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How to Prepare for a Licensing Board Disciplinary Review

Insurance Agent and nurse prepare for a licensing board disciplinary review

Dealing with a licensing board disciplinary review can be overwhelming and potentially devastating for healthcare providers. One complaint can require a provider to fight for the professional license it took years to get. That’s why it’s critical to understand the process, be prepared, and know how a medical malpractice insurance policy could help.

In this article, we’ll explore what the licensing board review process entails, as well as potential board disciplinary actions. We’ll also explain how these reviews differ from peer reviews and malpractice claims. Most importantly, we’ll explain how you can help protect your license and the reputation you’ve worked so hard to build, especially if you’re going through an upcoming licensing board review.

What Is a Healthcare Licensing Board Review?

State healthcare regulatory boards or professional licensing boards protect the public in a number of ways. One of these is by investigating and, if appropriate, disciplining licensed professionals whose actions are seen as violations of medical standards of care and competence, the state ethics code, or federal or state law.

The licensing board typically starts an investigation when it receives a complaint filed against a licensed provider. Though often from patients, complaints can come from just about anyone, patients, family members of patients, co-workers, disgruntled former significant others, or even employers.

According to the Federation of State Medical Boards, after receiving a complaint, the licensing board “has the power to investigate, hold hearings and impose discipline.” The discipline associated with a case is referred to the “action” and can include assessing fines, suspending a license, or, in extreme cases, revoking the license.

How Common Are Licensing Board Disciplinary Actions?

Healthcare disciplinary actions are not all that common, but they do occur. For example, in 2021, according to the National Council of State Boards of Nursing (NCSBN), there were 18,145 adverse actions against nursing licenses, which accounted for 1% of all nursing licenses.

Because the state licensing board is responsible for protecting the public, it must review all complaints when the competency of a healthcare professional is in question.

How Does a Licensing Board Review Differ From a Malpractice Claim?

Licensing board reviews differ from malpractice claims in many ways, including:

  • Licensing boards are designed to protect the public by ensuring regulations and standards for the medical profession are upheld, while malpractice claims are designed to compensate a patient or family for alleged damages.
  • Licensing boards are generally made up of licensed professionals in the specific healthcare field. Depending on the county and specialty, they may also consist of members of government or industry experts. Malpractice claims are decided by a judge or jury in a court of law.
  • Licensing board actions affect only the healthcare provider (with fines or license restrictions), while a court judgment impacts both parties (compensation made to the patient from the provider, legal fees for both parties).
  • If a medical professional is found negligent in a civil malpractice case, they won’t automatically lose their license. But they can have a license suspended or revoked from a licensing board review.

How Does a Licensing Board Review Differ From a Peer Review?

Typically peer reviews and licensing board processes differ significantly. However, it’s important to note that when a peer review uncovers misconduct or ethical violations, the review committee may refer the matter to the state licensing board. Here are some of the biggest differentiators:

  • Peer reviews are typically used to resolve disputes between a patient and a provider, or the provider and a third party. They are more of a mediation service, whereas licensing board reviews can have complaints submitted anonymously and often have more serious consequences for the provider.
  • Peer reviews typically focus on the quality and appropriateness of care or the fairness of fees.
  • Peer reviews aim to have a resolution within 30-90 days, while licensing board reviews can take months.
  • The outcome of a peer review remains confidential, but licensing board resolutions can be publicly sourced.

14 Common Causes of Healthcare Board Complaints

So now that you know what a licensing board disciplinary reviews are, let’s look at why they happen. Some of the more common reasons healthcare professionals face disciplinary action from a licensing board include:

  • Failure to comply with health or safety regulations or codes
  • Negligent patient care
  • Misdiagnosis or inappropriate treatment
  • Criminal arrests, charges, or convictions. (guidelines vary by profession and state, but in general it is recommended that healthcare professionals should be forthcoming and report any felony or serious misdemeanor offenses, even if they aren’t related to their practice)
  • Substance abuse while on duty
  • Boundary violations (e.g., giving or accepting inappropriate gifts, excessive self-disclosure, or starting business relationships)
  • Violations of patient privacy/confidentiality
  • Failure to obtain informed consent for treatment
  • Physical or sexual abuse of patients
  • Sexual misconduct toward a patient
  • Falsifying patient records or errors and omissions in documentation
  • Exploiting a patient for financial gain
  • Unfit moral or ethical conduct, such as when conduct causes an immediate threat to a patient or conduct violates state licensing guidelines
  • Ignorance, incompetence, or a pattern of behavior inconsistent with the basic knowledge and skills expected

Licensing Board Process

The licensing board disciplinary process varies by state, specialty or license, and licensing board panel. Anyone facing this process should make sure they understand each step.

How a Complaint Gets Filed

First, a complaint is filed with the state licensing board. Complaints can be anonymously filed by anyone concerned about a provider’s conduct, competence, or care. Usually, they’re filed by a patient, patient’s family member, co-worker, or employer, and yes, even an angry roommate or former significant other. In addition, a criminal investigation against a provider could also trigger a complaint.

Initial Review

Once the complaint is received, the licensing board reviews it to determine the following:

  • Whether the complaint involves a legitimate violation of the guidelines
  • Whether the board has jurisdiction
  • Whether the complaint would impact licensing if the allegations were proven to be true

If the board decides that the complaint meets these qualifications, it will advance the case to an investigation. But if the case is found to lack merit, the board will file it away, with no further action.

