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Medical Board Settlement Proposal

Over the weekend I received a certified letter from the medical board with their new settlement proposal – aka proposed Stipulated Order. This morning I met with my lawyer to discuss our options regarding this settlement proposal subsequent to the medical board investigation.

Here is an example of what a Stipulated Order looks like; I found this one online. I’ll share mind with you guys once this case settles.

 

Medical Board Settlement Proposal

This is Deja-vu for me. Just last month I received a disciplinary action letter from my state’s medical board seeking to revoke my license and fine me $10k. I assumed that was the end of my medical career. 

In reply to that letter, my lawyer requested a hearing and demanded all pertinent records that the medical board obtained during their investigation. We didn’t hear back from the medical for nearly a month, until now. 

The medical board has sent me a settlement proposal, what they call a proposed Stipulated Order, which includes the following:

  1. a licensee reprimand
  2. civil penalty of $10k
  3. medical license suspension for 30 days
  4. must abide by all federal/state practice of medicine laws

I’ll break each of this down in a moment. In this settlement letter was included the wording which will be used in my public profile for this reprimand and they also included how and why they came up with this settlement proposal:

  1. unprofessional or dishonorable conduct
  2. willful violation of board order
  3. improper patient-physician relationship
  4. used authority to pressure a nurse 
  5. disruptive physician behavior/lack of respect 
  6. placed my own self-interest above that of the patient’s

 

Meeting with My Lawyer

My lawyer is my age, has a family, competent, confident, efficient, and humble. It’s always a pleasure meeting with him.

He was quite dismayed with the results even though just a month ago I was going to lose my medical license altogether. 

He mostly disagreed with the facts and reasoning used by the medical board to come up with their settlement proposal. Though a 30-day license suspension is much better than having your medical license revoked, it’s no less troublesome. 

My Options

I can right now accept this medical board settlement proposal by signing the document that was mailed to me or I can have my lawyer negotiate the terms of this proposed Stipulated Order on my behalf.  

I immediately wanted to jump on accepting the settlement proposal just to be done with it all. My lawyer explained that accepting the terms could bite me in the ass in the future. 

Negotiating with the Medical Board

The medical board wants to come out looking like they did what they were paid to do – protect the unsuspecting public from rogue physicians such as myself. 

He knows the players on the medical board and knows what we can negotiate and what they won’t budge on. 

You’ll never know what you could have gotten if you don’t ask. Trying to negotiate, if done tactfully, won’t harm me in any way. The only thing I would stand to lose is $300/hour legal fees.

Lawyer’s Suggestion

My lawyer recommended that we don’t try to go to the next step which would be the hearing. The medical board is pissed about my actions and they want blood. Even if we got a favorable hearing from the administrative law judge (ALJ) during that hearing, the medical board can maintain their original position and still suspend me. 

However, he was strongly in favor of me negotiating the 30-day suspension. Let’s go through each item one-by-one and I’ll share what I learned from my own research and from my lawyer. 

If you’re curious what a medical board hearing before an administrative law judge would look like then you can refer to this example I found online.

 

1. Licensee Reprimand

  1. licensee reprimand
  2. civil penalty of $10k
  3. medical license suspension for 30 days
  4. must abide by all federal/state practice of medicine laws

I didn’t know this but the reprimand is the worst of all of these things on the list. It means that what I did was egregious enough that I needed a medical board spanking. It’s the equivalent of having a prison sentence – it’s a permanent quasi-criminal mark on my record. 

My lawyer doesn’t think there is a way to get rid of this unless I am willing to go through the process of a hearing. A hearing would involve hiring our own investigator, subpoenaing records, interviewing witnesses, and rehashing the entire case before an ALJ. I’d rather get my dick caught in my zipper.

Reprimand on my Record

Having a reprimand on your record means that every time you are asked “Have you ever been reprimanded by a medical board” you have to answer yes.

