• The Medical Board and You


    I have served on the Georgia Composite Medical Board, our medical licensing board, for more than a year.

    The learning curve is steep, and I still consider myself a neophyte in a few areas. Nevertheless, I have learned a tremendous amount the easy way – i.e., by watching what happens to other doctors rather than the hard way – by having to deal with a personal investigation and fumbling through the process as some doctors do. My purpose is to have you gain an appreciation for your medical board and learn the best way to handle board inquiries.

    Thomas Harbin
    Thomas S. Harbin, MD, MBA

     

    First, I have been impressed that our board dedicates itself to protecting the public through a process that is fair to physicians. The board is the friend of ethical, properly practicing doctors. All boards are part of the Federation of State Medical Boards (FSMB). After reading medical board communications, I have no doubt that all other states are similar to ours in Georgia.

    Lesson No. 1: Read Those Board Letters Carefully.

    Most doctors have little direct contact with their boards after they get a license and thus have little appreciation for all that boards do. Because of this, some doctors pay scant attention to board communications, occasionally to their regret.

    For example, our state legislature passed a law making registration mandatory for the Prescription Drug Monitoring Program (PDMP), the program by which a doctor can learn about controlled substance prescriptions for patients. Some states refer to this as Prescription Monitoring Program (PMP).

    Despite numerous reminders from state medical societies and our board, a small number of doctors did not register and were thus in violation of the law. They were then subject to a fine and public reprimand, something that will stay on their records for the remainder of their practice lives.

    Lesson No. 2: The Board Can Be Your Friend in Protecting Our Patients From Unethical Doctors Who Have Made Poor Decisions.

    Ethical doctors sometimes see patients harmed by other doctors who have not followed the standard of care. The process of helping these patients gain redress through the courts is a time-consuming and public process, one which a doctor, especially in a small community, may not want to undertake.

    Another option is to counsel the patient to make a complaint to the board or make a complaint yourself anonymously, an option in many states. The board will take it from there and your duty to help the patient is fulfilled without undue publicity to yourself.

    Lesson No. 3: Do Not Ignore or Disrespect Board Investigations.

    Patients upset by a bad outcome (or rude behavior) from their doctors can complain to the board. In this situation, the board investigates and contacts the doctor. This could happen to you even if you did nothing wrong in your care.

    If this happens to you, whether deserved or not, do not blow it off. Do not write an angry, self-serving response. Cooperate with investigators and send all records requested. If you are invited for an interview, take advantage of the opportunity.  Strongly consider hiring legal counsel. Every community has health care attorneys familiar with board investigations and the administrative law process, and this is the type of lawyer you would need to represent you.

    Take your attorney with you to the interview. Be respectful, open and objective, all pursuant to your attorney’s advice. Fellow doctors comprise the majority of boards. In my experience, we on the board are well able to distinguish between a bad outcome vs. a poor practice pattern.

    In like fashion, boards investigate all malpractice settlements or verdicts. The preceding paragraph applies in this situation as well. Occasionally, an insurer will force you to settle a case even if you did nothing wrong medically. Here again, the board process will likely recognize this fact, assuming you follow the correct procedure in defending yourself.

    Lesson No. 4: Take the Easy Way and Get the Help You Need.

    Doctors are human and some become addicted to alcohol or other drugs. Others – including family, colleagues or hospital administrators – recognize this situation and either confront the doctor or file a complaint. In the ideal situation, the substance abuser becomes aware enough to seek help, but doctors too rarely turn to help in the mistaken belief that they can handle it.

    There are two ways to address addiction when it has advanced to the point of potentially harming patients. One you may consider the “easy” way is to take advantage of the board-affiliated Physicians Health Program (PHP). In Georgia, this is the name of the program, but other states may have slightly different versions for the same program.

    It involves contacting the program, taking the required residential several month rehabilitation process and participating in at least five years of monitoring with random urine, blood and hair screens. This is by no means easy, but participating in these programs means that the board never learns of your problem and your license to practice is not endangered.

    A second avenue, one I consider the hard way, is to ignore your problem until the board receives a complaint, possibly after you harm a patient. At that point, the board knows about the problem and will mandate your participation in a rehab program, but you will be on its radar screen forever.

    You will likely have to sign an Agreement Not To Practice and later petition the board before you can return to practice. You may have a reprimand on your record that is visible to the public.

    Another manifestation of doctors being human involves inappropriate sexual behavior- boundary issues. This could involve sexual contact with office or hospital staff or, worst of all, patients. If they involve office or hospital staff relationships, people suffer. In addition, morale will suffer and complaints made. If with patients, as with staff, they may be harmed. Patients are even more vulnerable than staff as they can worry that their care could be compromised.

    In Georgia, a doctor may not have a sexual relationship with a patient unless the doctor terminates the patient from the practice and waits two years. Any shorter time interval and the doctor violates board regulations. Other states may have different intervals.

    In most instances, especially in these times of the Me Too movement, boards learn of these relationships and do not tolerate them. Here again, there’s the easy way and the hard way.

    PHPs not only treat substance abuse but also sex addiction. There are programs across the country that deal with this specialized problem. Unlike substance abuse problems that can be monitored with objective screening tests, compliance with post-treatment programs can be accomplished. How? Polygraph tests can reliably detect lapses so there are ways to ensure proper behavior.

    Lesson No. 5: See Lesson No. 4.

    In summary, state licensing boards protect patients in many ways while affording physicians a fair process in investigations. Here are the lessons again:

    1. Pay attention to board communications.
    2. Let the board help in protecting patients from doctors who have made poor decisions.
    3. Handle board investigations carefully and properly, ideally with legal help.
    4. If you have substance abuse or sexual boundary problems, enroll in your state’s PHP, get the help you need and avoid board oversight.