1. MEDICAL QUALITY ASSURANCE COMMISSION: Roles and Responsibilities in a Disciplinary Investigation
Benton Franklin Medical Society
February,
Jimi Bush: Performance and Outreach Manager

2. Agenda/Topics To Be Covered
Mission / Purpose
Who we are
Complaint Intake
Investigations
Types of Disciplinary Actions
Case Study
Summary
Questions
Washington State Medical Quality Assurance Commission
@WAMedBoard

3. Mission Statement
Promoting patient safety and enhancing the integrity of the profession through licensing, discipline, rule making, and education.
Washington State Medical Quality Assurance Commission
@WAMedBoard

4. Purpose of the Medical Commission
RCW
“It is the purpose of the Medical Quality Assurance Commission to regulate the competency and quality of professional health care providers under its jurisdiction by establishing, monitoring, and enforcing qualifications for licensing, consistent standards of practice, continuing competency mechanisms, and discipline.”
Rules, policies, and procedures developed by the commission must promote the delivery of quality health care to the residents of the state of Washington.
Washington State Medical Quality Assurance Commission
@WAMedBoard

5. Protect Public by Assuring Quality Healthcare
Mission and Duties
Protect Public by Assuring Quality Healthcare
Licensure Qualifications
Consistent Standards of Practice
Practice Rules and Policies
Assurance of Continuing Competency
Paramount duty of Commission is to protect and maintain public safety.
Establish, monitor and enforce
Licensure qualifications
Consistent standards of practice
Assurance of continuing competency
Practice rules and policies
Washington State Medical Quality Assurance Commission
@WAMedBoard

6. Who We Are 21 Commissioners: 52 Employees: Commissioners Staff:
1 from each congressional district;
2 Physician Assistants;
6 Public Members;
3 Physicians at large;
52 Employees:
Medical consultants;
Attorneys;
Clinical Investigators;
Administrative Staff;
Washington State Medical Quality Assurance Commission
@WAMedBoard

7. How We Are Governed Semi-Independent body appointed by the Governor.
Governed by Statute:
RCW 18.71, 18.71A,
WAC ,
Washington State Medical Quality Assurance Commission
@WAMedBoard

8. Complaints Discipline process is complaint-driven. Complaint sources:
No attempt to conduct random audits, etc.
Complaint sources:
Patients and family members;
Other health care providers;
Self-reporting;
Federation of State Medical Boards;
Malpractice settlements;
Other agencies (states, professional associations, hospitals);
Law enforcement;
Application problem;
Washington State Medical Quality Assurance Commission
@WAMedBoard

9. Overview: Processing a Complaint
A report is reviewed by a panel of at least three commissioners, known as the Case Management Team (CMT).
If warranted, the report is assigned to an investigator.
Completed investigation given to a Reviewing Commission Member (RCM) and Staff Attorney.
RCM presents case to Commission panel composed of 10 or 11 members for decision.
Washington State Medical Quality Assurance Commission
@WAMedBoard

10. Complaint Intake 1393 Reports received in 2016.
98.99% of them were processed within 21 days.
Every report received is brought before the CMT.
The Respondent and the Complainant receive notice after the report has been heard by CMT as to the decision to investigate or not.
Washington State Medical Quality Assurance Commission
@WAMedBoard

11. Investigation Process
In 2016 we opened 44% of cases for an investigation.
Investigator may collect statements, medical records and other materials as authorized by the CMT.
In investigations were closed.
The Reviewing Commission Member will review the case and discuss any needs with the Investigator and Staff Attorney before presenting to the Commission Panel for a decision to charge or close.
Washington State Medical Quality Assurance Commission
@WAMedBoard

12. Legal
A panel of 10 or 11 Commissioners will determine if the case warrants action.
Only the reviewing commissioner (RCM), the staff attorney, and the investigator know the name and location of the provider.
Violations fall into 2 categories:
Unprofessional Conduct:
Conduct relating to incompetence, negligence, moral turpitude, fraud, sex, or other misconduct.
Impairment:
A mental or physical condition making the practitioner unable to practice medicine with reasonable skill and safety.
Washington State Medical Quality Assurance Commission
@WAMedBoard

13. Washington State Medical Quality Assurance Commission
@WAMedBoard

14. Types of Actions Jimi.Bush@doh.wa.gov
Washington State Medical Quality Assurance Commission
@WAMedBoard

15. Cases Closed Below Threshold (BT)
Complaints Closed after CMT.
No reporting.
In cases were closed BT.
There is a complaint reconsideration process.
The complainant must provide NEW information for the CMT panel to consider.
Washington State Medical Quality Assurance Commission
@WAMedBoard

16. Informal Actions Stipulation to “Informal” Disposition (STID).
Licensee does not admit to unprofessional conduct.
Accompanies the Statement of Allegations (SOA), prepared by staff.
Licensee agrees to sanctions:
Prescribed CME;
Modifying practices or procedures;
Writing paper or giving presentation;
Monitoring for stated period;
Cost recovery up to $1,000;
MQAC agrees not to pursue formal action but reports to NPDB.
Washington State Medical Quality Assurance Commission
@WAMedBoard