Investigation

If the complaint passes the initial screening, it then moves to the investigation phase to determine its validity.

During this stage, the licensing board assigns an investigator who requests information from the healthcare professional, the individual who filed the complaint, and any witnesses. The board may also require medical records or other documentation, such as a bill for services. Depending on the complaint and what’s involved, the investigation can take several months.

Licensing Board Proceedings

Based on the investigation, the board determines whether to close the case, hold a hearing, or conduct a settlement conference. If the allegations are extreme (e.g., criminal or fraud charges), the board may choose to file formal charges for disciplinary actions, which could mean the provider would be temporarily unable to work.

Licensing Board Disciplinary Actions

If the board rules in favor of the claimant, it may take several actions against the healthcare provider, including:

  • Imposing fines
  • Requiring additional education/training or other remedial actions
  • Suspending the provider’s license
  • Revoking the provider’s license

What Happens After Board Actions

The licensing board is required to report its disciplinary actions to the National Practitioner Data Bank, and the results are entered into a public database. Fines are typically paid to the nursing board or to the regulatory agency that oversees licensing.

How Malpractice Insurance Can Help With a Board Hearing

Having medical malpractice insurance that includes “licensing board protection defense” can be incredibly helpful if facing this stressful process. It’s important to know whether your current malpractice insurance policy includes this coverage. Employer-provided policies, in particular, often do not provide this benefit, but having your own policy would.

At Berxi, all our malpractice plans automatically come with coverage extensions to help with legal defense costs for licensing board reviews. This means you’d get your own attorney from a nationwide panel of experts to assist you as part of your policy coverage.

What’s more, when our clients contact us about a board action, a claims adjuster reaches out to them within one business day to provide support and walk them through the process. Once the claims adjuster determines the coverage is available, they will assign an attorney to assist with the board hearing and be that calming point of contact throughout the process.

How a Lawyer Can Help With a Licensing Board Review

Whether or not you have medical malpractice insurance to cover the costs of legal counsel, you have a right to legal representation during the board review process. You can consult with an attorney before speaking with investigators and have your attorney present when being questioned. Here are more ways an attorney can help during a board review:

  • Preparation and representation. The hearings and interviews can have a significant impact on the outcome of your case. Your attorney will help ensure you’re prepared and have the strongest case possible. They practice with you by walking you through potential questions you might be asked and reviewing your responses.
  • Avoiding adverse actions. Throughout the process, your attorney can also negotiate on your behalf to reduce the chance of disciplinary action being taken against you, stopping your ability to practice.
  • Requesting appeals. Your attorney can advise you on the practicality of an appeal and how to structure it.
  • Enforcing reinstatement. If your license is suspended or revoked, a lawyer can help with options regarding restoration or reinstatement.

5 Ways to Prepare for a Licensing Board Hearing

With so much at stake in a board licensing review, it’s critical that you’re prepared in the event you should ever face one. Here are some steps you can take:

1. Prepare Your Notes

Practice thorough, daily note taking in all your work. Make sure your patient notes on examinations, diagnoses, treatments, finances, and other related matters are complete, accurate, and detailed. Also, do not alter or add to your notes. You may not want to bring your notes into the hearing since they would be open to review by both sides, but they can help with the preparation of your defense.

2. Notify Your Insurance Company Immediately

As soon as you learn that you’re part of a disciplinary case (usually via letter, email, or phone call), contact your insurance company. Your claims manager will need time to review the case, determine proper coverage, and find you an experienced attorney who can help you prepare.

If your insurance is offered through your employer, you may need to coordinate with your employer to manage the licensing board matter. Keep in mind that board reviews might not be covered under your employer’s policy.

3. Be Honest

Be truthful in all your interactions, interviews, and testimony regarding your case. Your attorney can help you prepare your story to ensure it’s accurate. You don’t want to provide information that can lead to further examination.

4. Remain Calm

A disciplinary proceeding can be incredibly stressful and unnerving. It’s important to remain calm and focused on your case. There’s a process to follow, and the outcome should not be presumed. Remember that you have extensive support and guidance throughout the process.

5. Keep the Case Private

Discretion and confidentiality are key. Reach out to only a small group of trusted people who will not share the case with others. Remember, if you speak with others directly involved with the case, their recollection of details may differ from yours, which can lead to more confusion.

Final Thoughts

Being the subject of a licensing board complaint can be extremely difficult and stressful, with the license and reputation you’ve worked so hard to earn at risk. Keep in mind that while board reviews feel frustrating — and often unmerited — the goal is to keep the general public safe. A few takeaways from this piece:

  • Having an attorney assist with your defense should help in many ways (stress included).
  • Having your own medical malpractice policy that includes coverage for board actions may be your best defense.
  • Keeping careful notes on all patients is the best preparation for any board hearing, peer review, or malpractice claim.
  • Disciplinary actions do not have to be severe. They might require further education and training while keeping your license.

If you don't have your own malpractice policy or you don't have coverage for board actions, Berxi can help. With affordable coverage and a simple application, you can get the protection you need in no time. Get started today!


Image courtesy of istock.com/Charday Penn


Last updated on Sep 14, 2023.

Originally published on Sep 08, 2023.

The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice.

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