Commonly, you’ll have this question phrased on your credentialing application in the following manner:

Have your medical licenses, privileges, institutional affiliations, health insurance participation, or professional membership)s) ever been, or currently are in the process of being, denied, revoked, suspended, reduced, limited, placed on probation, not renewed, surrendered, investigated, terminated, lost, withdrawn, restricted, reprimanded, disciplined, stipulated, fined, excluded or discharged made subject to a consent order or relinquished?”

With a reprimand on your record you’ll always have to answer yes. Furthermore, a reprimand is public record and is searchable by everyone and anyone.

Discoverable & Reportable

Another problem with this public reprimand is that it’s reported to all the other state medical boards and to all insurance groups and malpractice companies.

I should get ready to wield a ton of inquiries from pretty much everyone and anyone who is involved in me practicing medicine upon the Stipulated Order finalizing.

Each entity will ask me for records, explanations, and can perform their own separate investigation. Fortunately, I am entitled to a due process. That means that before I am terminated from any position, I have the right to explain myself.

Unfortunately, these entities can choose to do whatever they want with this information. Just because I give a good explanation doesn’t mean they have to keep me on as a per diem, an employee, a medical director, or a physician on an insurance group panel.

 

2. Civil Penalty

  1. licensee reprimand
  2. civil penalty of $10k
  3. medical license suspension for 30 days
  4. must abide by all federal/state practice of medicine laws

The more you have to pay for a civil penalty, the worse it will look. It’s best to try to negotiate this down. 

The medical board settlement proposal demands that I pay this sum within 60 days of agreeing to the settlement. At the very least, we’ll ask to break it up into 6 equal payment. Since I won’t have to pay interest on these payments it’ll give me chance to hold on to my money longer.

From a financial perspective, the longer I hold onto my money the more money I’ll make.

 

3. Medical License Suspension

  1. licensee reprimand
  2. civil penalty of $10k
  3. medical license suspension for 30 days
  4. must abide by all federal/state practice of medicine laws

It’s a shit-show. First they wanted to completely revoke my medical license and upon my lawyer protesting, they have proposed to suspend my medical license for 30 days.

A medical license suspension looks terrible no matter how you spin it. It sends the signal that this physician posed a harm or risk to patients or colleagues.

Suspending the Suspension

Unfortunately, fighting the suspension is a very time and money consuming proposition. He recommended we ask for a suspension of the suspension. Meaning, we ask that the medical board delay my medical license suspension. Ideally for up to 2 years but the medical board may only agree to 6 months or not agree at all.

I would have to find a physician colleague who would become my mentor and whom I would need to meet with every few months. This person would then write a report on my behalf to the medical board regularly to demonstrate that I am compliant with the board’s stipulated orders.

I would have to take yet another remediation course, if not several. I may also need a psychiatric evaluation if that’s what the medical board comes back at us with.

Cost & Time Frame

It’s natural to worry that your lawyer will suggest options to you on to pad their wallet.

It’s therefore important that you look for the kind of professional who isn’t desperate for the income. Someone who is good at what they do. The kind of professional who loves what they do more than the money it earns them.

An intelligent consumer would be wise to get all the facts – the pro’s and con’s – and make their own final decision. I haven’t felt any financially motivated pressure from my lawyer thus far.

If anything, he wants me to learn from this and understand why the medical board is trying to punish. He has a genuine interest that I don’t end up in this same role again.

 

4. Abide by all Federal/State Practice of Medicine Laws

  1. licensee reprimand
  2. civil penalty of $10k
  3. medical license suspension for 30 days
  4. must abide by all federal/state practice of medicine laws

Sounds innocuous doesn’t it? It’s not.

This last part of the settlement proposal means that they would have the right to revoke my medical license immediately if I get into any other trouble with the medical board.

Furthermore, this allows them unlimited access into my medical practice, indefinitely. They can audit me, investigate me, and monitor me until the day I give up my medical license.

