Understanding The Investigative Process
THE BOARD’S PURPOSE
The Georgia Composite Medical Board (GCMB) is the licensing agency for physicians, physician assistants, respiratory care professionals, perfusionists, acupuncturists, orthotists, prosthetists, auricular (ear) detoxification specialists, residency training permits, cosmetic laser practitioners, pain management clinics and medical geneticist. The Medical Board investigates complaints and disciplines those who violate The Medical Practice Act or other laws governing the professional behavior of its licensees.
One important way that the Board fulfills its mission is by determining when a licensee’s professional conduct or ability to practice medicine falls below accepted standards and may warrant remedial and/or disciplinary action. The Board is authorized to take remedial and/or disciplinary action by the Medical Practice Act.
This brochure is intended as a guide to help consumers and licensees understand the Board’s Investigative Processes.
The Board reviews complaints reported to it from a variety of sources, including patients, family members and others advocating on behalf of patients, GCMB licensees, other health care professionals such as nurses or pharmacists, and, at times, law enforcement. The Board also receives anonymous complaints, which may be investigated. In addition, the Board investigates certain reports that are made to the GCMB by hospitals or other health care institutions (which report changes in staff privileges,) malpractice insurance carriers (which report professional liability payments) and other insurance companies, federal and state agencies, and the National Practitioner Data Bank. The term “complaint” is used broadly to describe any or all of the above sources of information.
COMPLAINT REVIEW PROCESS
All complaints are evaluated by the Board’s medical director and management staff to determine if the complaint is within the jurisdiction of the GCMB. A complaint within the jurisdiction of the Medical Board undergoes a rigorous, multistep process of review that determines the ultimate action taken by the Board. The complaint review process may take up to six months or longer to complete, depending on the complexity of the case.
All information and records obtained during the investigation of a case, including medical records, staff reports and investigative reports, are confidential and are not available to the public unless the matter proceeds to a formal hearing. Cases that are closed with no Board action remain nonpublic. Investigations may need to be disclosed to other licensing authorities and law enforcement agencies, but only at the Boards discretion.
When a complaint is received, the licensee is provided with a written notice that advises him or her of the existence of a complaint or other information forming the basis for the Board’s investigation. If completing an online complaint, you will automatically receive your complaint acknowledgement letter, which you should print or save for your records. Notices are not provided in those cases where doing so would jeopardize the Board’s investigation.
The Board contacts the licensee to obtain a response to the complaint. The licensee may be sent a letter containing the allegations listed in the complaint received by the Board and asked to respond in writing, or he or she may be interviewed by a Board investigator. The Board expects licensees to provide a complete and accurate account of their involvement in the matter under review within the time permitted. In many cases, the written response is the licensee’s primary opportunity to explain his or her perspective and to bring any mitigating factors to the Board’s attention. Most often, a clear and thorough response from the licensee, along with supporting medical records or other documentation, provides the Board with all the information it needs to complete a review.
In other cases, additional information is needed and a Board investigator is assigned to facilitate the case. Serious complaints, criminal violations, public safety threats, and similar situations are referred directly for formal investigations by the Board’s agents. These agents are certified law enforcement personnel who are trained in both traditional and specialized investigations. The results of investigations by agents are also evaluated by Board members to determine if there are violations of Board rules or Laws and to determine if any discipline and/or prosecutions are warranted.
Once licensee responses are received, cases are thoroughly evaluated by the Board staff. All matters that involve quality of care are forwarded to the Medical Director or the Assistant Medical Director. Cases are assessed by one of the medical directors. Which includes a review of the allegations in the complaint, the response from the licensee and the medical records. In cases that were investigated by an investigator the medical director also reviews the investigate report. The medical directors then make recommendations for each case they review. Those recommendations are sent to the Board staff to be added to the next Investigative Committee meeting.
All cases and their accompanying recommendations receive an additional round of review by the Investigative Committee. This committee is made up of GCMB members, Board staff, the medical directors and an attorney from the Attorney General’s Office. The Investigative Committee examines each case and makes a recommendation for Board action by consensus agreement. The Investigative Committee recommendation may or may not differ from the preliminary recommendation prepared by either of the Boards medical directors.
The Investigative Committee recommendations typically include the following: closed with no action, close with a Letter of Concern (loc) (this is a non-disciplinary action that is used to bring attention to areas of improvement), table (usually to allow time for additional information to come), further investigation (usually to collect additional information that the committee has asked for), investigative interview (this allows the licensee to come in front of Board members to better explain the situation), peer review (the case is reviewed by a non-board member physician to see if the standard of care was breeched), or disciplinary action (all cases either suspension, revocation, or public or private Board orders are referred to the Attorney General’s office). Cases may also be referred to other licensing boards, other state agencies and local, state and federal law enforcement agencies.
