When to File a Complaint Against a Doctor
If you have experienced unprofessional conduct or inadequate care at the hands of a doctor, it is important that you file a complaint with the state medical board in your state. The Federation of State Medical Boards (FSMB) provides contact information for every state medical board in the U.S. and its territories. It is important to note that state medical boards do not assist in the preparation of medical malpractice lawsuits.
Many patients do not know where to turn when they have concerns about the competency or conduct of a doctor. State medical boards are government agencies empowered to investigate complaints about doctors and, when warranted, take action against them.
Importance of Reporting
While the overwhelming majority of doctor-patient interactions that occur each day in the U.S. are conducted in an appropriate and professional manner, state medical boards recognize that issues such as doctor alcohol and substance abuse, fraud, incompetence and sexual misconduct exist.
These issues are taken very seriously by state medical boards, which in recent years have advocated for strengthened reporting requirements to ensure individuals or organizations who are aware of, or witness, inappropriate behavior come forward to report the problem. Doctors, hospitals, law enforcement agencies and consumers all can help reduce future issues by reporting inappropriate behavior.
In most states the duty to report issues that may impact patient safety—including inappropriate or unprofessional conduct—is included as a formal requirement of doctors and health care professionals. Consumers must feel safe and secure in any medical interaction, and they should always speak up if they suspect inappropriate behavior.
How to File a Complaint
To file a complaint against your doctor (for unprofessional conduct or incompetent practice), find your state medical board and follow the steps explained on the state medical board’s website. State medical boards allow patients to file complaints either online, by email, phone or standard mail.
Complaints are prioritized according to the potential for patient harm; cases in which an investigator determines imminent patient harm is possible are typically “fast-tracked” to ensure swift action by the state medical board. Examples of complaints receiving high priority by investigators may include a doctor engaging in sexual misconduct, practicing medicine while under the influence of alcohol or drugs, and providing substandard care.
The most common complaint received by state medical boards is an allegation that a doctor has deviated from the accepted standard of medical care in a state. Some of the most common standard-of care complaints include:
- Prescribing the wrong medicine
- Inappropriately prescribing controlled substances
- Failure to diagnose a medical problem that is found later
- Willfully or negligently violating the confidentiality between physician and patient except as required by law
- Disruptive behavior and/or interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care
- Failure to provide appropriate post-operative care
- Failure to respond to a call from a hospital to help a patient in a traumatic situation
The Complaint Process
1. The complaint is assessed for jurisdiction: When a complaint arrives at the state medical board, the first step is to determine whether the board has the authority to investigate it under the state’s Medical Practice Act. If yes: Go to Step 2. If no: The complaint may be referred to another agency with jurisdiction. If that isn’t possible, the person who filed the complaint is sent a letter stating that the board has no jurisdiction.
2. The case is prioritized and an investigation begun: Before taking any action, the state medical board determines if there is an imminent threat to the public. If this is the case, it typically has the power to immediately suspend a doctor’s license and order the doctor to cease seeing patients. Other restrictions may also be applied if there is an imminent threat.
3. The investigation proceeds; all parties involved are contacted: After the case is prioritized, the state medical board begins a comprehensive investigation, identifying all the individuals and facilities that may have pertinent information. Individuals involved in the case are asked to describe the events that took place and provide any information they may have.
4. The physician and complainant receive formal notification: At this stage a letter is typically sent to the doctor, stating the allegation, seeking a response to the complaint and requesting any relevant records. The complainant is also notified.
5. The case is given medical review: Investigators for the state medical board determine whether a patient’s medical care has been impacted as a result of the complaint or whether the complaint involves other issues, such as fraud or behavioral/ethical problems. During this stage, an expert with professional expertise in the same specialty as the doctor in question may be called in to provide an additional opinion about the care provided.
6. The state medical board decides what action to take: A wide variety of disciplinary measures or other actions in response to the original complaint are available to boards. For the most serious cases, especially those that impact patient safety, the board may opt to file a formal complaint against the doctor, leading to disciplinary action that may include suspension or revocation of a license or imposition of fines. For less serious offenses, options may include, but are not limited to, a letter of concern; an appearance before the board; or the requirement of a physical, medical or psychiatric competency evaluation. For serious infractions or issues, which warrant filing of a formal complaint: Go to Step 7. For lesser infractions or issues: Board may consider imposing lower-level options or closing the case without formal action.
