Complaint Review Process

The Medical Board receives more than 8,000 complaints each year from a variety of sources (e.g., patients, family members, insurance companies, other health care practitioners, etc.). The Central Complaint Unit (CCU), part of the Enforcement Program, is responsible for the initial intake and review of all the complaints received to determine if there may have been a violation of the Medical Practice Act which warrants further investigation.

Listed below is a general description of the process used by the Central Complaint Unit to review complaints and determine which complaints should be forwarded to our district offices for investigation. This information is only intended to be a general outline of the process used by the Board as the unique nature of each complaint may require variations on the review process. This brief explanation is intended to assist physicians in understanding the complaint review process as well as alleviate some of the anxiety a physician may feel when contacted by the Board.

CCU staff review all new complaints to determine the nature of the allegations and whether the complaint falls within the Board's jurisdiction. Complaints alleging that the care and treatment provided by the physician were not appropriate are among the more common complaints received by the Board. To review these complaints, Board staff will request copies of the patient's medical records and a written summary from the physician along with any other relevant information (e.g. records from subsequent treating physicians). When CCU staff contacts the physician for a response to the complaint, a summary of the complaint allegations will be provided to help the physician respond appropriately. Business and Professions Code Section 800(c) states a licensee is entitled to full disclosure of information that could be used by the Board to make a determination that would affect the licensee's rights or privileges. If the physician would like to request a complaint summary directly from the Medical Board, the request should be directed to the Central Complaint Unit and mailed to the Medical Board, 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815 or faxed to (916) 263-2435.

Once all pertinent information has been received in CCU, the complaint is forwarded to a medical consultant for review. A medical consultant is a physician with the pertinent education, training and expertise to evaluate the specific standard of care issues raised by the complaint. The medical consultant reviews all information provided to determine if there has been a departure from the standard of care in the medical community in the care and treatment provided to the patient. If no departure is found, the complaint will be closed and maintained on file for one year. If a simple departure is found, the complaint may be closed and maintained on file for five years. If the complaint is closed in CCU, the physician and the complainant will be notified in writing.

If the consultant determines the complaint warrants further review, the complaint will be forwarded to one of the Board's district offices for further investigation. The physician will be contacted by an investigator to schedule an interview so that a more thorough review can be conducted. When all relevant information has been obtained by the investigator, a second review by a physician expert (Expert Reviewer) will be performed. When the investigation has been concluded, notification of the results will be sent to both the physician and complainant.

The flow chart entitled Enforcement Process provides additional information on the process used to review and investigate complaints.