What Happens During a Medical Board Investigation?

Receiving notice of a medical board investigation can feel nerve wracking and unsettling. Physicians might wonder what steps to take first, what the investigative process will entail, and what the possible outcomes are. This article answers all three questions, specifically regarding investigations of allopathic physicians by the Arizona Medical Board. Although the investigative process described in this article is specific to the Arizona Medical Board (Board), all licensed clinicians can benefit from guidance regarding what steps to take upon receiving notice of a licensing board investigation.

What Should You Do After Receiving Notice of a Board Investigation?

MICA members should contact MICA as soon as possible after receiving notice of a Board investigation. The MICA Claims Department will confirm coverage availability and, where coverage is in order, appoint an attorney from MICA’s panel of attorneys. The Board usually gives physicians two weeks to respond, so it is important to contact MICA right away for coverage determination and next steps. MICA does not recommend going through this process alone. Physicians interested in learning about the pitfalls of responding to a Board complaint without an attorney should read this MICA article: Navigating a Medical Board Investigation – Optimize Your Medical Malpractice Coverage.

Additionally, physicians should refrain from certain actions, including:

• • Do not contact the complainant. The Board will contact the complainant during its investigation, if necessary.
    
    
  • Do not change the patient’s medical record in an attempt to explain the underlying events.

Contacting MICA and avoiding the actions listed above will help ensure physicians are prepared for the investigation itself.

What Can You Expect During the Investigative Process?

Besides wondering what steps to take after receiving notice of a Board investigation, many physicians wonder what the investigative process will entail. In general, the Board’s investigative process includes the following steps:

1. The Board receives a complaint. Complaints can be filed by numerous sources, including patients, other health professionals, and health care facilities.

2. Initial review. The Board reviews the complaint to confirm the allegations are within the Board’s jurisdiction. The Board investigates complaints of the Medical Practice Act. The Board generally cannot act on a complaint alleging any violation of the Medical Practice Act that occurred more than four years before the complaint was received by the Board.¹

• • If the complaint is not within the Board’s jurisdiction: the complainant is notified by letter and the complaint is closed.
    
    
  • If the complaint is within the Board's jurisdiction: the physician is notified that the complaint is under review and receives a copy of the complaint.
    
    
    • The complaint is mailed to the physician’s last known address of record on file with the Board.²
      
      
    • The physician also receives a letter with the allegations, response date, and contact information for the investigator assigned to the case.
      
      
    • Licensing boards do not look kindly on physicians who did not receive notice of the complaint due to outdated contact information or failure to check their email inbox. As a result, it is very important that physicians check their inbox and ensure their contact information provided to the Board is always current.

3. Investigation. The investigator requests a response from the physician, interviews witnesses, obtains medical records, and collects other evidence as necessary. Allegations of unprofessional conduct are reviewed by the investigator. Allegations of patient harm from a breach of the standard of care are reviewed by a medical consultant.

• • If the allegations are not sustained: the complaint is forwarded to the Board’s Executive Director for dismissal. Complainants can appeal the dismissal.
    
    
  • If the allegations are sustained: the physician receives a copy of the investigator’s report or medical consultant’s report. The physician can respond to the specific allegations.
    
    
    • A supervisor reviews the investigation. The Chief Medical Consultant reviews quality of care complaints, and the Investigations Manager reviews unprofessional conduct complaints. The supervisor can recommend dismissal, request further investigation, or sustain the allegations and send the investigation to the next step.

4. Staff Investigational Review Committee (SIRC) Recommendation. The SIRC reviews the materials and requests any additional information needed, including an interview with the physician. The SIRC consists of the Investigations Manager, the Chief Medical Consultant, and the Board Operations Manager.

• • If the SIRC recommends non-discipline: the case is sent to the Board for final disposition.
    
    
  • If the SIRC recommends discipline: physicians can agree to sign a consent agreement, participate in a formal interview before the Board, or request a hearing before the Office of Administrative Hearings (OAH).³
    
    
    • SIRC recommendations for suspension or a revocation longer than twelve months are automatically forwarded to OAH.
      