The final step is evaluation by the full Board. The Investigative Committee Chair presents the Investigative report to the full Board. Sometimes, the Board accepts the committee recommendation and votes to carry out the action. Sometimes the Board may determine that additional information is needed. In these situations, the case will be sent back to the investigative unit for further information. The case then repeats the cycle. The Board makes its final determination about a case only when its members are satisfied, they have all the information they need to make a reasoned decision.
POSSIBLE OUTCOMES OF INVESTIGATIONS
The Board may decide to take no formal action (Accept as Information or AAI); the Board may vote to take private action (such as issuing a private letter of concern); or, the Board may vote to take public action to resolve the case. Complainants are notified when a case is closed and are provided with general information about how it was resolved.
The outcome of an individual case depends on the unique circumstances of that case, as well as any mitigating or aggravating factors (such as a prior disciplinary history with the Board) that may be present.
Cases are resolved in three main ways. The descriptions below are intended to provide a general guide to the factors that are present when the Board votes to resolve a case in the following ways:
Closure with no action
After a thorough review the Board closes a case with no action due to no evidence to support the allegation, no jurisdiction. The Board finds no violation of the Medical Practice Act. In some cases, there could be other circumstances for closure. Licensees and complainants are notified of the decision. The case is closed and kept on file in the licensee’s confidential permanent file. Complainants may request that the board re-review the decision upon submission of additional evidence.
The Board does not find a violation of the Medical Practice Act that warrants public action, but it is nonetheless concerned about some aspect of the licensee’s conduct or performance. Private action is taken, such as a confidential letter of concern (LOC) to the licensee or a request that the licensee attend a private meeting to discuss their conduct with members of the Board. LOC’s are non-disciplinary letters that point out areas of improvement for the licensee. These letters are not public information. The Board may also issue private consent orders to address issues that typically pose no risk to public safety.
The Board determines there was a violation of the Medical Practice Act that requires remedial and/or disciplinary action. For example, the licensee may have engaged in conduct that was illegal or unethical, or may have issues with clinical competence, posing a potential threat to patient safety or welfare. Wherever possible, the Board develops corrective action for a violation that provides adequate patient protection without placing undue restrictions on the licensee. Public action consists of suspensions, revocations, probation, public orders and voluntary surrenders. These cases typically involve public safety issues such as the licensee is not fit to practice, public safety concerns, violation of board rules and laws, sexual misconduct, and other violations of board rules and laws. When the Board decides to take public action, it is placed on the licensee’s profile as well as on the website on monthly Board orders.
What’s a ‘public action’?
Public actions range from a public letter of concern, which the Board considers to be non-disciplinary, to suspension or revocation of the license, with many options in between. For example, the Board may issue a fine, reprimand the licensee or impose limitations on his or her scope of practice. All public actions of the Board are posted on the GCMB’s public website,
www.medicalboard.georgia.gov. Actions against an individual’s license may be viewed online by the public via that individual’s Licensee Information page. If the Board’s review determines that some type of public action may be warranted, it is possible the outcome of the case will be determined through a public hearing. However, most cases that result in public action are resolved through negotiated settlements known as consent orders.
What if I don’t agree with the Boards Decision?
If a licensee is issued a private or public order and agrees to it then the order is signed by the licensee then returned to the Boards office. The order is then signed by the Board Chair and the Executive Director. The order is then docketed and posted. If a licensee refuses to sign an order the case may then go to a hearing in front of an Administrative Law Judge (ALJ).
If the licensee does not agree to the order than the licensee has a right to a hearing.
All cases, for which the board recommends license revocation, suspension or if the licensee doesn’t agree to the sanctions, are referred for formal hearing. This process is as follows:
- Formal complaint filed by the AG’s office.
- Full evidentiary hearing before an ALJ
- ALJ issues a recommended decision may include dismissal non-discipline or discipline
- The Board may adopt modify and adopt or reject the ALJs decision.
If the Board adopts the ALJ decision the licensee may appeal, the process is as follows:
1. Request for rehearing or review board hears this request if the physician does not prevail
2. Judicial review actions superior court if the physician does not prevail
3. Notice of appeal and briefing before the court of appeals if the physician does not prevail
4. Petition for review before the Supreme Court discord can choose whether to hear the appeal.
The Board understands that being the subject of an investigation is both disconcerting and inconvenient, and we appreciate your cooperation over the course of the investigation. Complaints to the Board are an important avenue for members of the public to air their concerns. In addition, complaints can provide a valuable opportunity for licensees to view their practices from a different perspective and, when appropriate, modify and improve certain aspects of conduct or care.