Frequently Asked Questions

Complaints are referred to the Department of Consumer Affairs (DCA), Division of Investigation's field office closest to the area of the state where the incident occurred. The supervising investigator reviews the case and assigns it to an investigator. The investigator determines the proper investigative steps required to thoroughly investigate the complaint.

Complaints alleging negligence that involve patient death or serious bodily injury are given the highest priority. In addition, complaints alleging physician impairment, sexual misconduct or complaints which present immediate concern about patient harm, i.e., injury or death, are considered "high priority cases" and are given priority handling. Investigators are peace officers and have the authority to pursue criminal and administrative violations of the law.

Investigative steps may include, but are not limited to the following:

• Obtaining medical records or other information/evidence
• Locating and interviewing the complainant, any witnesses, and the physician
• Obtaining expert review of the case
• Drafting and serving investigational subpoenas
• Inspecting the location where the allegations occurred
• Executing search warrants
• Conducting undercover operations

In general, after information is collected and compiled and the complainant has been interviewed, the investigator, and perhaps the supervisor or a medical consultant, interviews the physician to discuss the details of the complaint and ask questions.

Quality of care issues are then reviewed by a medical expert. The standard of proof for administrative cases is "clear and convincing evidence to a reasonable certainty," a much higher standard than for civil litigation cases. This can be very challenging when pursuing a complaint because administrative charges must be proven before an administrative law judge who uses this higher and more difficult standard

If the investigation does not support a violation of the law, the complaint is closed. Also, if the evidence obtained in the investigation shows a violation occurred, but the violation is insufficient to support administrative action, the case is closed and maintained on file for future reference. The investigator will notify the complainant and the physician by telephone or in writing of the disposition of the complaint.

If the investigation reveals sufficient evidence of violations of the Medical Practice Act or other laws that would warrant discipline against the license, the case will be referred to the Office of the Attorney General (AG), Health Quality Enforcement Section, for administrative action.

When an investigation is complete, the case is reviewed by the supervising investigator who provides a recommended action to the Board. The Board reviews the investigation and determines whether sufficient evidence exists to support sending the case to the AG's Office for disciplinary action. If the matter warrants disciplinary action, the matter is referred to the AG's Office. If a violation is not substantiated, the case will be closed and the complainant will be notified.

The AG's office determines if an accusation or petition to compel competency, psychological, or physical examination should be filed. The AG's Office reviews the investigation information and determines what charges may be filed based on a review of the evidence obtained. Since every case is unique, the Board and the AG's office will determine the most reasonable and appropriate action to ensure public protection. This process can be complicated and lengthy. Further questions should be directed to the assigned investigator. If the AG's office rejects the case, it will be closed, and the complainant will be notified.

From time to time, patients express concern about the potential for a lawsuit resulting from the initiation and/or participation in an investigation. Civil Code Section 47 provides some protections against a lawsuit, and this issue can be further discussed with the assigned investigator. A copy of this section of law can be obtained from your local library or on the Internet at leginfo.legislature.ca.gov.