      
    • All cases not referred to OAH are sent to the Board for final disposition.

5. Adjudication. The Board determines whether the case warrants discipline. When reaching its determination, the Board considers all previous non-disciplinary and disciplinary actions against the physician.⁴ Board members can request a formal interview of the physician.⁵

• • If the Board finds the case should be dismissed: the case is considered complete, and the complainant cannot appeal.
    
    
  • If the Board sustains the allegations: the Board will discuss appropriate disciplinary or non-disciplinary action.

What Are the Possible Outcomes of a Board Investigation?

Once the investigation is complete, physicians likely wonder what the possible outcomes of the investigation are. In general, Board actions fall within one of two categories: non-disciplinary action and disciplinary action.

Non-Disciplinary Action

If the Board determines that the information gathered during the investigation is “not of sufficient seriousness to merit disciplinary action” against the physician, the Board can take non-disciplinary action, including:⁶

• • Dismissal. If the board determines that the allegations in the complaint are without merit, it can order dismissal of the complaint.⁷
    
    
  • Require completion of continuing medical education courses.⁸ Courses usually must be completed at the physician’s own expense.
    
    
  • Issue an advisory letter. Advisory letters usually inform physicians that continuation of the activities that led to the investigation could result in discipline by the Board.⁹ Physicians can file a written response to the Board after receiving an advisory letter.¹⁰

Disciplinary Action

If the Board determines that disciplinary action is appropriate, it can take one or more of the following actions:

• • Require completion of continuing medical education courses.¹¹
    
    
  • File a letter of reprimand.¹² A letter of reprimand informs the physician that the physician’s conduct violates state or federal law and may require the Board to monitor the physician.¹³ 
    
    
  • Issue a decree of censure.¹⁴ This is an official action against the physician’s license and can require restitution of fees to a patient.¹⁵
    
    
  • Require probation.¹⁶ Probation can include temporary suspension of a physician’s license for less than twelve months, restriction of the physician’s license, or restitution of fees to a patient.¹⁷
    
    
  • License suspension.¹⁸ If the Board determines that suspension of a license for more than twelve months might be appropriate, the Board will order a formal hearing before OAH if no hearing was previously held.¹⁹
    
    
  • Revocation.²⁰ If the Board determines that revocation of a license might be appropriate, the Board will order a hearing before OAH if no hearing was previously held.²¹
    
    
  • Civil penalty.²² In addition to any other action taken, the Board can order a civil penalty for an amount between $1,000 and $10,000 for each violation of the Medical Practice Act.²³

Overall, receiving notice of a Board complaint and investigation will likely leave physicians feeling nervous and apprehensive. However, understanding what initial steps should be taken, what the investigative process will include, and what the possible outcomes of a Board investigation are will help physicians feel more at ease even under these unfortunate circumstances.

<sup>[1] See A.R.S. § 32-1451.03(A).

[2] See A.R.S. § 32-1451(R).</sup>

<sup>[3] OAH is an independent state agency that conducts formal hearings when someone disputes a decision made by a state agency or board. OAH hearings are held before an administrative law judge, who submits a recommendation to the Board based on evidence presented during the hearing.

[4] A.R.S. § 32-1451(U).

[5] See A.R.S. § 32-1451(H).

[6] A.R.S. § 32-1451(E).

[7] See A.R.S. § 32-1451(E)(1).</sup>

<sup>[8] See A.R.S. § 32-1451(E)(2).

[9] See A.R.S. § 32-1401(3).

[10] A.R.S. § 32-1451(E)(3).

[11] See A.R.S. § 32-1451(I)(2).

[12] See A.R.S. § 32-1451(I)(5).

[13] A.R.S. § 32-1401(14).

[14] See A.R.S. § 32-1451(I)(6).

[15] Id.

[16] See A.R.S. § 32-1451(I)(7).

[17] See id.

[18] See A.R.S. § 32-1451(J).

[19] See A.R.S. § 32-1451(H).</sup>

<sup>[20] See A.R.S. § 32-1451(J).

[21] See id.

[22] See A.R.S. § 32-1451(K).

[23] See id.</sup>