Surviving a Medical Board Investigation

Mark Crane

Disclosures

April 13, 2016

In This Article

What the Boards Are Scrutinizing

Prescriptions of narcotics receive the highest level of scrutiny. Most states have a database that allows physicians to check which medicines a patient is taking, including by quantity and how often they've been prescribed. The rules require doctors to check it to make sure the patient isn't doctor-shopping for painkillers.

"Doctors can get into trouble for not checking it," said Adelson. "It's easy for investigators to see what a doctor prescribes, how often, how many pills, etc. Some doctors are naive, and patients can take advantage," says Adelson. "Word travels that it's easy to get a prescription from a given doctor. Boards think that primary care physicians shouldn't be long-term prescribers of pain medicine, and they look at that carefully."

FSMB says the most common complaint received by medical boards is an allegation that a physician has deviated from the accepted standard of care. Other common complaints include overprescribing or prescribing the wrong medicine; failure to diagnose a medical problem that is found later; failure to provide a patient with medical test results in a timely manner, which can lead to harm; failure to provide appropriate postoperative care; and failure to respond to a call from a hospital to help a patient in a traumatic situation.

Here are some of the other issues boards focus on:

Impairment. Any activity that could suggest the physician may be impaired will receive aggressive scrutiny. "Let's say a physician is arrested for driving under the influence of alcohol," says Chapman. "He or she may plead no contest, or the court may take it under advisement and then dismiss the charge in 6 months. In most states, that's still considered a conviction and doctors need to report it to their state board."

If the physician is licensed in more than one state, he or she should self-report it to the other states as well. "Even if the criminal charge is dismissed, boards will still investigate. It's a different burden of proof. The board wants to know whether the doctor might have a drinking problem," says Adelson.

Documentation. Physicians are busier than ever, even as reimbursements are falling. Doctors justifiably complain that they don't have the time for extensive documentation. But that argument won't fly with a medical board.

"Since the advent of electronic medical records, boards and insurers are complaining that doctors are simply copying and pasting information into patients' charts," says Adelson. "They call it the 'cloning' of notes. There are plenty of check boxes. We tell our clients they have to affirmatively go into each section and address what happened to the patient. The notes can't all look the same, or the board will find fault."

Wrong-site surgery. Boards have insisted on steps health professionals must take to make sure they're operating on the correct patient and correct site. They may want the patient to be identified by two independent sources, and have time-outs so everyone in the operating room knows who the patient is, what procedure is being performed, and on what side.

"In a case I handled, the surgeon was supposed to operate on the patient's left knee," says Chapman. "However, the right knee was prepped and draped. Before he made the incision, the surgeon realized the error. He was still reprimanded by the board for wrong-site surgery because he had marked the spot on the wrong knee. Even though he never cut on the wrong side, he was fined $10,000."  

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