Unfortunately, if you’ve been practicing medicine long enough, you might run into an issue where a patient or other individual or entity reports you to the medical board. While this mechanism serves an important purpose to protect patients and society, unfortunately it can also result in a lot of stress, inconvenience, and other consequences for the physician, even if the physician has done nothing wrong. In many of these instances, the complaints may be unmerited, as the patient’s perception of what is right and wrong may not correlate with the doctor’s professional and ethical responsibilities. Nonetheless, the medical board is obligated to investigate these complaints, and physicians should take them seriously, regardless of how much they believe the complaint is warranted. While this article is not meant to be legal advice (we are not lawyers), this article shares the collective advice and experiences of physicians who have had to deal with this issue on our physician communities.
Disclaimer: Please note that medical board procedures vary by state, and this is not individualized legal advice. We are not attorneys and you should consult appropriate licensed legal professionals and do your own independent research and due diligence before making decisions. The information provided here in this article should be viewed as opinions being shared in communication between peers. No action should be taken on the basis of this article alone without consulting an attorney that can take into consideration your particular situation or facts.
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What is a Medical Board Complaint and/or Investigation?
The medical board’s job is to process all information about medical professionals in that state. These could be coming from multiple sources, including complaints filed by patients or other individuals or companies, self-reported data by the physician at the time of renewal, information from licensing boards or the NPDB (National Practitioner Data Bank), hospital system medical executive committees, medical malpractice cases, or other sources like criminal or media sources. If you are arrested for anything or get a serious offense such as a DUI, the medical board will likely know about it automatically. Some medical boards actively monitor arrest records and other legal databases. Even if they don’t, it is usually one of your responsibilities to self-report any criminal offenses.
You may not always be able to identify where a complaint came from. Medical boards vary in what information they require when taking a complaint, what they will reveal to the physician who the complaint is about, and whether they allow anonymous complaints. Generally, If there is a complaint that is specific enough to look into, and the complaint has to do with something that would be in violation of the standards of the medical board, the medical board will most likely dig deeper. They will usually reach out via a written notice or a phone call, but depending on the seriousness of the allegation in the case of an investigation, a specific board investigator could show up in person or individually reach out to you by phone. Depending on the particular board’s procedures, the interactions will vary. You may be able to handle everything in written correspondence, as is the case for many complaints, or there may be a more involved component such as a phone call, teleconference, or in person interview or statement.
Many reports to the medical board are dismissed from the point of complaint as they don’t raise concerns about your ability to professionally or ethically practice medicine, but if the medical board has contacted you, it has already passed through a preliminary screening and you will have to respond.
Bottom line - don’t ignore an outreach from the state medical board. This will not just go away, and even if you don’t respond, the medical board will continue its process of investigation. You want to make sure you advocate for yourself, as the consequences of a medical board inquiry can be significant, including losing your license.
What should I do if I’m contacted by the Medical Board about a Complaint or Investigation?
While your first reaction is almost undoubtedly going to be panic, take a deep breath. If you haven’t done anything wrong, trust that the process will show that. If you have done something wrong, it’s important to be honest and sincere throughout the process, and show steps to make it right.
Regardless, you should respond in a professional and timely manner - but not without first getting formal advice from either attorney or speaking with someone else that’s familiar with the process.
Most state medical boards should tell you when they notify you how long that you have to submit a response. Take these deadlines seriously. While they will sometimes allow you to extend this deadline if you have a good reason, you should not save the request until the last minute. All in all, the quicker you reply, the more the medical board will take it as a sign of good faith that you are taking the complaint seriously.
Every interaction that you have with the medical board requires that you stay cool, calm, and collected. You want to come off as the professional that you are, and address the complaints with the gravity they deserve by showing appropriately concern, but not being angry or vengeful.
Who should I contact once I’ve been told by the Medical Board that there is a Complaint or Investigation against me?
If you are an employed physician within a healthcare system, the first call is likely your in house counsel. While we often see people correctly saying that you should contact your malpractice carrier immediately, many hospital systems do prefer that they are involved prior to contacting the malpractice insurance. It’s also part of the bylaws of many medical system staff agreements that you inform the medical executive committee of these issues, so you will probably have to let them know in a timely manner regardless.
