Maryland Medical Licensing Boards

Responding to Inquiries and Complaints by Maryland Medical Licensing Boards:
Ten Common Mistakes and Recommended Actions
By: Neal M. Brown, Esquire and Nicole A. McCarus, Esquire
Waranch & Brown, LLC
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“Ten Common Mistakes and Recommended Actions” »

“I thought this letter from the board was no big deal. Boy was I wrong!”
Your medical license is your livelihood — every inquiry from a medical licensing board is a “big deal.” The licensing boards have almost unfettered authority to investigate, prosecute and impact your ability to practice medicine in the state of Maryland. How you respond to a board’s inquiry, no matter how innocuous, may have substantial and long-term ramifications. Described below are our recommendations regarding board inquiries, common mistakes and recommended actions.
In pursuit of their disciplinary function, licensing boards may initiate an investigation based upon a complaint or any other information, including newspaper articles, arrest records, lawsuits and citizen/patient complaints. An investigation usually begins with a letter to a health care professional requesting an explanation of the circumstances surrounding the complaint, a subpoena for patient records, or actual physical entry onto the premises of the health care office for access to patient records.i The board may then seek an interview, whether informal or under oath, or refer the matter for formal charges against the health care professional named in the complaint.
Failure to obey a board’s request may result in harsh action against the health care professional. For example, failure to obey a subpoena, take an oath to testify, or answer board inquiries may lead to contempt of court or even summary suspension.ii Failure to respond to a subpoena for an appearance before the board may also lead to disciplinary action against the health care professional. Likewise, if a health care professional does not respond to a request for explanation or a subpoena for medical records, the board may interpret such action as a failure to cooperate with the investigation, and issue formal charges.iii Maryland’s licensing boards are empowered to revoke or suspend a medical license, as well as to reprimand a licensee or place a licensee on probation.
A health care professional may be required to report disciplinary actions under his/her professional liability insurance policy. Likewise, a health care professional may be required to notify managed care plans and participating patient health insurance plans. Licensing boards are required to report disciplinary actions to the National Practitioner Data Bank, with which hospitals consult before granting or renewing medical staff privileges and with which insurance carriers check to determine provider eligibility for participation in patient health plans.iv The health care professional who ignores or mishandles a complaint from a medical licensing board risks seriously adverse financial and professional consequences. Therefore, the importance of responding appropriately to a board complaint or request cannot be overstated.
Based on our experience representing health care providers before various boards in Maryland, we have summarized some common mistakes health care professionals make following receipt of a board complaint or inquiry. In addition, we offer recommendations for responding to licensing boards to help avoid adverse outcomes.
1. Common Mistake: “It’s no big deal.”
After reviewing a complaint or inquiry from the board, some health care professionals believe that the allegations are frivolous, meritless or an outright fabrication by the patient. Other health care professionals tend to underestimate the potential for a negative outcome and ignore the complaint.
Recommended action: Treat any correspondence from the licensing board as a serious matter, requiring your immediate and thoughtful response. You have devoted a great deal of effort to obtain your medical license and most likely your livelihood depends on your practice. Treat the complaint or other board correspondence as a potential threat to your livelihood.
2. Common Mistake: “I don’t need to involve my insurance carrier in this matter.”
Some health care professionals feel that the allegations in a board complaint can be handled without involvement of their insurance company. Other health care professionals may be embarrassed by the allegations and may avoid requesting assistance. Under some professional insurance policies, one may have a duty to provide notice of an existing claim, or any potential claim that may activate coverage, as soon as possible. Likewise, many health care professionals in group practices or employed by health care institutions are required to inform their risk manager or someone within the organization of the claim, no matter how embarrassing or meritless the charge. Failure to provide notice of formal complaints to such parties can jeopardize insurance coverage, employment, ownership interest in an organization, or even a health care professional’s career. Furthermore, the insurance company or entity with which the health care professional is affiliated may provide or pay for legal assistance, including experienced counsel to represent the health care professional before the board. Therefore, keeping a board complaint secret from these parties is detrimental to the health care provider both professionally and economically.
