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