I Just Received a Letter from the Medical Board: Now What?

Professional Licensing Boards are government agencies which regulate healthcare professionals.  This regulation includes ensuring that applicants for licensure are properly qualified and competent to practice in their respective healthcare fields.  It also includes ongoing monitoring of healthcare professionals and disciplinary actions.  The Professional Boards have the power to revoke a healthcare provider’s license, place it on suspension, levy fines, and issue other orders for discipline against a healthcare provider.  All healthcare providers are governed by some Professional Board, the major ones in Nevada being the State Board of Medical Examiners (which regulates physicians, physicians assistants, and respiratory therapists), the State Board of Dental Examiners (which regulates dentists and dental hygienists), and the State Board of Nursing.  Other healthcare providers with regulatory Boards include osteopathic physicians, chiropractors, podiatrists, optometrists, veterinarians, pharmacists, physical therapists, psychologists, marriage and family therapists, and social workers, just to name a few.  Each of these professions and Boards have their own set of statutes and regulations contained in the Nevada Revised Statutes and Nevada Administrative Code.

Typically, the healthcare professional has interaction with these Boards when he or she first applies for a license in Nevada, when he or she renews that license, and/or when there is an inquiry for an investigation regarding some act or omission of the provider.  A Board may also seek information from the healthcare provider regarding the act or omission of another provider for which he or she may have knowledge or information.

Each Board handles its investigation differently, though in general the process is similar.  Usually, a Board will send the provider a letter indicating that a complaint has been made by a patient, or someone else, regarding that providers care of a particular patient.  Several of the Boards are required to investigate every complaint, no matter how frivolous it may seem.  In general, the Board will initially send the subject healthcare provider a letter requesting information and medical records.  The time limit to respond to such letter is typically short, i.e., 15 to 21 days. If such a healthcare provider receives such a letter regarding a patient’s complaint from a Professional Board, he or she should always take the letter extremely seriously.  Mail which comes into a busy office is usually handled by staff and may take time to get to the intended healthcare provider recipient.  All healthcare providers should instruct their staff to immediately hand them any letters from their Professional Boards.

So when should a healthcare professional who has received such a letter of inquiry from a Professional Board contact an experienced attorney?  The short answer is always.  Upon receipt of such correspondence, the healthcare provider should always contact an attorney immediately.  While the patient complaint at issue may seem trivial, minor, or otherwise not worth taking the time to deal with, the healthcare provider should remember that the Boards take every complaint seriously.  The investigation letter can ultimately lead to a complaint against the provider’s license, which can lead to revocation, suspension, or some other form of discipline.  It is imperative that there be a timely and comprehensive response to the letter.  Otherwise, this can result in discipline and of itself, and/or the Board will not take the provider’s point of view into account in assessing whether to proceed with the complaint for discipline.

But how can attorneys help in the process?  Much like an attorney likely doesn’t have the slightest clue how to treat or triage a patient, the healthcare provider who receives an investigation letter from his or her professional board typically has little or no experience in preparing a comprehensive response. On the other hand, attorneys with experience in this field have done hundreds of such letters and know generally what the Board is looking to accomplish. These attorneys also have a relationship with the Board attorneys and can often obtain information on the Board’s intent which would not otherwise be available to the doctor dealing directly with the Board. An attorney can meet with you and assist you in preparing a comprehensive response to the investigation letter. The aim is to convince the Board that the investigation should be closed with no discipline being imposed. While a comprehensive response to an investigation letter may often end the inquiry, on matters which are more serious or of more concern with the Board, the Board may still seek to file a complaint or impose some form of discipline. In most cases, an attorney can help guide the provider through the process and work to try to minimize the discipline and impact on your practice. To effectively do that, it is important that the attorney get involved at the very beginning, when you first receive the investigation letter. The attorney can often obtain extensions to respond to the letters to give you time to provide a complete and convincing response. If a patient’s complaint cannot be resolved informally with the Board, the next step is often a formal hearing with the Board. These are essentially trials before the Board in which each side presents witnesses and evidence.  Unfortunately, unlike a jury trial, discovery is limited, or non-existent, and the jury is the Board who brought the complaint against you.  Boards who prevail at hearings are typically allowed all of their attorney’s fees and investigation cost. After a full hearing, these can range as high as $25,000.00 to $50,000.00. A Board’s decision may be overturned on appeal to the District Court. However, the standard for appeal is extremely high (abuse of discretion) and it is often very difficult to overturn the Board’s final decision.

An attorney can also assist a healthcare provider with determining whether there is any insurance coverage for Board actions. Often professional liability policies will provide coverage for Board actions (though sometimes this requires an additional premium). However, this is typically limited. The limitations on this coverage can range from $5,000.00 to $100,000.00. Typical coverage is usually in the $25,000.00 range. It must be remembered, though, that this coverage usually only provides for your attorney’s fees and costs. Any fines, investigation fees and cost, and any other penalties, are typically not covered under insurance and the provider must pay these amounts out of his or her own pockets.

Lastly, a board investigation or imposition of discipline will likely have future ramifications for a healthcare provider’s hospital privileges and/or credentialing with other licensing bodies and health insurers. An attorney can guide the practitioner through this process and help to take pre-emptive measures to try to prevent any problems in these areas.

In sum, it is important for all healthcare providers to immediately contact an attorney on receipt of any type of investigation letter from a Professional Board. It is critical that the attorney be involved early in the matter. This helps to ensure a more speedy resolution and, more often, a favorable resolution.