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Overview of the Disciplinary Process
Each year approximately 800 complaints are made against Colorado physicians and physician assistants. The Medical Board relies on patients and their families, medical professionals, specialty societies and other government and law enforcement agencies to bring to the attention of the Board specific cases where issues of poor or questionable medical care are raised.
Each complaint is reviewed and investigated by an Inquiry Panel of the Board. The Board provides the practitioner with a copy of the complaint and the practitioner must respond in writing. The Inquiry Panel often obtains a copy of the pertinent medical or office records and may request that Division investigators interview witnesses or have cases reviewed by specialty experts. The Board has jurisdiction to take disciplinary action if it ultimately finds that the licensee has violated the Medical Practice Act.
Following are the actions that the Board may take following initial review of the complaint:
- The Inquiry
Panel may dismiss the complaint if it finds that the physician's
actions are either not in violation of the MPA or not within the
Board's jurisdiction to review.
- The Inquiry
Panel may seek additional information by referring the case to
the Division's Office of Investigations.
- The Inquiry Panel may pursue disciplinary action. This may include letters of admonition, probations, suspensions, stipulations (negotiated agreements) in which the practitioner agrees to complete specific requirements or refrain from particular acts or behavior, and lastly, revocation of the practitioner's license.
In cases where the Inquiry Panel is unable to resolve the complaint with the physician, or revocation of the physician's license is the desired outcome, the case is referred to the Attorney General's Office for filing of a formal complaint with the Division of Administrative Hearings. These cases are often taken to a hearing wherein evidence is presented and testimony of witnesses and experts is taken. A decision is rendered by an Administrative Law Judge and the case is forwarded to a Hearing Panel of the Board. The Hearing Panel, made up of different members of the Board than the Inquiry Panel, makes the final decision as to whether or not discipline is appropriate and the terms of the sanction or discipline.
The Board is able to resolve the majority of complaints within six months. Those complaints which are referred for a formal investigation or are sent to the Colorado Attorney General's Office for initiation of legal proceedings against the practitioner require significantly more time before final resolution of the complaint is reached. The Board does not represent private citizens who seek to recover fees paid or remuneration for injuries. Nor can the BME give legal advice to individuals about their rights in civil cases. A legal action to recover money damages from a practitioner is separate from a BME proceeding. You may wish to consult a private attorney about your legal rights and remedies.
Physicians who are placed on probation are monitored through a system of reports provided by practice reviewers, treatment programs and therapists. With the assistance of these parties, the Board receives regular assurances that a physician on probation is practicing safely and in accordance with generally accepted standards.
Consumer Guide to Filing a Complaint with the Medical Board
The Colorado Board of Medical Examiners (BME) is divided into two panels with seven members (four physicians and two public members) on each panel.
Each year over 700 complaints are made against Colorado physicians and physician assistants. Each complaint is reviewed by a panel designated as the Inquiry Panel.
Consumers are encouraged to use the Complaint Form when filing a complaint. This provides a convenient format to assist the BME in obtaining accurate and complete information. Because of the large number of complaints, please type or print your complaint.
The complaint form asks for the following information:
- Name and address of the practitioner against whom the complaint is being filed.
- Name, address and telephone number of the person filing the complaint. If the complaint is being filed on behalf of the patient, provide the name, address and telephone number of that individual and include your relationship to the patient (son, daughter, father, mother, etc.)
- Approximate dates of treatment.
- Details of your complaint. Clearly and concisely, describe the nature of your complaint on a separate sheet of paper.
- Your signature
in the authorization section of the complaint form. This
allows the BME to obtain your patient records from the practitioner
and from any other treating health care professionals or facilities.
- Copies of documents supporting your complaint should be included. Do not send originals. This material should include treatment records (if you have them), correspondence, promotional or instructional materials and anything else you believe relevant to your complaint.
Defining Unprofessional Conduct
Nearly all complaints received each year allege some violation of the Medical Practice Act. The Practice Act "defines" what the Board may consider unprofessional conduct. It is very specific in some respects, and allows the Board members considerable leeway in others. Conviction of a felony, committing a fraudulent insurance act, advertising in a manner that is misleading, deceptive, or false are all examples of unprofessional conduct which are clearly spelled out in the statute.
The Board most frequently receives complaints from patients and families who allege that a physician did not provide appropriate medical treatment to the patient. This is defined in the Medical Practice Act as "Any act or omission which fails to meet generally accepted standards of medical practice." Reliance must be placed upon the physician Board members to use their medical knowledge and experience to determine if the care did, or did not meet "generally accepted standards." Making this decision is often a difficult task as medicine is not always an exact science and medical knowledge is constantly changing. Board members may call upon the expertise of a specialist or consultant when investigating the complaint.
Some additional examples of frequently alleged unprofessional conduct include:
- Resorting
to fraud or deception in applying for or renewing a medical license
- Habitual
intemperance or excessive use of any habit-forming drug
- A physical
or mental disability which renders the licensee unable to practice
medicine with skill and safety
- Engaging
in a sexual act with a patient during the course of patient care
or within six months immediately following the termination of
the physician/patient relationship
- Prescribing,
distributing, or giving to a family member or to oneself (except
in an emergency) any controlled substance on the Drug Enforcement
Administration's Schedule II list.
