What Should I Do if I Must Undergo a Medical Board Investigation?

According to a 2019 study conducted by the Federation of State Medical Boards (FSMB), nearly one in five Americans say they have interacted with a physician who they believe was acting unethically, unprofessionally, or providing substandard care. Some of these patients most likely filed a complaint with their state’s medical board, the entity that licenses medical doctors, investigates complaints, and disciplines physicians as appropriate.

The state board may or may not start an investigation into the complaint. Many complaints are not fully investigated because they are frivolous, such as grievances about waiting times or insurance billing errors. A physician may not even know about these complaints.

When a medical board complaint merits an investigation, the medical doctor must be responsive and prepared. It is not a good idea for a physician to represent themselves in an investigation. A physician lawyer can collect evidence, prepare a defense, and guide the physician throughout the investigation process.

Does the State Board Regulate Other Providers?

In the Commonwealth of Pennsylvania, the State Board of Medicine regulates:

• Medical doctors
• Physician assistants
• Radiology technicians
• Respiratory therapists
• Nurse-midwives
• Acupuncturists
• Practitioners of oriental medicine
• Perfusionists
• Behavioral specialists
• Athletic trainers

Is a Medical Board Complaint the Same as a Malpractice Lawsuit?

Medical board complaints and malpractice lawsuits are different. Medical doctors are rightfully concerned about and insured against medical malpractice lawsuits. However, a complaint to the state medical board can have serious consequences, including:

• Fines
• Decline in business
• Loss of income and future earning power
• Revoked hospital privileges
• Damage to reputation
• Loss of insurance
• License restriction
• Suspension
• Revocation

In Pennsylvania, it is quite easy for a patient to file a complaint to the medical board, and it generally does not cost anything.

It is important to note that a malpractice lawsuit might accompany a medical board complaint, so a physician must be prepared and adequately covered by insurance for all circumstances.

What are Common Medical Board Complaints?

A state medical board will determine the merit of each complaint and will further investigate. State boards will generally prioritize or fast-track cases that pose imminent dangers to patients’ health and safety.

The following are common complaints:

• Practicing under the influence of drugs or alcohol.
• Sexual assault or abuse.
• Deviation from standard care or accepted courses of care.
• Inappropriate post-operative care.
• Failure to respond to a summons to help a patient in trauma.
• Prescribing the wrong medicine or incorrectly prescribing medicine.
• Failure to diagnose a medical problem that is found later.
• Willfully or negligently violating patient confidentiality laws.
• Disruptive behavior or interaction with doctors, hospital personnel, patients, family members, or others that interfere with patient care.

In addition, state medical boards will investigate the following circumstances:

• Arrests or convictions.
• Criminal violations that affect fitness to practice or moral.
• Improper billing practices.
• Poor documentation or record-keeping related to patient care and billing.
• Insurance fraud or other financial misconducts.
• Patient abuse, harassment, or neglect.
• Practicing without a license.
• Failure to notify a state medical board of an arrest or conviction in another state, or an adverse disciplinary action taken by a state medical board in another state.

What is the Process for Medical Board Complaints?

The process can be lengthy, complex, and time-consuming, and the respondent must pay strict attention to guidelines and deadlines. For these reasons, a lawyer can be a valuable asset for anyone responding to a state medical board complaint.

Once a complaint is received, the process generally proceeds as follows:

• The complaint is assessed for jurisdiction and prioritized.
• The board identifies individuals and other parties that have information and evidence relevant to the case.
• The person making the complaint receives formal notification from the board that an investigation has started. The physician also receives formal notice of the complaint along with any record requests.
• The physician fulfills all record requests and other requests for information.
• The board conducts a medical review to determine if health and safety were compromised.
• The board rules on the complaint.
• If it is not settled by the board ruling, the case is set for an informal hearing and can be formally settled at this stage. If not settled, the matter proceeds to a formal hearing.
• Cases go to a full hearing for adjudication.
• The board rules on the evidence presented.
• Disciplinary action ordered by the board is entered into public record. It is then part of the physician’s permanent record, and it is available to the public through various sources.

How can Physicians Protect Themselves Against Complaints?

The best way for a physician to protect themselves against complaints is to behave in a professional manner and within the American Medical Association’s (AMA) Code of Conduct and Code of Medical Ethics. Still, even the most ethical and professional physicians may not be immune to complaints.

Physicians should review their medical malpractice insurance to determine if they are covered for legal costs associated with defense for board complaints. If so, what are the dollar limits of coverage? Often, complaint legal costs are riders to the primary policy and may not be in amounts that would adequately cover legal defense.

If a physician finds themselves the target of a complaint, they should contact a lawyer who is experienced in helping defend medical providers against medical board complaints. There are other steps a physician can take to lessen the chance of board complaints:

• Be careful of social media posts and photographs.
• Do not treat or prescribe medication for oneself, staff, or family members.
• Bill insurance companies, Medicare, and Medicaid correctly.
• Keep medical records according to accepted practices.
• Record and track prescriptions according to state regulations. Overprescribing, particularly of opioids, is a common subject of investigation.
• Strictly follow all privacy rules and practices.

How can a Lawyer Help with a Medical Board Complaint?

Being the subject of a medical board complaint is nerve-wracking, emotional, and time-consuming. The board will ask for copious records and information. Proper preparation and response are essential. A lawyer who focuses on physician complaints and malpractice suits can do the following:

Guide the respondent throughout the complex process. There are strict timelines and other guidelines that a physician needs to understand, so having a lawyer is comforting and professionally responsible.

Help respond promptly. A physician may have only 20 to 45 days to respond to a complaint, so they must do so in a timely and transparent manner. The lawyer will be an asset at this critical time. Not responding to a complaint could result in immediate disciplinary action.

Compile documentation. Think of this documentation as evidence. A lawyer can help determine the type of documentation needed, including records, notes, information about other patients, and more. In fact, a state medical board could request to see virtually any patient or financial record in the office.

Coach and prepare the physician for responding. Some physicians may offer up too much or irrelevant information that weakens their defense or raises other questions or complaints. Some may respond in anger. A lawyer can help prepare appropriate responses.

Help with defending related, additional, or more serious charges that arise out of the investigation. If a malpractice suit or additional complaints are filed, a lawyer can be beneficial. Health care law is complex, and an efficient lawyer can provide legal guidance.

Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Defend Physicians Against Medical Board Complaints

Our experienced Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. know how to respond to medical board complaints and guide physicians. Our legal team is ready to answer your questions. Call us at 215-569-1999 or complete our online form for a free consultation today. Located in Philadelphia, we serve clients throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.