“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
A fundamental tenet of US jurisprudence is equal justice for all. The federal government oversees the National Practitioner Data Bank (NPDB). If a doctor’s carrier pays a settlement or judgment for a professional liability lawsuit, that is reportable to the NPDB. It doesn’t matter whether the payment is $1 or $10M. If you live in a state that is doctor-friendly, the likelihood of being a line item in the NPDB is lower than in states with more hostile medico-legal environments. If you are trying to figure out which of those states you live in, you can just compare professional liability premiums. That will deliver the answer.
There are also differences between states in terms of whether withdrawal of an application for a medical license while under investigation will trigger a NPDB report. Yes, I know. Sounds esoteric.
The rule is this:
If you withdraw a new medical license application while under investigation by that Medical Board, it is NOT reportable.
If you withdraw a renewal medical license application while under investigation by that Medical Board, it IS reportable.
What might trigger an investigation? Well, a complaint to that state’s Board. Or discipline by another state Medical Board. Lots of things.
On the surface, it makes sense. If you are just getting started in a state, and preparing to work there, that state doesn’t really have jurisdiction over you. But, if you already have a track record in that state, the state might assert jurisdiction.
The simplest cases are where a physician has worked in a state for decades. He renews his medical license every year. A patient files a complaint. There is an ongoing investigation. The doctor then submits his renewal application while this investigation is ongoing; or just lets his license lapse – again while the investigation is ongoing.
That is reportable to the NPDB.
Now for a different scenario, that is not so intuitive.
A doctor had a medical license in state A decades ago. He let it lapse after he moved to state B. He has an active license in state B. Been that way for decades. A complaint is filed in state B, and this doctor is disciplined in state B. He then decides he’s had it with state B, and he wants out. He decides to submit an application for a medical license in state A.
On the surface, it seems like a new application. It seems like his old license in state A expired decades ago, right? Hold on.
State A will likely conduct an investigation based on what took place in state B.
If the doctor withdraws his application while the investigation is taking place, is it reportable to the NPDB? Is it considered a new or renewal application? Here, the doctor’s license lapsed decades ago.
Well, each state treats this differently.
In Massachusetts, for example, if an ancient license lapses and one wants to obtain what is ostensibly a “new license” years later, Massachusetts treats this as reviving a lapsed license.
If the Board has reason to believe the lapsed licensee has committed a violation of law or regulation or has deviated from good and acceptable standards of medical practice, the matter will be forwarded to the Enforcement Division. The Enforcement Division will review the lapsed license application and if necessary, investigate the matter as an open complaint. The Board may defer action on the lapsed licensee renewal pending completion of the investigation or 180 days after the Board’s receipt of a complete lapsed license application, whichever is shorter, or, should the Board issue a Statement of Allegations against the lapsed licensee, pending completion of the adjudicatory process by the Board. The 180-day period allowed for investigation shall be extended by any period of time during which the licensee is unavailable or fails to cooperate with the Board. (243 CMR: BOARD OF REGISTRATION IN MEDICINE).
Meaning, in Massachusetts, an old license can be “revived” as part of the application process for what the doctor believed was a new license application. If the application triggers an investigation, and the doctor then withdraws his application, that action will be reported to the NPDB as withdrawal of renewal license while under investigation.
In contrast, in Alaska, this revival of a lapsed license peters out at five years.
To apply for reinstatement of a license that has been lapsed for one to five years, an applicant must continue to qualify for a license and must submit:
-
- A completed application (this is the same form that is used to apply for an initial license)
- Payment of the license renewal fee
- Proof of meeting the continuing medical education requirements
- Clearance from the Federation of State Medical Board (FSMB) and Drug Enforcement Administration (DEA)
- Arrange for verification of licensure to be sent from each state where the applicant is or has been licensed as a physician
- Arranges for verification of hospital privileges to be sent from each hospital where the applicant has held privileges within the past five years.
A license that has been lapsed for five years or more is considered expired and may not be reinstated, an applicant must apply for a new license.
So, Alaska and Massachusetts would treat the original vignette differently. In both states, there may very well be an investigation. But in Alaska, because decades transpired between original licensure and application for the updated license, it would NOT be treated as a renewal application. If the doctor withdraws his application in Alaska while under investigation, decades after his original medical license lapsed, that act should not be reportable to the NPDB.
In contrast, in Massachusetts, the act of applying for an updated license will trigger revival, and be treated as a renewal application, even decades after the original medical license seemingly lapsed. If an investigation is initiated, withdrawal of THAT application, in Massachusetts, will trigger a NPDB report.
Confusing, right?
What’s the take-home message? Before withdrawing an application, consult with knowledgeable counsel on what’s at stake, if anything, with that action. If there’s an ongoing investigation while the application is withdrawn, the outcome may depend upon which state you are in, and your past history with that state.