The definition of "unprofessional conduct" may be found in Section 12-36-117 of the Colorado Revised Statutes and in other selected portions of the Medical Practice Act.
Jurisdiction of the BME and Fee Disputes
The BME has jurisdiction to discipline physicians and physician assistants. It also has the power to take legal action against any person practicing medicine without a license to do so.
Discipline may be imposed only for conduct that violates the Medical Practice Act (MPA) or rules of the board. Examples of unprofessional conduct include substandard care, sexual contact with a patient, abuse of drugs or alcohol, falsifying patient records, insurance fraud, and not having the malpractice insurance required by law. Conviction or pleading guilty to a felony or to certain other crimes is also considered unprofessional conduct.
The BME does not have jurisdiction to take action regarding fee disputes between a patient and a practitioner or insurance company.
The BME does not represent private citizens who seek to recover fees paid or remedies for injuries. Nor can the BME give legal advice to individuals about their rights. A legal action to recover money damages from a practitioner is separate from a BME proceeding. You may consult a private attorney about your legal rights and legal remedies.
The BME will provide the practitioner with a copy of the complaint. The practitioner must respond in writing, and may be asked to provide a copy of your medical records.
Upon receipt of the practitioner's response, the complaint is reviewed by the Inquiry Panel. The Inquiry Panel may resolve the case then or it may refer the case to the Office of Investigations of the Department of Regulatory Agencies for investigation. This investigation may include review by an outside consultant or specialist with expertise in a particular field of medicine. The investigator obtains relevant documents and may interview the complainant, the practitioner, and other relevant witnesses.
After C&I submits a report of its investigation, the case is reviewed by the same Inquiry Panel to decide what action to take. This review, conducted with the assistance of an Assistant Attorney General, is confidential and not open to the public.
What action might be taken by the Board?
The BME has jurisdiction to take disciplinary action only if it ultimately finds that the licensee has violated the Medical Practice Act.
The following actions may be taken by the BME:
Dismissal
of the complaint. The BME may dismiss the complaint. In some
cases the BME may dismiss the complaint with a confidential "letter
of concern" to the practitioner. Colorado law prohibits disclosure
of the letter of concern to the complainant.
Disciplinary Actions:
- Letter of Admonition. A reprimand against the practitioner.
- Probation. When probation is ordered, the practitioner's practice is usually monitored for quality of care. The BME may also require the practitioner to have medical or psychiatric treatment, to take medical education courses, or to restrict the practitioner's scope of practice.
- Suspension of the license. A suspension may be for a definite or indefinite period of time.
- Revocation of the license.
- Stipulations. In most cases, the practitioner will consent to imposition of discipline by entering into a written agreement called a stipulation. The stipulation may impose any of the forms of discipline listed above.
All of the public disciplinary actions are reported to the National Practitioner Data Bank. The National Practitioner Data Bank is a central repository of information on practitioners. By federal law, access to this data bank is limited.
Due Process Rights of a Licensee
Whether an immediate suspension of a practitioner's license has been imposed or not, the practitioner has the right to a formal hearing. Hearings for the BME are conducted by an Administrative Law Judge (ALJ) from the Division of Administrative Hearings (DOAH). At hearing, witnesses and evidence may be presented by the Attorney General on behalf of the Board as well as by the licensee. The licensee may be represented by an attorney.
In DOAH cases, the ALJ writes an Initial Decision which makes findings on credibility of witnesses, facts, conclusions of law, and recommends disciplinary sanctions. The ALJ's findings and recommendations may then be affirmed, modified or rejected by the Hearing Panel of the BME. The Hearing Panel is composed of the five board members who were not on the Inquiry Panel that investigated the complaint. The action of the Hearing Panel becomes a Formal Order of the BME. The Formal Order is a permanent public record. The practitioner has the right to appeal a Formal Order to the Colorado Court of Appeals.
How long until I find out what happened to my complaint?
The BME is able to resolve the majority of complaints within six months. Those complaints which are referred for a formal investigation or sent to the Colorado Attorney General's Office for initiation of legal proceedings against the practitioner, require significantly more time before final resolution of the complaint is reached.
Please be aware, however, that the BME will notify you in writing if your complaint is being sent to the Office of Investigations or the Attorney General's Office.
Confidentiality of Patient Names and Records
During the investigation of a complaint, the identity of the patient and medical records are available only to persons who need that information to review or respond to the complaint, or to attorneys who represent the BME or the practitioner. Any document, such as a Formal Complaint or Stipulation, which is available to the public, identifies patients only by their initials or by numbers. A patient's medical records are never made available to the public or the media.
My complaint was assigned to an investigator. Why did that happen and what will the investigator do?
If your case is assigned to an investigator, it means that the Board desires more information before making a decision about the complaint. Visit the Office of Investigations website for additional information.
Staff members who process complaints against physicians:
- June Nieto (303) 894-7598; june.nieto@dora.state.co.us
- Ginny Swem (303) 894-7477; ginny.swem@dora.state.co.us
- Lorraine Lucero (303) 894-7713; lorraine.lucero@dora.state.co.us
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