17. Formal Actions Statement of Charges (SOC) Hearing
Alleges unprofessional conduct or impairment.
Prepared by MQAC attorneys and AG prosecutor after panel instruction.
Served on licensee – may have settlement conference.
Failing settlement, proceeds to hearing.
Hearing
Health law judge presides and writes order.
Panel of 3-5 commissioners unfamiliar with case.
Attorneys usually involved.
“Clear and convincing evidence” required.
Potential hearing outcomes
Charges sustained or not sustained.
Final Order Issued.
Washington State Medical Quality Assurance Commission
@WAMedBoard

18. Summary Actions May occur at any stage of complaint process.
Concern that licensee poses immediate danger to public.
Effect of limitation:
Practice only to extent allowed by assigned limitations.
Limitation remains until full hearing held AND limitation lifted.
Effect of suspension:
Cannot practice until full hearing held AND suspension lifted.
Subject to due process with a ‘show cause hearing’.
14 v. 20 day instances and their cites.
Washington State Medical Quality Assurance Commission
@WAMedBoard

19. Case Study A walk through of the discipline process
Washington State Medical Quality Assurance Commission
@WAMedBoard

20. Complaint Overview
Case Involved a death following a surgical procedure.
There was a companion case regarding the Hospitalist’s care.
Case was approved for investigation at CMT.
Washington State Medical Quality Assurance Commission
@WAMedBoard

21. Investigation Plan
Investigative plan is developed incorporating the notes made at CMT.
Contact other DOH agencies who may be (or become) involved;
What materials / medical records are needed?
Investigative notice is mailed to the provider;
The provider may obtain representation;
Interviews (in-person and telephonic);
Periodic check-in with the RCM;
RCM Direction of an investigation
Washington State Medical Quality Assurance Commission
@WAMedBoard

22. Investigation Dates of care are verified.
Interviews with provider and subsequent providers are conducted.
Medical Records are obtained.
DOH, Facilities and the Nursing Commission reviewed this case and it was subsequently closed.
Investigator compiles information and writes an investigative report for RCM review.
Washington State Medical Quality Assurance Commission
@WAMedBoard

23. RCM Review Patient was a 75 yo Male;
Multiple comorbidities who presented with severe abdominal pain;
ER evaluation diagnosed acute pancreatitis:
CT: pancreatic edema, gall bladder normal without stones.
Ultrasound: Normal thickness, gall bladder with stones present.
Lipase 27,000
Bilirubin and LFT’s normal, creatinine 1.2.
Notes from RCM to Present to panel
Washington State Medical Quality Assurance Commission
@WAMedBoard

24. RCM Review (Continued)
Surgical consult with the written statement:
“Gall bladder will be removed during this admission when the patient is improved and stable“
Over the ensuing few days, the lipase normalized but the bilirubin and creatinine rose.
Chest x-ray showed bilateral edema and pleural effusions.
Supplemental oxygen requirements increased.
CRP significantly elevated.
Washington State Medical Quality Assurance Commission
@WAMedBoard

25. Despite these signs, the surgeon proceeded with the operation.
You are the Panel of Commissioners, how would you handle this case?
Washington State Medical Quality Assurance Commission
@WAMedBoard

26. Getting to the Bottom
Why did the surgeon operate?
Other questions asked:
Was there documentation justifying the operation?
Was it crucial that the operation happen during this admission?
What is the standard of care?
Was standard of care followed?
“What would I have done in this instance?”
“Did the practitioner miss anything?”
Washington State Medical Quality Assurance Commission
@WAMedBoard

27. Responsibilities of the RCM
Be objective and recuse when needed;
Stay focused on the facts of the case.
RCMS do not interview the provider or patient and must rely on the records and documentation.
Do not disclose the name or location of the respondent when presenting.
What evidence, if any, supports the complaint?
What is the rational for closing the case?
Understand the sanction schedule.
Know the standard for the type of case.
Washington State Medical Quality Assurance Commission
@WAMedBoard

28. Summary Oversee: Discipline process is complaint driven.
Licensing;
Discipline;
Rule making;
Education;
Discipline process is complaint driven.
We do not data mine.
All complaints are reviewed by CMT to determine if they warrant investigation.
Violations fall into two categories:
Unprofessional conduct;
Impairment;
Types of Action:
Informal;
Formal;
Summary;
RCM presents evidence based facts.
Panel does not know any identifying information.
Do not data mine sources like the PMP or hospital reports
Washington State Medical Quality Assurance Commission
@WAMedBoard

29. The Medical Commission is Coming to Kennewick!
Questions?
Website
doh.wa.gov/medical
Policies, Guidelines, rules and Statements
Rulemaking activities
Current Topics
Contact The Medical Commission
The Medical Commission is Coming to Kennewick!
June 29 and 30
Thursday June 29:
Lunchtime presentation (usually 1230)
Policy Meeting (1600)
Friday June 30:
Business Meeting (0800)
Personal Appearances
Washington State Medical Quality Assurance Commission
@WAMedBoard