Otherwise, the first call should be to your malpractice insurance, as in addition to malpractice cases, many malpractice insurance policies also include coverage for responding to inquiries instigated by the medical board. There may be certain conditions about this, such as they may only get involved if the complaint is about patient care that could create a malpractice issue.
Additionally, most malpractice policies require that you notify them about any medical board complaints within a specified time period, and almost all of them will ask about any active inquiries or investigations when you go to renew your policy. If you don’t abide by these policies, you may leave yourself uncovered for any incidents related to the complaint, or they may even cancel your policy. The malpractice company will let you know if they provide an attorney. This could be one that they assign to you based on their connections or contracts, or they may allow you to choose your own. Ideally they pay that attorney directly, but in some cases they may say that you have to pay upfront and they’ll reimburse you up to a certain amount.
If your malpractice insurance does not help with this, if you are in private practice, you may have access to a practice attorney that can help you to navigate this or recommend an attorney that can help you with next steps.
If you don't have access to an attorney though these means, it's time to consider seeking out your own attorney that deals with medical board issues. When in doubt, we tend to feel it’s worth seeking out the guidance of an attorney experienced in these matters, as they can help you navigate the process. Even if you think a complaint is not a big deal, we’ve rarely heard someone on the communities say that they regretted getting an attorney involved. They will provide insight on how to best respond, and be able to warn you and guide you if things are taking a turn for the worse (and hopefully prevent things prospectively from taking this turn).
Of course, you have the option of responding yourself if you really feel this is a trivial complaint without potential for serious professional consequences. If you don’t seek out an attorney, at least make sure you speak with some colleagues who have been through the process and have somebody proofread your response to gage how you come off. If you respond in anger, it will come across in your response. You want somebody to objectively tell you that you come off as professional and balanced. Also make sure that you use proper grammar and punctuation, as again, impressions matter. A sloppily written letter will indicate that you aren’t treating this as seriously as you should.
What should my response to a medical board complaint include?
If you are notified in writing a complaint, you will be asked for a written response. In general, the Board prefers hearing from you directly, but that doesn’t mean you should write it yourself and send it off. You are almost always better off crafting this response with the help of an attorney. Depending on what your counsel prefers, they can prepare a draft for you to look over, or they might ask you to prepare a draft which they will then review.
Your lawyer will advise you how to best structure your response, but in general, after a brief introduction, you are going to specifically address every concern or issue that has been raised in the complaint by recounting your side of the story and your rationale for why you did what you did.
A logistical concern - while your medical board has access to the information that’s been provided to them in the inquiry, remember that you are bound by HIPAA, and all of your correspondence should appropriately respect HIPAA and be in compliance with its guidelines. This means all communications should be secure, regardless of the mode via mail, fax, or email. Make sure you don’t send an unencrypted email with identifying information about a patient or their Protected Health Information.
What is the typical process for a medical board complaint for physicians?
In most cases where there is no merit to the complaint, this is a relatively simple process.
The medical board will notify you (usually in writing).
You will notify your malpractice insurance.
The malpractice insurance will provide you with or tell you to get an attorney, or you will get an attorney on your own if your malpractice insurance declines to be involved.
You will respond to the medical board with the help of your attorney.
The medical board will respond back and let you know that the issue is resolved.
If the issue is not resolved, things will escalate to the next steps. The board may ask for more information, possibly launch a larger investigation, or proceed with disciplinary actions and/or hearings.
This is often the point where many medical boards will contact a physician that is on their peer review committee, or multiple physicians. This person(s) will usually be given access to relevant records and correspondence and be asked to weigh in on whether the physician’s conduct or performance reflects a deviation from the standard of care, if there was harm as a result of the physician’s misconduct or negligence, and other questions specific to the complaint. After the reviewing physician(s) have submitted their reports, their findings will then typically be discussed by the medical board’s committee, which will then vote on next steps.
At this juncture, a few things may happen:
The complaint may be dismissed. If a complaint is dismissed and viewed as a non-issue, it will typically not go on your public record or result in any national reporting such as to the NPDB.
Issuing a “letter of caution” or similar. In this situation, the medical board feels there should be some consequence, or duty to inform or warn the public about what happened. This will typically be a public record that stays on your record.