7. The case is set for a hearing: For serious infractions or issues, state medical boards schedule a hearing – a formal review of the case in which doctors have an additional opportunity to respond to the complaint. As sometimes happens in the U.S. legal system, some cases may be settled before the hearing date. When that happens, the settlement offer goes before the full board at a regularly scheduled board meeting, where a decision is made about whether to accept the settlement agreement. If accepted, it is placed into effect. If not, the matter proceeds to a hearing before the board. If no settlement: Go to Step 8. If settlement: Board closes case.
8. Adjudication: Cases that are not settled are adjudicated, meaning they go to a full hearing, similar to a court trial. There is a formal proceeding, with presentation of evidence and witnesses. Afterward, the board deliberates and makes findings on whether one or more violations of a state’s Medical Practice Act have been proven. If a violation has been proven, the board determines the appropriate disciplinary actions to impose on the doctor, which can include a reprimand; conditions or restrictions placed on the doctor’s license; or suspension or revocation of the license.
9. Public notice: If a board finds that a violation of the Medical Practice Act has taken place, and disciplinary action has been taken, this information is entered into the public record. The information becomes part of the doctor’s permanent professional record and is shared with other state medical boards via the FSMB’s Physician Data Center. Patients have access to this information directly from their state medical board or by accessing docinfo.org.
Understanding State Medical Board Disciplinary Actions
State medical boards utilize a variety of tools as they go about the process of regulating the activities of doctors and other health professionals. When issues arise — whether they are minor, such as failure to pay a fee, or more serious, such as inappropriate behavior with a patient — board actions may be taken by state medical boards, allowing them the flexibility to apply a level of disciplinary response that is appropriate for the issue being addressed. Categories of board actions include:
State Medical Board Disciplinary Actions vs. Malpractice
The differences between a disciplinary action taken by a state medical board and a malpractice judgment or settlement against a doctor are significant. State medical board actions and malpractice claims are two different things. Board actions are issued against doctors after a formal process of complaint, investigation and hearing. While an action taken by a state medical board against a doctor indicates that a violation of the Medical Practice Act has occurred, malpractice claims are not always reliable measures of a doctor’s competence or a violation of the law. Issues such as a doctor’s time in practice, the nature of the doctor’s specialty, the types of patients treated, and geographic location can have a significant influence on the number and amounts of malpractice judgments and settlements. Malpractice settlements are sometimes handled by insurance companies who opt for settlement based on the terms of coverage, not the validity of the underlying claim. These terms may also authorize settlement of a claim without any consultation of the doctor involved or an ultimate determination of fault. It is common practice for state medical boards to use malpractice data as a tool to detect unprofessional conduct that may violate the Medical Practice Act. Some boards have built-in levels of malpractice that trigger investigations, such as a certain number of malpractice settlements in a certain span of time.
|Administrative action:||Non-punitive action that does not result in the modification or termination of a doctor’s license. These actions are generally administrative and may be issued for reasons such as failure to pay a licensing fee.|
|Fine:||In some cases, state medical boards may impose a monetary penalty against a doctor.|
|CME required:||Doctor is required to complete continuing medical education (CME).|
|Conditions imposed:||Doctor must fulfill certain conditions to avoid further sanction by the state medical board.|
|License denied:||Doctor’s application for a medical license or renewal of a current license is denied.|
|License restricted:||Doctor’s ability to practice medicine is limited (e.g., loss of prescribing privileges).|
|License revoked:||Doctor’s license is terminated; individual can no longer practice medicine within the state or territory.|
|License surrendered:||Doctor voluntarily surrenders medical license, sometimes during the course of a disciplinary investigation.|
|License suspended:||Doctor may not practice medicine for a specified period of time, perhaps due to disciplinary investigation or until other state medical board requirements are fulfilled.|
|Probation:||Doctor’s license is monitored by a state medical board for a specified period of time.|
|Reprimand:||Doctor is issued a warning or letter of concern.|