Recommended action: Review your professional insurance policy. Even if it is unclear whether you have a duty to notify the insurance company or your risk manager, contact your agent to evaluate the situation. The agent will help you obtain any legal assistance that may be available under your policy. Even if your policy does not apply to the situation at issue, you will be able to discuss your options with a knowledgeable person.
3. Common Mistake: “I don’t need an attorney to respond to this complaint.”
Some health care professionals may feel that if the complaint or inquiry involves a simple matter, they should respond without legal assistance. Others may be concerned with cost, or issues of pride or professional rivalry, such that they do not consult legal counsel. Most attorneys who are experienced in defending health care professionals in these situations quickly determine the value they can add by providing legal assistance and preparing a response.
Recommended action: Do not attempt to contact the board to discuss the merits of the complaint or your response prior to involving legal counsel. Promptly provide your counsel with all pertinent information and documents, and any known grounds for defending the allegations. Do not omit significant details in the hope they will not surface later. Your attorney needs to be fully informed and not surprised by damaging facts that subsequently emerge in the case. Your attorney may also ask you for advice concerning a consulting expert, to get an objective opinion concerning the care and the issues raised by the complaint.
4. Common Mistake: “I’ll get to it when I can – there’s no rush.”
When informing a health care professional about the complaint, the licensing board usually provides a deadline to file a written response to the allegations, as well as a deadline to produce the patient’s records. Any failure to respond timely or to do so in a rushed, insufficient response can result in the imposition of sanctions by the licensing board.
Recommended action: Calendar the due date for the response immediately. If an extension is necessary, request one from the licensing board so that the appropriate response may be furnished within the time approved by the board.
5. Common Mistake: “I’m sure I can work it out with the patient.”
Upon receiving and reviewing the allegations of the complaint, some health care professionals feel that communicating with the patient will clear up any possible misunderstanding. Such a thought may lead the health care professional to contact the patient directly. This approach carries significant risks, as you have potentially provided damaging evidence against your best interests. It may also appear that you have attempted to intimidate the complaining party.
Likewise, you may want to contact the board directly to provide an explanation for the allegations of the complaint, in the hope that the board will change its mind and retract the charging document. Remember, at some point the board may be seen as a potential adversary. You should not be misled based upon a friendly or collegial discussion with a board investigator. The goal of the investigator is to obtain information. Thus, any statements that you make without the presence or guidance of counsel in this setting may later adversely affect your case. You should avoid any conversations with third parties, including potential witnesses, board investigators and others because such conversations are not protected by the attorney-client privilege or other legal protection.
Recommended action: Consult legal counsel before engaging in any substantive discussions about the case. If you have been approached to discuss the facts or circumstances of the case, politely decline discussing the matter with anyone without your attorney present. This ensures that your lawyer is able to protect your legal rights whenever possible.
6. Common Mistake: “I can just correct the patient’s chart.”
There are no situations in which a health care professional should alter or destroy a medical record, even if he or she believes that modification of the record will improve its accuracy. A discovery of any such alteration or destruction of records will lead to a swift and severe discipline in most cases.v
Recommended action: DO NOT alter, modify, destroy or otherwise dispose of medical records. Rather, you must promptly gather or obtain copies of all of the requested records and see that they are furnished to the medical board consistent with HIPAA’s federal privacy rules, as well as state privacy laws. If you feel there are errors or omissions in the original record, you may supplement the record, but only in accordance with previously established recordkeeping guidelines. The date and the reasons for any supplement, amendment or addendum should be clearly noted, and the original record in its un-amended form should be produced. The health care professional and his or her counsel must be prepared to explain the reasons why there was an omission or error in the record, and any amendment, supplementation or addendum to the record.
7. Common Mistake: “The patient was not harmed, so the board cannot find against me.”
The focus of the licensing board may simply involve whether the requisite standard of care was met. Therefore, irrespective of any harm to the patient, the board can sanction care that is outside the standards of quality practice of medicine.