2nd Strike

Just like criminal offenses, your next offense will weigh more heavily because of your first offense.

This is a big problem because all it would take is a pissed-off patient to report me to the medical board and I would have to deal with the consequences.

 

Wording in my Public Record

We will negotiate with the medical board to change the wording in my public record. The wording is intentionally derogatory and accusatory as a form of punishment.

It’s the US. We love our punishments – the more public the better. There is no justice unless there guilty suffer. I’ll eventually share the wording with my readers but not until this investigation closes.

The medical board has worded my public reprimand to emphasize that I am a male physician, that the patient was a female, that I abused my power as a physician, that I threatened a nurse, and that I benefited from this interaction somehow.

Negotiating the Wording

We read over the wording in detail and dissected it so that we could come up with the best alternative phrasing – something the medical board would accept. There isn’t a lot of negotiation room – in fact, the medical board can outright refuse any alterations altogether.

 

Violating Medical Practice Act

I discussed in previous posts that the Medical Practice Act needs to be violated in order for the medical board to take disciplinary action. I never knew such an act even existed until it was thrown at me.

My state medical board, as I mentioned above, decided that I had the following Medical Practice Act transgressions. This is what led them to impose the proposed Stipulated Order.

  1. unprofessional or dishonorable conduct
  2. willful violation of board order
  3. improper patient-physician relationship
  4. used authority to pressure a nurse 
  5. disruptive physician behavior/lack of respect 
  6. placed my own self-interest above that of the patient’s

 

1. Unprofessional/Dishonorable

My actions were considered unprofessional and dishonorable because I didn’t follow standard protocol with this person/patient.

I placed her at risk by entering a quasi-patient-doctor relationship.

2. Willful Violation of Board Order

Guilty, as charged.

The medical board is rightfully upset because they asked for particular details which I refused to give out the first time around. I later provided them with the facts they asked for but, too late.

Bad idea.

The medical board has the equivalent power of the police and FBI. I should have given those names out right away.

3. Improper Patient-Physician Relationship

By asking the nurse to do a test on that woman I entered a patient-doctor relationship.

Unfortunately, my dear friends, everyone but us gets to decide the nature of the relationship we have with a patient. I explained this to you guys after I completed my Professional Boundaries course.

The best thing I could have done is never gotten into such a scenario in the first place.

4. Use of Authority to Pressure a Nurse

I placed the nurse in a compromising position.

Even though this kind of thing is routine at our medical group, it only mattered that she got fired over it.

Even though I never threatened her or even talked down to her, it doesn’t matter because that’s what she claimed.

5. Disruptive Physician Behavior/Lack of Respect

From reading their explanation on this you would think that I pulled down my pants and painted the waiting room walls with diarrhea. The medical board is upset that I bypassed the standard protocol for my medical group and shortcut the system.

It doesn’t matter that the nurses routinely bombard me with requests on patients who have never gotten checked in. Or for me to sign orders on patients I have never seen. Or to look in the ear of their child or nurse friend from another department.

6. Placing My Self-interest Above the Patient’s

I didn’t get a BJ from this woman. She didn’t pay me any money. I didn’t get a trophy for trying to help her get this test. But for some reason the medical board thinks that I had some motivation that wasn’t sincere.

Their explanation in this regard is vague. But they very clearly insinuate that I had an improper physician-patient relationship with this woman.

 

Next Steps…

My lawyer will enter negotiations with the medical board’s attorney to change some of the wording and try to drop the civil penalty down a little.

Next, the medical board will present me with the final settlement proposal which I must sign unless I want to go to a hearing, which I don’t.

I will then be assigned a case manager or whatever the fuck they are called. It’s basically a person who will be on my side but works for the medical board. They will make sure that over the next few years I comply with the medical board settlement proposal.

Other State Medical Boards

We will report this incidence to the other states where I hold a medical license. They will want to do their own inquiries which means I’ll have to communicate with them through my lawyer.