A formal complaint will be filed against you, which is an actual legal proceeding that may result in disciplinary action, revocation of a license, a fine, required education, participation in a particular program, or other form of remediation. The state medical board may propose a recommended course of action based on the information it has, and you will typically have an option to accept or contest the recommended course of action(s).
If you elect to contest what the medical board concludes, you will most likely have a hearing of some sort. Many states start with a hearing in front of your peers, where you’ll have a chance to present your side of the argument and they will make a decision or recommendation about what should be done next. If the complaint is deemed to have merit, the physician can either abide by the recommended course of action or go forward to a more formal medical board hearing.
Things that get to the point of a formal hearing make it very unlikely that things will go in the physician’s favor for complete dismissal. More likely than not, there will be one or several of the consequences mentioned above, which in many cases will result in long standing consequences for the physician and future licensing in both that state and potentially others. If you are the physician being accused in this situation, it’s generally best to resolve matters before they get to this point. You should have had a lawyer involved well prior to this point, and you should lean on them heavily to help you navigate this situation.
What happens if the medical board shows up at your doorstep for an investigation?
Unlike the complaint process, if the medical board determines from its preliminary review of a complaint that a more serious approach is required from the get-go, someone will typically reach out to you personally via a phone call or in person. This may involve someone showing up to your place of work without any notice, or with very little notice.
Again, be professional and polite. Ask them to provide identification of who they are (scammers do exist). If there’s any question that they’re a real person, you can also call the medical board and confirm that they are indeed a representative. At this point, there is no obligation for them to reveal information that they do not want to, nor for you to provide any information that you do not want to. It is okay to state that you would rather have your attorney present before answering any questions, and if you have any doubt about how you should proceed or how you should answer questions, it is a good idea to pick up the phone and call your malpractice company and/or attorney.
Deal with this personally - do not let them talk to your staff, as your staff may not know how to appropriately handle this situation. In general, do not make any statements yourself or allow anyone else in your office to do so without first speaking to an attorney. Again, be polite, but tell them you’d prefer if there was an attorney present as you’re unfamiliar with this process and uncomfortable with the situation. They should hopefully understand this if said nicely.
Legally Required Immediate Compliance
If this is a very serious situation, the investigator may show up with a subpoena, order, search warrant, or similar already in hand.
You should contact your legal counsel immediately in this situation. While it is important to comply with these legal requirements, you will want your attorney to help navigate what is lawful for them to take and to come up with a mutually acceptable approach to providing the requested information.
If possible, if providing a physical document, provide a copy rather than the original is advised. If they take the original, ask to make a copy for your records as well.
Search warrants are rare in this situation but if utilized are a sign of a criminal investigation. You have to contact your lawyer the second they show this to you. While you cannot prevent them from taking things, keep a record of what they take, and make copies if you can.
Interviews or statements:
Make sure that you talk to your attorney before providing any formal statements.
Remember again to notify your malpractice insurance ASAP as discussed above. After these preliminary steps, your lawyer will guide you throughout the process. Investigations are very serious and you should not try to handle this by yourself.
What should you do about the patient who filed the complaint with the medical board?
You’re only human. It’s natural to have some resentment towards the patient for putting you through this process. That said, you are still their physician and should maintain professional interactions. Remember that they were also frustrated and trying to advocate for themselves. Nonetheless, you may determine that this experience is no longer conducive to a productive doctor-patient relationship. If this is the case and you feel that you need to dismiss them from your practice, make sure that you dismiss them according to the proper legal procedures for dismissing a patient, as you do not want to be accused of patient abandonment.
Conclusion
While receiving a complaint from the medical board is anxiety provoking and something that should be taken seriously, it’s important to keep it in perspective. The goal of the proceedings is simply to ensure that the public is safe, and nobody is interested in making you lose your license if its unwarranted. You will have several opportunities to present your case, and in most cases, you can count on your peers to give you the benefit of the doubt. Stay professional in all of your communications, get appropriate legal counsel, and follow the policies and procedures outlined to you by the state and by your attorney. You’ve got this. If you need an attorney to help you navigate this process, we have some resources in our physician attorney database.