Medical Board Is Empowered to Investigate Doctors’ Misconduct, Incompetence

The Medical Board of California is the state agency that licenses, regulates and disciplines physicians and certain allied health professionals, such as podiatrists, physical therapists, psychologists and respiratory-care practitioners.

It is made up of 12 physicians and seven public members. The governor appoints 17 members. Two public members are appointed by the Legislature.

The board may investigate patient complaints or initiate investigations based on reports it receives of hospital disciplinary actions and malpractice payouts of $30,000 or more.

Known as the Board of Medical Quality Assurance until this year, the board is empowered to look into a wide variety of allegations. These include negligent or incompetent medical care, physician impairment from mental illness, drug or alcohol abuse, excessive prescribing of narcotics or other drugs, sexual misconduct with patients, falsification of medical records and practice without a license. But some complaints, such as fee disputes and Medi-Cal or Medicare fraud, are outside its jurisdiction.

The medical board is not the only body that oversees the activities of physicians. For instance, in nearly all hospitals the performance of doctors is monitored by peer review committees, in which physicians examine the care delivered by their colleagues. There is no comparable mechanism to monitor the quality of care delivered in a doctor’s office even when surgery is performed.

The peer review process occurs almost entirely in private and has little public accountability. Many physicians maintain that without such strict confidentiality they would not speak candidly of their colleagues’ performance and peer review would become a meaningless exercise. When the process results in, for example, loss or restriction of hospital privileges, the action is reported to the medical board.

The board assigns complaints with possible merit for investigation in order of a priority that is based on actual or potential patient harm. If a violation is confirmed, a decision is made whether to pursue formal disciplinary charges.

Formal charges become public when they are filed. They are prepared by the state attorney general’s office. In some instances, the board may also refer cases to a local district attorney for criminal prosecution or compel a physician to take a competence or psychiatric examination to determine if an accusation should be pursued.

After a charge is filed, a physician has a right to a public hearing on the charges. The case is heard by an administrative law judge and by a panel of physicians and laymen or by an administrative law judge alone. The accused physician may be represented by a lawyer, may call witnesses and may present evidence.

The results of most hearings, including all those in which serious penalties are assessed, are submitted to the board’s division of medical quality, which makes the final decision on discipline. Physicians may appeal the decisions of this seven-member board to the Superior Court and, if unsuccessful, through the state Court of Appeal and the state Supreme Court. If board discipline is appealed, a judge decides whether the penalty should be imposed immediately or delayed until all appeals are exhausted.

Penalties include license revocation, suspension and probation. Physicians may be required to take competence or psychiatric exams, take additional medical education or perform community service. Special conditions may sometimes be imposed, such as prohibition from prescribing certain drugs, or a requirement that the physician work under supervision at all times.

In cases where the charges are considered less serious or the evidence weak, the board can take “compliance actions” that are not made public. A doctor may receive a warning letter, be called in for a “nondisciplinary review” or be referred to a diversion program for mental illness or drug or alcohol problems.