Current Employers

Depending on the contracts I have with my current telemedicine companies, I might need to let them know that I have been disciplined by the medical board.

Until I sign the settlement proposal and enter the Stipulated Order I don’t have to make any big moves.

Insurance Companies

Most of us don’t know this but during the credentialing process we also become trusted providers for insurance companies. This could be local and private insurance groups or CMS.

I won’t have to notify them but they will likely notify me and allow me the opportunity to defend myself. After a review which may be in person with their risk team or over email, they will determine my fate.

It’s perfectly appropriate for a medical group to refuse to hire me if I cannot get credentialed by an insurance group.

Malpractice Groups

If I can’t get malpractice insurance then I cannot get employed and I wouldn’t be able to see patients.

I can always shop around for my own malpractice policy but a medical group or employer doesn’t have to accept that.

I am also going to guess that this will increase my annual premiums.

Board Certification

Finally, I need to let my professional groups and board certification entities know about this disciplinary action.

I am only board certified through NBPAS. I am curious what they will do with this information. I have a feeling that ABMS would tear me a new one but fortunately I no longer have to deal with them.

7 replies on “Medical Board Settlement Proposal”

The board wants you to understand that being a physician is what defines you and any time you interact with anyone you have to abide by those standards that you gave your oath to in medical school. It might be a good idea to write the board a sincere letter explaining your lack of negligence and the lessons you learned. Since this is your first offense maybe the board will forgive you. I am sure their intention is not out to get you but to mold you into a ‘responsible’ physician. Unless you explain yourself sincerely they won’t know your intentions and the lesson you learnt. A sincere letter won’t hurt.

Your incident reminds me of the perils of being a single male physician. I am a single male physician and I truly believe some of the women employees in the hospital are out to get me. Since I started private practice I’ve been accused of hitting on married nurses and being verbally abusive/bad behaviour. Patently false allegations. It’s very scary…I’ve felt like Kavanaugh a couple of times at work but it sounds like you got grilled just like he did. Hope everything gets worked out for you.

I don’t want to keep working in such a hostile environment so I’m stashing cash at 33 years old for financial independence hopefully in 5-6 years. Great blog

The nurse who got fired made up a lot of lies about me to the medical board which got their antennas up. The initial questions they were asking me were ridiculous – they didn’t want to reveal what the nurse had said but it’s rather obvious when you’re asking certain types of questions of a male doctor. The fact that the patient was a woman didn’t help my case, either. During the investigation they were making statements like “but this woman was rather attractive, you had no relationship with her other than a professional?” Not only was that absurd, it was doubly so because all they had to do is ask that patient and my colleagues and they’d know that I’m an altar boy at work. But, just like you, it burns me royally that this entire situation dwindled down to me having a penis. I now imagine how easy it would be for anyone to come along and make a claim against me – I’m a target forever.
I’m sure what burns you as much as it does me is that I’ve never had a history of fucking a coworker or patient. I’ve never flirted with nurses and I’ve never lost my shit on anyone at work. But none of that matters. It’s as if everything I did in the past is ignored which is something I’ve had the toughest time with. Like, why bother. Dunno, it’s a massive sore spot for me still so maybe I’ll stop being so butt hurt about it. My brother in law is a doctor and he’s actually way more handsome than me and so he’s had a lot more female related issues to deal with. That smart motherfucker started his own practice and has an associate running it – he himself doesn’t see any patients and stays home collecting a paycheck. I like it.

You had mentioned in a previous article about getting a private health insurance, that you would depend on getting curbside consults from your colleagues and were surprised at one of your colleagues reluctance to do the same.
Hope you understand now, that you are putting your colleagues into a compromising position by doing that. You yourself followed your advice and got into trouble.
I know, Hippocrates wanted us to give freely to our colleagues, but try to go and tell our twisted Medical Boards that.

