Each professional Board has its own rules, procedures, and customs. The following is an example of how one Healthcare Board manages a complaint. Your Board complaint process may differ, but there are general similarities.
The initial event is triggered when a complaint is filed against the professional from one of a number of sources (patients, patients’ families, other healthcare providers, other agencies, medical malpractice insurers, or a licensing Board). The complaint is assigned to a Lead Investigator, who contacts the complainant (the person who filed the complaint), explains the process, and serves as the contact person for the complainant and the professional. The Lead Investigator also notifies the professional of the complaint and requests a response. A healthcare consultant, who practices in the same field, is often asked to perform a review of the complaint.
Stage One is the best time to hire an attorney. Ideally, the attorney will be able to have the complaint dismissed before it progresses beyond this stage. An attorney can assist the healthcare professional in putting together a favorable and persuasive response that proves that the complaint lacks merit. If the allegations cannot be substantiated or if there is a satisfactory explanation for the conduct, the case is dismissed. If the healthcare consultant finds that there was a deviation from the standard of care, the consultant’s report and related documents are sent to the professional. The professional then has an opportunity to respond to the specific allegations and findings of the healthcare consultant. Again, an attorney can be instrumental in the preparation of an influential and convincing response, especially if the attorney has experience in both law and healthcare.
The Investigational Review Committee makes a recommendation for discipline or no discipline. Each committee member must agree that the investigation is ready to move forward. The assistant attorney general, who represents the State, must find that the professional’s right to due process has been satisfied.
The Quality Assurance Manager suggests how to process the case, but the Executive Director makes the final decision. Cases where suspension or revocation of the professional’s license has been recommended or where the case is highly complex, may be sent to the Office of Administrative Hearings. There, an Administrative Law Judge conducts a formal hearing, and then submits a recommended order to the Board. All other cases are sent to the Board for a final decision.
The Board reviews the case at its monthly meeting. A staff member summarizes the case. Then, the healthcare professional may make a five-minute statement, take questions from Board members, or both. At the end of the questioning period, the professional or his/her lawyer can make brief summarizing comments to the Board. The Board Chair then asks for a motion on the case. A Board member may move for a dismissal of the complaint or may move for a finding of unprofessional conduct, citing the statutory provision that was violated. Dismissal terminates the case, and the complainant may not appeal the decision. If a motion for unprofessional conduct is passed, the Board then discusses whether disciplinary or non-disciplinary action is appropriate. Possible actions include issuing a non-disciplinary advisory letter, a letter of reprimand, a decree of censure, probation, or a combination of these actions. The Board may also vote to suspend or restrict a professional’s license. If the Board decides to revoke a license, it will refer the case to the Office of Administrative Hearings for a formal hearing. Except for a summary suspension or referral to formal hearing, the professional has 35 days to appeal the Board’s final order.
Board complaint procedures vary from case to case. Real-world cases can be found here.