Civil complaints can arise when a patient feels as if they have been mistreated according to the “standard of care”. Some patients have legitimate cases, yet there are other people who are looking for a possible lawsuit. This paper will explore the process for filing a civil complaint against a physician. This paper will discuss what patients and consumers will use in the event of suspected misconduct or possible incompetence. It will also explore the roles of the respective regulatory agencies in investigating allegations and determining and applying any appropriate disciplinary actions.
It will also identify any potential criminal liability that might result to the health care professional relative to abuses perpetrated in practices involving procedures, as well as professional misconduct, and explore the events the follow in the event that criminal charges are filed for the described criminal behavior. Physicians are essential, vital, and costly elements of the health care system. The role of a physician is to not only evaluate, treat, and care for patients; it has also become a coordinator and healthcare coach.
Physicians provide care and treatment for individual patients according to their medical history by using the decision-making technique. The decision-making technique helps the physician make the right choice for the patient by identifying facts related to the patient’s case, develop relevant diagnoses, and prescribe and implement the treatment(s) accordingly. As the health care profession evolves, the responsibilities of physicians changed from less physician-patient interaction to more management type work.
Technology is changing each day and it is also the physician’s responsibility to keep up with it. New technology means, new medical information, diagnoses, and treatments. A civil complaint can be filed against a physician for malpractice action. Physician malpractice actions include but is not limited to: impairment of ability to practice due to drug or alcohol abuse, or due to physical or mental illness, failing to meet minimal standards of care in reating patients, prescribing drugs in an inappropriate manner or without legitimate reason, inappropriate sexual conduct, conviction of a misdememeanor in the course of practice or conviction of a felony, falsifying information or fraud, performing duties beyond the scope of a license, and failing to meet continuing medical education requirements (The Medical Board of California, 2010).
The process in which to file a civil complaint against a physician is to first contact the facility’s medical board. If the complaint is within jurisdiction, within the seven year time frame, and shows evidence of breach of duty, causation, and harm or injury, the person who complained will receive an acknowledgement letter advising them that the board has received their complaint and that it will be forwarded to an analyst for review.
If the complaint concerns the care and treatment received, copies of the medical records will be requested by the analyst and a written summary of their care from the physician, along with the authorization for release of medical information. The analyst will contact any subsequent physician(s) listed on the authorization forms. When all requested documents have been received, the person who complained with received a notice stating that all their information including the complaint(s) has been sent to medical consultants for review.
The reviews are completed by physicians practicing in the same medical specialty. The person who complained will be notified by the analyst handling the complaint (The Medical Board of California, 2010). There is not a specific time frame in which the process of evaluating a complaint will take. That information varies depending on the number of cases that are handled by the medical consultants. The time is also determined by the complexity of the complaint. It can take several days to several months to review and/or resolve a complaint.
The person who is making the complaint will not be disclosed to the physician the complaint is against when retrieving all the necessary medical information for evaluation (The Medical Board of California, 2010). The primary role of the Medical Consultant at any healthcare facility is to provide an unbiased, objective and comprehensive evaluation of the complaints received by the Board to determine whether the care and treatment provided by the physician was within the standard of practice.
During the evaluation process, medical records that are relevant to the complaint are requested and review by the medical consultant. After reviewing all the relevant material the consultant determines if there is a need for a formal investigation by the Board investigative staff or if the complaint is can be resolved by a preliminary review of the medical records and the accompanying physician narrative statement. Medical Consultants are employed by the healthcare facility as independent contractors.
The consultants do not hold salary based positions with the healthcare facility. Qualifying candidates for a Medical Consultant position must have a currant, valid medical license issued by the Medical Board in the state in which they are practicing, has to have the ability to maintain a high level of confidentiality, has to have the ability to provide objective and an unbiased evaluation, and has to have the ability to articulate and to legibly document findings.
Other desired qualifications are to have a currant and active practice or retired for fewer than five years, a minimum of three years in practice, Board certified, and peer review experience (The Medical Board of California, 2010). Physicians would have to face criminal liability if the Board and Medical Consultants determine that they are in negligence, gross negligence, malpractice or any other crime was committed in the complaint. These crimes can be punishable by a fine, imprisonment, and/or loss of medical licenses.
Negligence is the misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. This includes the professional putting another patient at risk or harm. Gross negligence involves the extreme lack of knowledge, skill, or decision making that the physician clearly should have known would put others at risk for harm (Bermand, Ph. D, RN, AOCN, Snyder, EdD, RN, & Kozier, MN, RN, 2008). When the Board and Medical Consultant make the decision to send the complaint to the Board investigative member, it will most likely result into a trial or out of court settlement.
If the case goes to trial a jury is chosen and all aspect of a trial such as jury selection, opening statements, plaintiff’s case presented along with cross-examination, defendant’s case presented along with cross-examination, closing statements, a jury deliberation and verdict (Bermand, Ph. D, RN, AOCN, Snyder, EdD, RN, & Kozier, MN, RN, 2008). If this case is proven to result in criminal penalties the physician should be aware of anticipated fines, imprisonment, financial restitution, and loss of medical practicing licenses (Tenpas, 2000).
A civil Compliant can sometimes result in something that can be resolved by the healthcare facility and other times result into something resulting in court hearings. A patient must prove that there is a breach on duty, causation, and damages before the complaint can go any further. Not all civil complaint results in settlements or court hearing. Some complaints are dismissed by the Board because they lack cause. A lot of aspects are considered when reviewing civil complaint, after all, a physician’s medical license is on the line.
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