Investigation Procedures for Complaints Margaret B. Hansen, PA-C, MPAS, CMBE President
Patients Patients’ families Malpractice settlements or judgments Other physicians Other providers from the medical team Hospitals Insurance providers
‘Some people from the medical board are here to see you.’
Board’s mission is to protect the public The Board is not out to “get” anyone About 80% of complaints are dismissed
Dismissal Complaint received/reviewed Dismissal Response requested/received Investigation Complaint Process
Fee disputes Wrong agency (e.g. nurse, podiatrist, etc.) No physician-patient relationship established No clear allegation in the complaint Rude Provider Claims of abandonment when clear proper physician properly relationship termination Etc.
Board staff notifies and requests a response from the provider within 10 to 14 days Options: ◦ Supplemental response e.g. medical expert Investigative Review Panel Board member reviews and makes recommendation to the Board
What do you do if someone files a complaint?
Review the complaint and allegations Prepare response Decide whether to get an attorney Gather records Extensions are granted as necessary
InvestigateClose Continue Investigation Warning Resolve by Consent Board Member Recommendation to the Investigative Review Panel Recommendation to Board Board Final Decision Hearing: Administrative Law Judge or Board Licensee Optional Appeal: Circuit Court
Not Public: o Complaint dismissal o Letter of concern (not a board action, private except to other state licensing boards) Public o Reprimand o Limit, condition, probation etc. o Suspend or revoke
State Medical Board notice - website AIM ExecNet FSMB Disciplinary Alert NPDB Other…
confidential information clearinghouse ◦ must report disciplinary actions
Board website Disciplinary Action License verification board order certified copy Board meeting minutes
SDCL , (7) Habits of intemperance or drug addiction, calculated in the opinion of the Board of Medical and Osteopathic Examiners to affect the licensee's practice of the profession; Applicants and Licensees are told: ◦ far better to self report problems
South Dakota Health Professionals Assistance Program (SDHPAP) Oversight from participating licensing boards Financial support: Medical and Nursing boards a multidisciplinary program for health professionals who are experiencing chemical dependency or mental health issues
multiple state licenses = action is reported to the other states. Disciplinary action is reportable, as required, to national databases: ◦ National Practitioner Databank ◦ Federation of State Medical Boards ◦ Drug Enforcement Agency ◦ American Medical Association. Disciplinary action may affect: ◦ medical malpractice insurance ◦ HMO coverage ◦ staff privileges