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Overview of complaint review process


I. INTRODUCTION

A. The Board of Medical Practice

1. The Board of Medical Practice (BMP or Board) consists of sixteen Board members appointed by the Governor; nine Board members must be doctors of medicine, one Board member must be an osteopath, and five members must be public members.

2. The Board regulates physicians, acupuncturists, physician assistants, athletic trainers, and respiratory care practitioners. The Board approves licenses or registrations for these individuals, and also decides when to impose disciplinary action.

B. Board Staff

The staff of the Board of Medical Practice are employees of the State of Minnesota who handle the day to day operations of the Board. Approximately 30 people are employed to gather licensing and complaint information for the Board's review and to handle administrative functions.

II. PROTOCOL FOR COMPLAINT PROCESSING

A. Complaints and Reports:

Information regarding physicians who may be in violation of the Minnesota Medical Practice Act (Minn. Stat. 147), comes to the attention of the Board through written complaints/reports. Complaints/reports may be filed by anyone. Complaints and reports are not public information and may not be discussed with anyone except the respondent (subject of the investigaton) and the complainant or reporter. The only exception is that the alleged victim of sexual misconduct, even if not a complainant, may be furnished a description of the actions of the Board relating to that complaint. The Board is mandated to investigate all jurisdictional complaints against individuals it regulates. In other words, if the complaint alleges a violation of the Medical Practice Act, the complaint will be investigated. An example of a non-jurisdicational complaint is one which alleges an excessive fee for services performed. The Board does not have the authority to determine how much a physician charges for services. Health care professionals and facilities are required by law to report conduct which may be grounds for disciplinary action under the Medical Practice Act. Minn. Stat. `147.111 describes the reporting obligations for licensed health professionals. Minn. Stat. `147A.14 describes the reporting requirements for Physician Assistants.

B. File Set up and Assignment:

1. Set Up: When a jurisdictional complaint is received, a file is assigned to an analyst who will have responsibility for that file until no further action is required.

2. Statute of Limitations: Effective August 1, 1996, the Board must commence proceedings against a respondent within seven years from the date of the commission of some portion of the alleged misconduct. Alleged violations of Minn. Stat. `147.091, Subd. 1(t), sexual misconduct, are not subject to the statute of limitations.

3. Beginning the Investigation: For most complaints, the analyst will obtain a response from the respondent and all pertinent medical records. Complaints alleging sexual misconduct must, by law, be investigated by the Minnesota Attorney General's Office. The completed investigation will be returned to the Board for appropriate follow up. Allegations of active chemical dependency or mental/physical illness presenting an imminent danger to the public are investigated on an individual basis.

4. Medical Coordinator Function:

a. The Medical Coordinator (MC) is a licensed physician. The MC is not a full time employee; rather, the MC usually works at Board offices once a week for several hours. The MC reviews complaints and provides medical expertise. In most cases, the MC will review complaints prior to review by the Complaint Review Committee (CRC).

b. Once the analyst feels the investigative information is complete, the information is sent to the MC. The MC may request additional investigation, or the MC may deem the matter ready for review by the CRC.

c. The MC conducts Medical Coordinator Conferences at the request of the CRC. These are informal meetings between the physician and the MC. The MC may recommend the file be closed after the meeting or suggest other action.

5. Outside Consultant Reviews: The Medical Coordinator, CRC, or the AGO may request that a consultant review the complaint material to determine if the physician's care met the minimum standard of care.

6. Triage: Most complaints are initially presented to the CRC during triage. During triage, the CRC will determine if a complaint should be closed or if further follow up is required. Triage is part of the monthly CRC meetings.

7. Closing the Complaint--When to Close:

a. One or more CRC members decides a matter is non-jurisdictional.

b. Two or more CRC members vote to dismiss after triage, after a discussion, or after an appearance.

c. The medical coordinator recommends closing after conducting a MCC at the CRC's request.

d. The physician's license is cancelled after two years of non-renewal.

e. The tax clearance certificate is received.

f. The respondent completes the requirements of his/her Agreement for Corrective Action and the CRC votes to dismiss.

g. The Board approves a Stipulation and Order.