What do you think?
Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
I have been following your newsletter for years and find it quite good- thank you.
Question about- “If you are trying to figure out which of those states you live in, you can just compare professional liability premiums. That will deliver the answer.”
Do you have a source for medical liability insurance rates by state?
1)The fact that physicians have to hire attorney’s just to figure out licensure issues is in itself insane.
2)The fact that a license that is not renewed remains lapsed in some cases for protracted periods instead of expired, was surprising when I encountered this years ago. This is bizarre because under normal circumstances in other areas of life, not paying renewal fees, causes a subscription to be cancelled. With an insurance policy lack of payment causes the policy to lapse and it can be reinstated if paid within a short period of time, measured in months. Why are medical licenses different? Rules written by bureaucrats.
3)Do any of these things make sense to ordinary people? No. These tangles of rules are meant to confuse and entrap physicians. For those of us that did some locum tenens work, in multiple states, we had to maintain medical licensure for long periods, at great cost, in order to be able to get assignments in a timely fashion. CME special requirements in some states required additional costly separate CME for legislative pet issues. Ex. in KY, there was a requirement that every few years each physician had to take an AIDS 2-3 hours of CME. Did we ever treat HIV. No. Those patients were being seen by their infectious disease specialists. Those of us that never treated HIV, never had to deal with those patients. So why the CME? It was useless, a waste of time, and had no bearing on our specialty specific education needs.
But it was required for renewal of licensure.
4)As far as the NPDB is concerned, is there any documentation that such reporting has saved a single patient’s life from an errant physician.? Have physicians been harmed over and over by such reporting? Of course. A minor complaint that might have been dismissed out of hand in the distant past, was investigated and used as a weapon against physicians, then reported to the data bank. This has resulted in physicians not being able to work. Such reporting is also triggered regarding medical staff privileging.
Interestingly while decades ago medical boards did not talk to each other, now the medical boards communicate actively. Therefore an issue with a physician in one state, is immediately communicated to other states. If the physician fails to notify the other state boards or the NPDB within 30 days, then the physician has violated their rules and is subject to additional sanctions and misery.
4)Do the bar associations in various states function like this? No. The number of incompetent attorneys has been listed as being as high as 30% (former Supreme Court Judge Warren Burger said that). The number of incompetent physicians was listed as being less than 3%.
A tremendous amount of harm, money and anguish has been caused by incompetent attorneys.
But they are held to a far lower standard than physicians, and they get to discipline themselves.
Board of medicine are typically run by attorneys. Are there any physician advocates on boards of medicine? No. There is inherent bias and the presumption of guilt if any physician shows up in front of the medical board. The only exception perhaps is the impaired physician, who is given great leniency by medical boards.
5)Where does the insanity end? We as a society spend a great deal of money training physicians.
But with the legally adversarial system in place at the NPDB and state board of medicine levels, it is easy for a physician to be entangled, difficult to extricate oneself, and often leads to a loss of not only huge amount of income, but also hit with huge fines, and perhaps loss of career. There are instances where for minor complaints physicians have to agree to courses of treatment for substance abuse, even if they have never abused any substance, or they will never get out of the board clutches. There are instances of physicians having to spend 30 days or more in residential treatment facilities or have a gun put to their head of loss of licensure. The physicians legal due process rights are limited.
6)IF any of this happened in a general court system there would be some legal protections.
These are stripped away when one agrees to abide by all terms and conditions imposed by the state boards, upon applying for licensure. Would an attorney allow their client to sign legal papers waiving rights under any other circumstance? Most likely not.
It is important to understand the genesis of the NPDB. Ostensibly it was established to “protect” the public against errant, incompetent physicians. That is a fallacy. The purpose of the NPDB is to “control and punish physicians” who at the time, tended to vote for Republicans.
Congress, at the time of the formation of the NPDB was controlled by powerful Democrats, especially those in California and Leftist states like Oregon. It was easy for Congress, because these political leaders BLAMED physicians for their high salary and “contribution” to the high cost of medical care.
Regulation is a powerful tool for Leftist, Marxist societies. We see this now actively in protests in colleges and the hiring of Leftist professors. Anything that causes disruption of family life contributes to the strength of Marxist changes in society. (This was ordained by Karl Marx).
The fact that it is a confused mess is deliberate also. Nobody really understands the NPDB. It is just a weapon. That was its intention from the start.
The fact that physicians have little, or no power is a direct result of Leftist Democrats. Whom you vote for has a direct implication on your career.
Michael M. Rosenblatt, DPM
This blog includes the significance of dealing with our success through screenings. Eye-opening!
Dr. Rosenblatt:
I always enjoy your commentaries.
It is so sad that medicine has so degenerated under government control.
More laws and more regulations do not make us more safe, or more free, but it does drain funds out of our pocket book.
Retired.