Complaint Review Process
The Medical Board receives more than 10,000 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 laws governing the profession 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.
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 licensee 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 licensee along with any other relevant information (e.g. records from subsequent treating physicians). When CCU staff contacts the licensee for a response to the complaint, a summary of the complaint allegations will be provided to help the licensee respond appropriately. Business and Professions Code Section 800(c) authorizes the Board to provide a summary of the substance of the complaint material to the licensee upon receipt of a written request. If the licensee would like to request a complaint summary directly from the Medical Board, the request should be directed to CCU and mailed to the
ATTN: Central Complaint Unit
2005 Evergreen Street, Suite 1200
Sacramento, CA 95815
via email to firstname.lastname@example.org
or faxed to (916) 263-2435.
Once all pertinent information has been received in CCU, the Board staff will analyze the information to determine if there is sufficient evidence for referral to a medical consultant. If referral to a medical consultant is warranted, the complaint is forwarded to a consultant for a thorough review. If no violation is found, or the Board finds insufficient evidence, the complaint will be closed and you will be notified. If a medical consultant determines that a violation may have occurred and more investigation is needed, the matter is referred to the Division of Investigation, Health Quality Investigation Unit (HQIU) within the Department of Consumer Affairs. Complaints that are of an urgent nature (i.e., sexual misconduct, physician impairment, etc.) may be referred immediately for investigation by HQIU. You will receive a letter from the Board if your complaint is referred to HQIU for further investigation. The investigation process is lengthy and thorough, and, consistent with due process of law, is conducted in an ethical manner to determine whether the Board can prove that a violation occurred by “clear and convincing evidence.” During the investigation, you may be contacted if the investigator needs additional information. If after investigation the Board determines that disciplinary action is not warranted, or the allegations cannot be proven, the case will be closed. However, if action is warranted, an accusation, which is a charging document identifying the allegations against the medical provider, will be filed by the Attorney General’s Office (AGO). The Board will send you a letter informing you if your complaint has been closed or referred to the AGO to determine whether an accusation should be filed against the provider.
The Enforcement Process
- B&P Code mandated reports
- Licensee/Professional Group
- Governmental Group
Central Complaint Unit (CCU)
Complaint Unit Analyst reviews the complaint to determine:
- If immediate investigation is needed. If yes, refer complaint to Investigation.
- If more information is needed, the Complaint Unit Analyst requests this from the complainant.
- Whether the complaint is within the Board’s jurisdiction. If not, it is referred to the appropriate agency.
- Whether the complaint involves care and treatment provided by the licensee. If so, medical records are obtained and a medical consultant reviews.
- Whether a minor violation of the laws governing the profession has occurred (e.g., failure to provide patient records, misleading advertisement, dispensing violations, etc.). If so, the licensee is then contacted and advised of the violation to bring him or her into compliance, or the matter is referred for a cite and fine.
- If the complaint may be mediated at this point if that is appropriate. If no apparent violation is found, the case may be closed.
Department Of Investigation/Health Quality Investigative Unit (HQIU)
The matter is sent for further investigation to determine if a violation exists.
- Closed, but retained for one year if a violation could not be confirmed.
- Closed, but retained for five years because the complaint is found to have some merit, but insufficient evidence is found to take action against the licensee.
- Referred to the Attorney General’s Health Quality Enforcement Section for determination whether to initiate disciplinary action.
- Referred for other disciplinary, nondisciplinary, or criminal action.
Citation & Fine Program
Minor violations of the laws governing the profession may result in administrative citation and fine rather than formal accusation and disciplinary action.
If he or she believes the case can pass the legal standard, a Deputy Attorney General drafts formal charges (accusation), and a hearing may be scheduled. During pre-hearing conferences, a stipulated settlement (plea bargain) of the charges/penalties may be accepted by both sides; if this occurs, no hearing is needed. The Board may direct the Attorney General to file a petition to compel the licensee to submit to a competency examination or a psychiatric examination in lieu of, or preceding the filing of, an Accusation.
A completed investigation may be referred to a local district attorney for prosecution of suspected criminal violations.
If the licensee contests the charges, the case is heard by an Administrative Law Judge (ALJ), who then drafts a proposed decision. The proposed decision is reviewed by a panel of the Board, who have the option to:
- Adopt the decision as proposed.
- Reduce the penalty and adopt the decision.
- Increase the penalty and adopt the decision. In this instance, the panel members must read the entire record of the hearing prior to acting. The licensee is given the opportunity to submit written and oral arguments.
Licensees may petition the Board for reconsideration of a decision up to 30 days after it is adopted. Thereafter, licensees may petition the Board for reinstatement of a revoked license, reduction of terms of penalty, or termination of a period of probation. Various time periods apply before petitions can be filed with the Board.
Final decisions may be appealed to the Superior Court, the District Court of Appeal, and to the California Supreme Court.