C. Complaint Review Committee Meetings:

1. The Complaint Review Committee

a. A Complaint Review Committee is comprised of three Board members who have agreed to serve on the Committee and are appointed for a one year term. At the end of the term, a committee member may be re-appointed and there is no limit to the number of terms a Board member may serve.

b. Each CRC is composed of two physician Board members and one public Board member.

c. Because of the number of complaints received and processed by the Board each year, it is usually necessary that two or more CRCs exist at any given time.

d. Each CRC meets once per month (usually) to decide triage, discuss pending disciplinary offers and petitions, and to meet with respondents who have been asked to appear before the CRC.

2. Outcomes of Discussions and Appearances:

a. Dismissal. The Committee may choose to dismiss the complaint and so inform the respondent. A dismissal requires the agreement of at least two Committee members.

b. Continue, pending further investigation or some other specified action.

c. Corrective Action. The Committee may recommend that the respondent enter into an Agreement for Corrective Action. This Agreement is a contract between the Committee and the respondent in which the respondent agrees to take certain remedial action, usually educational, to correct problems identified in the Complaint Review process.

Corrective action is not disciplinary action, but it is a public document. The Agreement is ratified by the Committee chair and does not require action by the full Board.

d. Disciplinary Action:

(1) The Committee may recommend that the respondent's license be conditioned or restricted.

(2) Should the Committee determine that the respondent's license be restricted or suspended, or if it feels a written reprimand is warranted, it will generally first offer to impose the disciplinary action by Stipulation and Order.

(3) The Committee may recommend that the respondent's license be immediately suspended. If the Board approves the summary suspension, based on a finding that the respondent has violated the Medical Practice Act and the respondent's continued practice creates a serious risk of harm to the public, the respondent is entitled to a hearing within 30 days of the issuance of the suspension order.

III. THE STIPULATION AND ORDER

A. Generally

1. The Stipulation is an agreement between the respondent and the Complaint Review Committee in which the respondent agrees that certain restrictions should be imposed on their medical license as a result of the Committee having identified areas in which the respondent violated the Medical Practice Act.

2. The Order is issued by the full Board when it has reviewed and ratified the Stipulation between the CRC and the respondent. The Order implements the terms of the Stipulation. The Stipulation and Order are incorporated into one written instrument.

3. When the CRC finds the respondent is in violation of the Medical Practice Act, it will ask the respondent to voluntarily enter into a Stipulation and Order to place restrictions on their medical license.

4. Should the respondent refuse to agree to stipulate to the restrictions offered by the CRC, or, if the full Board rejects the proposed Stipulation and Order, the matter may proceed to a contested case hearing initiated under the Administrative Procedures Act. The Administrative Hearing is held before an Administrative Law Judge (ALJ) and involves the presentation of testimony and submission of exhibits in a manner similar to a civil trial.

If the CRC is successful at the Contested Case Hearing, the ALJ will indicate that the Board's position is correct and make a recommendation which will be limited to "discipline" or "no discipline." After reviewing the ALJ report, the Board may issue a Findings of Fact, Conclusions of Law and Order, which describes the disciplinary action taken against the respondent.

IV. OTHER REGULATED PROFESSIONS

A. Additional Professions: In addition to licensing and regulating physicians, the Board's jurisdiction extends to the registration of Respiratory Care Practitioners (RCPs), Physician Assistants (PAs), Athletic Trainers (ATs), and licensure of Acupuncturists (APs).

B. Complaint Processing: Complaints against allied health professionals are handled in much the same way as complaints against physicians. The primary difference is that prior to triage, the complaint should be forwarded to the registrant's Work Group or Advisory Council. After the Group or Council has met and discussed the case, its recommendation is included with the information reviewed by the CRC at triage.

C. Appearances: A member from the respondent's Work Group or Advisory Council will usually attend the respondent's appearance before the Complaint Review Committee.

V. HEALTH PROFESSIONALS SERVICE PROGRAM:

A. Description: In 1994, legislation for the Health Professionals Services Program (HPSP), Minn. Stat. ``214.31-214.37, was approved. HPSP serves several boards, including the Board of Medical Practice. HPSP is a non-disciplinary approach to monitoring physicians who are unable to practice with reasonable skill and safety by reason of illness, use of alcohol, drugs, chemicals, or any other materials, or as a result of any mental, physical, or psychological condition.

B. Ineligible Licensees: Participation in HPSP is not permitted for certain licensees, including those accused of sexual misconduct or those who have been terminated from HPSP for non-compliance.

C. Location: The address for HPSP is

1380 Energy Lane
Suite 200
Saint Paul, MN 55108
Tele: 651-643-2120
Fax: 651-643-2163