Being a doctor means you’re constantly placing yourself in compromising positions; otherwise there would be no lawsuits or the need for a jury or medical board second guess our decisions. My colleagues are grown adults and physicians at that – they know how to make their best decisions and they come to me as much as I got to them for advice. It’s how we look out for each other. What kind of fearful life would that be if you’re constantly afraid of some bad outcome from doing the right thing?

I’m a family doc who found this site researching practicing in New Zealand. I have no blemishes on my record, but am looking to escape the insanity of the modern US. On a tangent…after reading all this…I realize that these posts are on state medical boards, but I’m reminded of the pit in my stomach sensation I had when I went back to my first AAFP (American Academy of Family Physicians) week-long board review course.

Man-o-man I wish 60 Minutes or some similar news expose program would send in a secret cameraman to videotape the absolute idriocracy demonstrated by all the practicing physicians who are present. Record all of the inane questions, absolutely stupid comments that ordinary reflect a physician who should not be practicing medicine. I don’t mean the “there’s no such thing as a stupid question” kind of stuff…I mean the kind of questions that come from people who don’t seem to be on board with germ theory kind-of-thing.

Medical boards are not about clinical competency….they just play whack-a-mole in response to any complaint. Sure, some moles need to be wacked, but how ironic it is that people who dedicated tens of thousands of hours of study before being granted a license to help people with problems…are thrown under a bus when they have a problem themselves.

Only a sadistic parent or friend would allow a loved one to go into medicine. Otherwise, stay away from women at work (I’m not religious, but Mike Pence’s biblical approach is about the only way to avoid frivolous lawsuits….until of course Mrs. Pense has a hormone change and utilizes no-fault laws to come up with her own frivolous complaint).

When I first read your comment my first impulse was to defend medicine a little. I read your comment the following day and I can’t disagree with you, even though I desperately want to. It makes no sense to make physicians such easy targets. It makes even less sense to restrict a physician’s license in any way unless they did something so fucking egregious that they should be behind bars.
Imagine if every person who ever got a parking ticket, a speeding ticket, an overdraft fine, or a credit delinquency had that marked on their record permanently. They wouldn’t be able to compete in the marketplace and they’d be forced to the sidelines. And we all know what happens on the sidelines.
I think we become complacent as physicians after a few decades of practice. We become robots and show up to work and just do what we’re supposed to. I have some very intelligent physician colleagues who even have gone back to get functional medicine/integrative medicine fellowships and their common sense is lacking. Not because they are stupid but because we have been forced into a mode of practice which requires very little exercise of our brains. New onset headache = CT. Strep throat = penicillin. Uncontrolled pain = opioids. Where is the incentive to do anything different from this? Why bother having an intelligent conversation with a family who is genuinely wondering if their kids should be immunized?
For a while I thought that I’m among the few who feels that way. And yet every one of my physician colleagues tells me that they would get out of medicine if they were overnight multi-millionaires. Nobody says that they’d use the extra time to go learn more about medicine and take courses and become even better physicians. There is no such thing any more as being a ‘better’ physician. Other docs just get chubbies when they hear a colleague spew off research paper after research paper. Or if they have the whole workup for an elevated ANA memorized. Any art left in medicine is practiced behind closed doors, quietly, as far as possible away from the reaches of the medical boards. And it often involves non-traditional medical care and off-label usage of medications.
You said something interesting about the insanity of modern US … I kinda feel as though the same stressed out culture we’ve adopted in the US is the same tragedy I’m witnessing in medicine. A country built on freedom has become anything but. Living with all this fear, impending doom, worried about a collapse… that’s not living. Let people live and most will do the right thing. Let people work and most will do the right thing. Instead of micromanaging everything, just enforce the laws from the top down.
Freedom of speech, motherfucker please! I had to answer for my opinions which I wrote publicly on this website before a judge in a medical board hearing. It was used against me by the California Medical Board to make their case.

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