Medical boards and lawyers: what hospitalists need to know

CERTIFIED LETTERS are hardly ever good news, and this is one of the worst: Somebody thinks you violated the standard of medical care and has filed a complaint against you with your state board. Maybe you remember the case; probably you don’t, but the suggestion that you’re a lousy doctor and the implied threat to your career are things you can’t ignore.

So you pull up the records (if you can, and if federal privacy regulations won’t get you into worse trouble). You look up the literature that supports what you did or didn’t do. Some of us ask a friend or colleague about it, or you check to see if one of your partners may have seen the patient(s). You also start sleeping poorly because you’re thinking of ways to counter the allegations against you.

Looking for moral or emotional support is understandable—but be careful in sharing both patient information and the fact that a complaint has been made. The senior doctor who helped you find your way around your group or hospital practice may be a little doubtful about recommending you for committee membership or group partnership if there’s a question about your competency. And other doctors who have dealt with the board may be reluctant to admit it.

Fortunately, there is one person you can talk to, and you should as early as possible: your malpractice attorney. Don’t have one? Your malpractice insurance company will not only recommend one, but it will pay for his or her services. The same lawyers who defend doctors from lawsuits will cheerfully support you against the board and whoever filed the complaint.

Getting started
The certified letter probably gave a deadline for your reply and told you something about your state’s process for handling complaints. Send a copy to the attorney, who will want to talk to you by phone or in person; have whatever records you can get with you. If you don’t work at that particular office or hospital anymore, don’t worry. Office and hospital staff will be VERY cooperative with requests from lawyers.

Typically, you will need to send documents that support your side of things—not just medical records, but relevant e-mails and/or evaluations from other doctors. Your group or hospital may have had a peer review that cleared you of wrongdoing, the chief of service may have written to thank you for your work when you left the facility, etc.

If the complaint is based on out-of-date standards, find an article to support the way things are done now. If at all possible, find one in lay language because many of the board’s employees and/or members are not doctors.

You will almost always have to send a written rebuttal of the claim explaining your side of things: the reason a different test or treatment was not indicated, the patient’s refusal to see a specialist or participate in treatment, or simple statements of fact.

Here’s an example: “I saw this patient only once, and that was six months before he developed symptoms of the illness.” Your attorney will suggest changes that will strengthen your case. Because you are paying for advice, take those suggestions seriously.

The conference
Most state boards, if the complaint looks plausible (as opposed to “Has a funny accent” or “Women doctors shouldn’t wear pants”), will have the records reviewed by doctors and then schedule a meeting with some of their members, both laypeople and physicians.

This is your chance to make a good appearance. Nowadays you can perform on Zoom instead of driving to the state capital, but wear polite attire (dark jacket and minimal jewelry) and be cooperative rather than assertive or defensive. The board is there to protect the public, not you, and a bad attitude or hostility toward the complaining party will count strongly against you.

The attorney may help you prepare an introductory statement about your training, work history and future plans. Give your statement but don’t read it, so you look both prepared and certain of your position. Do your best to project your good intentions and your ongoing efforts to provide the highest standard of care for your patients.

The group will almost always have questions, and your attorney will try to prepare you ahead of time for those. Answer carefully but briefly because the group will have a long day discussing cases like this and brevity will be appreciated.

The follow-up
The committee will probably say one of three things: “You’re fine,” “We need to consider further” or “Corrective action should be taken.”

The first means “forget all about this,” and your sleep should improve. Either of the second two will probably involve action on your part: a competency exam, remedial continuing education or something worse, such as a year of having your work checked by another doctor.

Even if you’re left wondering what comes next, thank the committee members for what they do. Their work is almost always unpaid and frequently tedious, so it doesn’t hurt to tell them they are appreciated.

You already take an interest in making sure that things go right for your patients. You may not be perfect, but you are trying to ensure quality care and good documentation. The board will take your good intentions into consideration, so make use of your lawyer’s expertise and advice and prepare well.

And one bright side: You will probably learn something from this experience about medical care and documentation that improves your future work.

Stella Fitzgibbons, MD, has over 30 years of outpatient and hospital experience. She also works with malpractice attorneys as an expert witness.