1. Disciplinary Actions Common complaints / discipline
Reporting: formal and public
Standard of Care (SOC)
Expert Witnesses
2016 AIM Executive Academy (AEA)
Kathleen Selzler Lippert, Kansas ED, JD, CMBE
201April 23, 2014

2. Complaint Investigation Board Action
Whether you have been an Executive Director for a medical board for a short or long time, the perennial question of ‘now what’ will hit your radar. Examples of ‘now what’ moments may include:
Complaint caller is extremely agitated, demanding that you require his physician to prescribe some medication they deem life saving or necessary for pain relief or they will end their life …. Right now.
Complaint caller is extremely agitated and believes your agency and staff to be co-conspirators with physician who is poisoning them and threatens harm against your staff, sends staff Facebook requests, or other stalking type behavior, law enforcement is challenged to locate them because they are homeless and call from track phones.
Complaints provide strong indication of practice violation but licensee employs attorney and all possible stall tactics to delay investigation including objecting to subpoenas, seeking court injunctions to block or limit subpoenas, and issue counter attack subpoenas.
Media calls, sets forth proposition that as a state agency there is a duty to be transparent and as a regulator your mission is public protection, so why is anything redacted from any agency document.
Media calls, notes that board discipline for boundary violation of intimate relationship between provider and patient was less than revocation, asks for explanation of how this order fulfills mission of public protection.
Media calls, notes that % of hospitals took privilege action against providers in your state and your board failed to identify providers on your web page that lost their hospital privileges and it appears there was no adverse license action for such mis-conduct.
Then there are the calls from legislators, the Governor’s office, and others that present a host of other questions about your agency disciplinary actions and reporting of such actions.

3. ‘Some people from the medical board
Some complaints, investigations, and board actions are more visible – or targets for a segment of NBC News episode of Dateline.
Sex
Drugs
Rock n’ roll
Are prime targets for additional scrutiny.
‘Some people from the medical board
are here to see you.’

4. Disciplinary Process Complaint Received Initial Investigation/ Review
Investigative Committee
Complaint Closed
Investigative Interview
Each board has a unique process and people who make decisions.
AND ….
Just like ice cream, boards and board members come in different “flavors”.
They have different voices and make different choices, and even the same board changes (their stance on an issue or discipline) over time.
Discuss:
Expert Witnesses:
Where do you get them?
What do they cost?
Testifying expert v. in-house staff medical reviewer
Standard of Care:
Best practice v. minimum standard
Further Investigation/ Outside Review
Final Board Action

5. Disciplinary Action Common Causes
Prescribing Violations
Impairment
Behavioral Issues
Boundary Issues
Criminal Convictions
Violations of Board Orders
Failure to update Physician Profile
Failure to timely renew license
Failure to obtain Board approval for supervision of PA prior to the PA beginning work
Substandard practice (Standard of Care SOC)

6. Board Actions / Orders Non- Public (if statutory authorization):
Letter of Concern (LOC)
Professional Development Plan (PDP)
Advisory Letters
Public:
Censure / fine / costs
Education / training
Reprimand
Impairment monitoring
Limitation / Restriction / Probation / Conditions relating to practice
Suspension
Revocation
Not everything the Board does is disciplinary.
Examples:
Physician who left practice to raise kids and wants to return to practice after being out of practice for 5 years. They have not done anything wrong. There is no clear evidence they are not competent to practice. There is cause for concern that they may be behind in their clinical competency but they may not be; it may depend on their area of specialty. A board order that provides for a proctor or mentor is not to discipline the person but to ensure public safety.
A physician who has a DUI but there is no evidence that substance use has manifested or impacted patient care. Board may want to ensure patient safety with a monitoring plan or abstinence plan to ensure patient safety but not to punish or discipline the provider but to ensure patient safety.

7. Reporting Board Orders
Who
NPDB
FSMB
Website
Newsletter
Media
What
Guide Book
Rules
Public info only?
Non-public info?

8. Reporting Board Orders
NPDB
NPDB Guidebook
Help line:
Regional Representative

9. FSMB Reporting
Is there a process to notify other state medical boards if a practitioner’s license is suspended? Or report any board action …
FEDERATION OF STATE MEDICAL BOARDS
The Disciplinary Alert Report is compiled and published by the Federation of State Medical Boards of the United States, Inc., as a reference source for its member boards.
The Disciplinary Alert Report or any of its data, listings, or other constituent elements may not be republished, sold, or duplicated, in whole or in part, for commercial or any other purposes, or for purposes of compiling lists or files without the express written permission of the Federation's Executive Vice President as authorized by the Board of Directors.
The use of this Disciplinary Alert Report to establish independent data files or compendiums of information is strictly prohibited.

10. Information to Consumers
How do you let the public know about board orders?
Board’s website (copy of board orders)
Newsletter by medical board
Verification of medical license (different search engines, copies of board orders)
Minutes for board meetings
Media – Call from Dateline or Reporters

11. Transparency … Isn’t always clear Doesn’t always make it safe

12. Transparency … Isn’t always clear
Transparency is a buzz word used by media, consumers, providers, stakeholders
Transparency is not always clear
Transparency does not always make it safe
Inherent conflict between transparency and confidentiality
My media box points (handouts)

13. 13

14. Questions? Kathleen Selzler Lippert, JD, CMBE
Kansas State Board of Healing Arts
Executive Director
800 SW Jackson
Lower Level – Suite A
Topeka, Kansas 66612
Questions? 14