Recommended action: Do not jump to conclusions about the merit of the case based upon the patient’s outcome. Speak with your attorney about your concerns and whether such a position will provide a valid defense to the allegations of the complaint.
8. Common Mistake: “I messed up. I should just admit it and get this over with.”
Sometimes, an acknowledgment of a mistake, followed by an expression of apology and a promise to improve your performance is the best possible response. However, very often the issue of fault is not clear. It is a rare circumstance where a health care professional’s conduct cannot be explained, or at least be cast in a better light. In addition, there is no guarantee that the board will accept the health care professional’s candor with a dismissal or a minor sanction. An unqualified admission may lead to the imposition of more severe sanctions.
Recommended action: It is often appropriate to express concern for the patient’s problem. However, you may not need to accept blame when your conduct is defensible or can be explained or characterized in a way that is less detrimental. Consult with your attorney to discuss the possible ways of defending or explaining your conduct, rather than simply admitting fault. Even where an admission of fault is the only option available, the best possible terms should be sought before a concession.
9. Common Mistake: “The board is full of health care professionals so I don’t need to explain the medicine.”
Although medical licensing boards are often composed of licensed health care providers, there are also lay board members. In addition, not every medical specialty is represented on the board. Because of this, the health care professional responding to a complaint should not respond in a technical manner or with specialized jargon that only an expert in his/her particular field would understand. On the other hand, the health care professional responding to a complaint should not respond as if speaking with unsophisticated individuals, or in a manner that appears condescending.
Recommended action: In your response, attempt to bridge the gap between these two extremes. Use a respectful tone to inform the board members about any peculiar aspects of the case involving your medical practice or specialty. Where the medical records are extensive, it may be a good idea to cite key pages of the records to support your defense rather than to expect the board to wade through the record to discover what is important. It may also be helpful to support your position with citations to medical references or with consulting physicians or experts to support your care and treatment.
10. Common Mistake: “I’m so angry, I can’t see straight!”
Your response to a board’s complaint may be one of righteous indignation. However, do not respond in writing in a way that translates as an angry or emotional reaction. Health care professionals may also be inclined to point the finger of blame at the patient or at other health care providers, rather than explaining their position in the case at hand. This can often have a detrimental effect on your defense.

Recommended action: Take time to think through your response. It is wise to consult with your lawyer concerning the tone of your response. Understand that the effectiveness of medical licensing boards is often based upon the percentage of doctors that they discipline. Their job is to police the medical profession in an effort to protect the public. Thus, while the board should not be predisposed against you, the board members are unlikely to be impressed by an emotional response to a complaint, or a health care professional who seeks to place blame with the patient or other health care providers. Your response should be professional, no matter how meritless the accusations. Be factual, precise and courteous in your response, avoiding extraneous information and personal attacks concerning the allegations in the complaint. Your response should also make clear that you are being cooperative in responding to the board’s investigation. It will also assist you to recognize the important role that the board plays in protecting the public at large.
As we hope is now clear, any inquiry from a licensing board is a “big deal.” We hope this information will help you navigate these potentially dangerous waters and help you achieve the best possible result in response to any complaint.
This article is not intended to constitute legal advice or create an attorney-client relationship, but is intended for general informational purposes only. An attorney or other appropriate resource should be consulted regarding individual cases.


i See e.g. Md. Code Ann., Health Occ. §14-206, et seq (2010).
ii Ibid; See also Md. Code Ann., Health Occ. §14-206(a) (failure to comply with subpoena punishable by contempt of court). (2010).
iii See e.g. Md. Code Ann., Health Occ. §14-404(a)(33) (2010).
iv Burt M. Kahn and Neal M. Brown, Medical Discipline in Maryland: Representing a Physician for Medical Discipline, MICPEL C-14 (1999).
v See Md. Code Ann., Health Occ., §14-404(a)(11), (12) and (40). See also Md. Code Ann., Health Occ. §§4-401 and 4-403 (2010) (providing for criminal and civil penalties for willful damage, destruction or alteration of a medical record).