OVERVIEW

Definitions & General Principles

Medical Practice Act: Each state has enacted regulations that govern the practice of medicine, codified in legislation known as the medical practice act. Physicians who violate these regulations may be subject to disciplinary actions.
State Medical Boards: State medical boards are tasked with licensing medical doctors, investigating complaints from others about physicians, disciplining physicians who violate the state’s medical malpractice act, and referring physicians for evaluation and rehabilitation when necessary.
Medical Board Complaints: typically consist of adverse reports made about a physician by a patient, colleague, employer (e.g. hospital system), or other health providing entity.) There are jurisdictional variations as to whether complaints are kept anonymous from the physician or not.

Jurisdictional Considerations

Each state’s medical practice act defines unprofessional conduct. Although laws vary by jurisdiction some examples of unprofessional conduct include:

not recognizing or acting on common symptoms,
prescribing drugs in excessive amounts without legitimate reason,
failing to maintain proper physician/patient boundaries,
disruptive behavior in the medical care setting,
failing to meet continuing medical education requirements,
performing duties beyond the scope of practice,
dishonesty or, felony conviction,
inappropriately delegating the practice of medicine to an unlicensed individual or failure to supervise a mid-level provider, etc.
physician actions outside of medical practice may also be grounds for disciplinary action, including crimes of “moral turpitude” (e.g., tax evasion).

Psychiatrists are over-represented among complaints to medical boards and psychiatrists are more likely to be the recipients of disciplinary actions from state medical boards. Psychiatrists were significantly more likely than non-psychiatric physicians to be disciplined for sexual relationships with patients and about as likely to be charged with negligence or incompetence.

Poor customer service (except for abandonment) or minor disagreements with patients generally do not fall under the purview of state medical boards. Medical boards exist for the purpose of protecting the public, not punishing physicians. While boards sometimes decide to suspend or revoke a physician’s license, on many occasions the board complaint can be resolved with additional education or training in appropriate areas. In other instances, physicians may be placed on probation or have restrictions placed on their license.

Finally, if the board believes a physician is a danger to the public due to a lack of fitness for duty, the board can mandate a fitness for duty evaluation. If there are concerns about impairment due to alcohol or drugs, the board may refer the physician to a recovering professionals program and monitor compliance with that program (See Regulation of Doctors and Impaired Physicians Section).

Medical board disciplinary actions (not complaints) must be reported to the National Practitioner Data Bank (NPDB) within 30 days. Therefore, whenever a physician seeks credentialing for a new position or medical staff privileges, information about the disciplinary action will be available to the potential employer or hospital. This prevents physicians from moving and obtaining a medical license out of state simply to avoid disciplinary actions from one state’s medical board.

Finally, board disciplinary actions are generally available for public review. While the public cannot query the National Practitioner Data Bank, many states post information about physician disciplinary actions on their medical board website. Additionally, patients may search Federation of State Medical Boards’ DocInfo for the disciplinary history of specific doctors in every state.

CLINICAL SCENARIOS

Scenario #1: A male psychiatrist receives notice that a female patient has filed a complaint against him with the state medical board. She alleges that the male psychiatrist has made flirtatious gestures and touched her inappropriately. She also alleges that while on a trip out of town the psychiatrist broke into her home and placed a device in her TV that sends her special messages about his love for her. What should the psychiatrist do?

A medical board complaint should be taken seriously by a physician and the physician should respond to the medical board in a timely manner but only after reaching out to their attorney or malpractice carrier.
A recipient of a medical board complaint should strongly consider obtaining legal counsel for advice and guidance in navigating the investigative process, regardless of the nature of the complaint

Scenario #2: An internal medicine physician with an excellent reputation in the community and a successful practice has been chronically late for work for the past few months. He is not available after hours when he is supposed to be on call, he has made unusual numerous charting and prescription errors, and has been the subject of complaints from patients about irritability and impatience. His partners suspect he may be impaired from alcohol or drugs. Do they have an obligation?

Physicians have a duty to report impaired colleagues or colleagues who may present a danger to the public through their practice to the medical board.
There is a duty and obligation to immediately report any good faith suspicion or concern about an impaired physician. Many states have a legal requirement to report a physician that may be practicing while impaired. While privately confronting the physician seems tempting, it commonly results in denial. Another option would be telling the physician you plan on making a medical board report and suggesting they self-report instead. However, the complaint would have to be made if the physician did not self-report.

ADDITIONAL TIPS

Documentation Tips

In the event that a physician is notified that a patient has filed a medical board complaint, it is prudent to never alter the patient’s medical record or attempt to recreate missing records after notification of the complaint. The physician should also not contact the patient directly. All correspondence with the medical board should be kept together in a secure file so it can be provided to legal counsel. Responses to the medical board should be completed in a timely manner and sent via certified mail.

Special Considerations

Medical board complaints may be significantly stressful for the physician involved. While it is prudent not to discuss the allegations contained in the complaint with others, seeking advice from other physicians who have successfully navigated the medical board complaint process may be helpful.

REFERENCES

Carlson D, Thompson JN. The role of state medical boards. Virtual Mentor. 2005 Apr 1;7(4):virtualmentor.2005.7.4.pfor1-0504. https://journalofethics.ama-assn.org/article/role-state-medical-boards/2005-04
Reich J, Schatzberg A. An empirical data comparison of regulatory agency and malpractice legal problems for psychiatrists. Ann Clin Psychiatry. 2014 May;26(2):91-6.
Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses. JAMA. 1998 Jun 17;279(23):1883-8.
National Practitioner Data Bank (NPDB): What you must report. Available from: https://www.npdb.hrsa.gov/hcorg/whatYouMustReportToTheDataBank.jsp
Federation of State Medical Boards DocInfo. Available from: https://www.docinfo.org/?_ga=2.100577240.756445922.1596919330-1344693480.1596919330#!/search/query

Additional Reading

Landess J. State Medical Boards, Licensure, and Discipline in the United States. Focus (Am Psychiatr Publ). 2019 Oct;17(4):337-342.

Overview | Clinical Scenarios | Additional Tips | References

By Richard Frierson, MD