How to obtain good results in tough licensure cases: Four examples

When facing a Board investigation, it is common among practitioners to fear the loss of their license, or the imposition of substantial restrictions upon their practice. Today I will discuss four such cases, involving two physicians, a pharmacist, and a nurse. In one of the cases, the practitioner went so far as to surrender his license, hoping to make it all go away. In all four cases, however, the practitioner prevailed, with the board imposing no discipline whatsoever.

The physician practicing under an evolving standard of care

In the first example, a physician was getting good results for all his patients, and he had no bad outcomes. The standard of care, however, was both disputed and evolving, and the physician had provided his patients with what appeared to be a lot of treatment, and it was the amount of treatment that prompted a complaint to the Medical Board. The case was resolved successfully after the Medical Board came to understand the perspective of several experts, the evolving standard of care, and the above average results that this physician obtained for his patients. In sum, the physician’s knowledge and thoughtful presentation, supported by expert opinion, literature, and good patient outcomes, carried the day. This case was closed without any discipline.

The physician treating chronic pain with narcotics

In the second example, a physician was treating chronic pain with narcotics in a small practice setting. This is a difficult medical practice in the best of settings, given the nature of the patient population, and the scrutiny imposed by state and federal regulators, including the Board of Medicine and the Drug Enforcement Administration (DEA). The physician’s charting was good, however, and, with the assistance of an expert to provide an objective assessment, the physician’s charting was organized into a comprehensive and detailed written report. Small discrepancies were spotted, self-corrected immediately, and disclosed to the Board of Medicine, leaving nothing for the Board to do. The physician’s presentation was persuasive, and the case was closed without any discipline.

The pharmacist-in-charge discovering and reporting a substantial drug loss

In the third example, the pharmacist-in-charge (PIC) discovered a large drug loss in his pharmacy. Security and protocol had been breached. The pharmacist-in-charge was very proactive, however, quick to discover the problem, quick to verify a pattern of theft, and quick to report the drug loss to the Board of Pharmacy and the DEA. The pharmacist-in-charge also confronted the person responsible for the drug theft and further implemented corrective measures. Although the pharmacist-in-charge worked closely with the Board of Pharmacy, it was the pharmacist-in-charge that lead the effort, an effort that was much appreciated by the Board of Pharmacy. And although the drug theft occurred under his watch, the pharmacist-in-charge promptly fulfilled his role in the state and federal regulatory scheme intended to secure the inventory of controlled substances. The case was closed without any discipline.

The nurse alleged to have exceeded his scope of practice

In the final example, a highly skilled nurse was alleged to have exceeded his scope of practice. The nurse’s advanced education and experience carried the day, however. The Board of Nursing concluded that the nurse in fact had the education, training and experience necessary to refute the allegation that the nurse had exceeded his scope of practice. The Board of Nursing reasoned that whatever dispute there was between the hospital and the nurse, it was an employment matter, not a licensure matter. The case was also closed without any discipline.

What you need to know

In difficult cases it is necessary to take the initiative, to perform the research and analysis necessary to take a lead role to get in front of the case, showing your licensing Board what you are doing, and further offering the conclusion the Board should accept without need of discipline. In the four examples offered above, none of the cases proceeded beyond an interview, and in two of the cases, investigators determined that an interview was not warranted. These examples illustrate the value of early action when defending your medical license.