation supposedly takes a little under 1 year to resolve. From what I have read, quite a few of these cases drag out past a year. And after doing more research, the process can take much longer.
The investigator will want to resolve cases as soon as possible. This means that they may not dig into the facts adequately. And that could hurt you if you don’t have adequate legal representation.
Some healthcare professionals will have only a few interactions with the investigator. Others will have an exhaustive number of back and forths.
Don’t drop your guard.
Even worse, don’t forget to respond to letters in a timely fashion. Should the investigator want to call you up randomly or show up at your work, don’t assume that you must reply right then and there.
Create solid replies with the perfect narrative. If you don’t know how to do this contact those who know, like myself or a lawyer, naturally.
The Medical Board Is Not Your Friend
In my case it was easy to tell that the medical board investigator wasn’t going to be my friend. Short of yelling at me on the phone, he took on the role of a condescending cop. However, another investigator might be quite friendly and even nonchalant. This shouldn’t push you to drop your guard.
It’s important to realize that even a simple investigation could turn into something much larger. Especially should the investigator uncover other issues even if they are completely irrelevant to the initial investigation.
The medical board investigation process is intricate. The medical board must demonstrate to the public that it takes its job seriously. They are there to represent the consumer and not the licensee.
Furthermore, the medical board has a lot of power. They are the ones who issue your medical license. But they can also request for criminal charges to be filed against you through the district attorney.
The investigators lie and deceit physicians in order to get what they want. I’ve experienced it myself and only learned about it after my lawyers confirmed this.
Don’t Give Out Protected Information
The Oregon Medical Board specifically states that as a healthcare professional I cannot refuse to give out confidential patient information.
However, all my research shows that you should never break HIPAA nor give out sensitive information even to the investigator unless you go through all the proper steps.
You can always buy yourself some time by telling the investigator that you will get back to them ASAP as soon as you speak to your lawyer. Who is your lawyer? Ideally one who knows how to deal with professional licensing boards and has had many physician clients.
Most Common Medical License Violations
Medical boards will investigate physicians for all sorts of reasons. Here are the most common ones:
Inappropriate care. This is among the most common reasons for the medical board to investigate a licensee. A patient or family member may complain to the board that the healthcare professional provided negligent or inappropriate care.
Substance abuse. The healthcare professional has displayed inappropriate behavior. Or has had DUI’s which have led the board to investigate the licensee.
Unprofessional patient relationship. This could be a healthcare professional who is harassing a patient or a sexual relationship between the licensee and the patient.
Fraud. Practicing without a license. Billing under a nurse inappropriately, hiring unlicensed professionals. False billing. And a whole lot of other reasons constitute fraud in medicine.
Altering of patient records. Apparently the most common time for this to occur is when a disgruntled patient tries to transfer their care to another provider.
Criminal record. If a healthcare professional is found guilty of a crime or arrested for a felony then they are responsible to report that to the board. Even if they don’t report it, the prosecutor may decide to report that to the board which sparks an investigation.