Question

Locate a case where a health care professional has been disciplined by the licensure board. Examine the issues, compare those issues with the professional ethics of that profession, and discuss the ethical violations that may have occurred in the conduct leading to disciplinary action.

Answer 1

Ans

One of the greatest fears for any physician is the potential loss of their medical license. Disciplinary action taken by the Federation of State Medical Boards (FSMB) stems from unprofessional, incompetent, or improper medical action on the part of the physician, which can result in medical license suspension or revocation.

The FSMB represents 70 medical boards across the United Sates, including all 50 states, territories, and Washington, D.C. The FSMB aides these state boards in following through on their Constitutional oath to protect public health, safety, and welfare via licensure and disciplinary action.

The FSMB published 2017 national data on medical board disciplinary actions taken against physicians in a 2018 report titled U.S. Medical Regulatory Trends and Actions. The national non-profit organization has published such data ever since its founding in 1912.

With technological advances over the past century, it has become easier for state medical boards to accurately identify situations requiring penalization, as well as the most appropriate avenue of disciplinary action. These improved capabilities may explain why, during the past 10 years, more than 4,000 physicians annually have received some form of censure from their state boards—a jump from previous decades. Of note, in 2017 alone, there was a total of 8,813 actions taken by state boards.

Let’s take a look at the top 10 disciplinary actions taken by the FSMB in 2017.

1. License revoked

License revocation is the most severe type of disciplinary action that a medical board may render unto a licensee. When a physician’s license is revoked, they may no longer practice medicine within their state or territory. State medical boards pursued a total of 264 cases of disciplinary action for license revocation in 2017.

2 License surrendered

A physician may choose to surrender their license during the course of a disciplinary investigation. When a physician does this, they must state in writing their intent to do so and file this letter with their state board. Generally, a surrendered license may not be renewed, reinstated, or restored. Physicians must apply for a new license in order to regain licensure, which may include a written examination. However, this option may not be available to a physician currently under investigation or for physicians against whom a state board has initiated disciplinary action. The FSMB reported 570 cases of surrender of license in 2017.

3 Probation

If a physician is placed on probation, it generally means that their license is monitored by the issuing state board for a specified period of time. Although the terms and conditions of probation will vary by situation and state board, some common requirements of probation may include supervision by another physician, additional training, and limitations on performing certain procedures. In 2017 alone, state medical boards pursued 764 cases of probation as disciplinary action.

4. License suspended

When a physician has their license suspended, they must temporarily cease the practice of medicine in their state or territory until granted permission to do so by the issuing medical board. A suspended license may be reinstated following the conclusion of a disciplinary investigation or until other board requirements are fulfilled. There were 796 cases of license suspension levied against healthcare professionals in 2017.

5. Continuing medical education (CME) required

Quality-of-care complaints will often result in disciplinary action against physicians—usually CME completion—with the aim of improving standard-of-care diagnosis and treatment skills. In 2017, state medical boards initiated disciplinary action under the category of required CME for 869 cases.

6. Conditions imposed

When the disciplinary action of “conditions” is initiated, physician must satisfy certain conditions to avoid further penalty by the state board. Of note, in 2017, there were a total of 887 conditions imposed by state medical boards.

7 Monetary fine

In some cases, state boards may impose a monetary fine against a physician. A full 890 healthcare professionals received fines from state medical boards in 2017.

8. Administrative action

When a physician has administrative action levied against them, it is usually a form of non-punitive censure that does not affect the status of their medical license. For example, a healthcare insurance carrier and state medical board may take administrative action against a physician to recover monetary funds in the event of overpayment. In 2017, there were 1,023 cases of administrative action taken against healthcare professionals by state medical boards.

9 Reprimand

A reprimand may be issued by a state medical board for minor violations, sometimes in lieu of formal charges or a filed complaint. This type of disciplinary action may be private or public and issued in the form of a warning, letter of censure, or non-disciplinary advisory letter. There were 1,147 reprimands issued by state medical boards in 2017.

10 License restricted

When a physician’s license is restricted, it limits their ability to practice medicine. A physician may have their medical license restricted for a number of reasons, including substance abuse issues, mental health issues, health conditions affecting cognition (eg, dementia), overprescribing prescription medicine, as well as non-medical criminal charges (eg, driving under the influence). Most commonly, licensure restrictions result in the loss of clinical privileges, such as the ability to prescribe medication. In 2017, there were 1,343 cases of licensure restriction initiated by state medical boards.

Upon comparing 2017 data with that of 2008, the FSMB found that certain disciplinary actions had increased, including the number of reprimands, restricted licenses, requirements for additional CME, suspended licenses, and surrendered licenses. Other actions, however, such as activities related to administration, fines, probation, and license revocation, decreased during this time period.

Board disciplinary actions usually begin with a formal complaint made by the state board in writing. If a complaint is filed against you in writing by your state medical board, you must reply on time. On time usually means within 30 days of the complaint issuance. If you are unable to file a response within 30 days, you must ask for an extension.

When responding to a complaint, it is imperative that you clearly describe all the facts and reasons regarding any relevant medical decision that you’ve made. You must also provide concise yet robust documentations from your medical records to support your position. Your first response can determine whether the board will pursue disciplinary action.

If you are employed by a hospital or healthcare organization, you must immediately inform the administration of any complaints filed against you and request a lawyer. If you are practicing on your own, hire a lawyer. Any lawyer from whom you seek counsel should be experienced with managing board complaints and disciplinary actions. Though it’s an overall good idea to confer with a lawyer throughout the entire process, it’s imperative that you do so before you meet with the board in order to formulate a solid, strategic approach. Of note, some insurers do provide legal representation to physicians.