Complaints and Investigations
THE BOARD OF MEDICINE ONLY REGULATES PHYSICIANS (M.D./D.O.) ACUPUNCTURISTS AND GENETIC COUNSELORS.
The Board does not have the authority to get involved in some matters, such as complaints involving health care professionals regulated by other agencies and complaints against hospitals, nursing homes and insurance companies. The Board cannot be involved in suing a licensee for damages or settling disputes over billing or disability ratings.
Iowa law authorizes the board to investigate complaints about physicians (M.D.s and D.O.s), licensed acupuncturists (L.Ac.) and genetic counselors (GCs) . If the board finds that the practitioner has violated state law or the board’s administrative rules, it may take action against the practitioner’s license to practice in Iowa. The board’s disciplinary procedures are located in 653 Iowa Administrative Code Chapters 23-26. You will find an overview of the disciplinary process below.
The board receives information about a licensee’s alleged wrongdoing from an array of sources—patients and families, physicians or acupuncturists, other health professionals, hospital administrators, pharmacists, insurance companies, hospital trustees, newspaper articles, the Pharmacy Board, Department of Criminal Investigation (DCI), the Drug Enforcement Agency (DEA), Medicare and Medicaid, the Insurance Commission and others. Whether the information is received in correspondence from a patient, newspaper article or malpractice claim report, the board identifies each of these as a “complaint.”
How to File a Complaint
The board office accepts complaints in the form of a letter, e-mail or on-line form. Click here to fill out the complaint form. You may also print it and fax it to the board or submit it via regular mail. A complaint may be faxed to 515-281-8641. Please mail complaints to the Iowa Board of Medicine at 400 SW 8th St, Suite C, Des Moines, IA 50309-4686.
If you write to the board with your complaint, please include the following information:
- Your name, address and telephone number
- The patient's name, address, telephone number, date of birth, and your relationship to the patient
- The doctor's name, address, telephone number, when and why the patient went to the doctor, and why you are making a complaint; please provide complete details
How Complaints Are Handled
As soon as a complaint is received, staff assigns a case number and opens an investigative file. The executive director, medical advisor, legal director and chief investigator meet weekly to review new complaints and the licensees involved to determine the level of investigation appropriate for each complaint. Cases that appear to be less serious or are out of the board’s purview are referred to the board, which will determine whether the complaint should be investigated. All other cases are assigned immediately to an investigator.
What Happens in an Investigation
The purpose of an investigation is to gather sufficient information from both the complainant and the licensee. With this information, the board is better able to determine whether the facts support that any wrongdoing occurred on the part of the physician or licensed acupuncturist.
To acquire sufficient information the investigator may:
- Interview those involved, e.g., complainants, licensees, and others
- Obtain relevant records, e.g., medical records, X-rays, EKG’s
- Examine the licensee’s disciplinary history with the board
- Contact law enforcement or other state boards
The investigator compiles the information and prepares a written summary to the board. The investigator does not make conclusions or recommendations to the board. The board reviews materials for each case and then makes its decision.
What Kind of Complaints Receive Board Action
The board uses its limited resources to focus on complaints that identify a significant danger to patients, including: serious competency concerns, severe patient harm, serious medical errors, criminal conduct, substance abuse or other impairment, sexual misconduct and/or severe unprofessional conduct that significantly impacts patient care.
Examples of concerns which the board considers to be less serious include cases that do not involve serious patient harm or that are isolated occurrences rather than part of a pattern of inappropriate treatment, billing disputes, a single incident of rude behavior or communication problems, personality conflicts, or poor recordkeeping practices that are not repeated and do not significantly affect patient care.
While the board may close a less serious case without taking any formal disciplinary action against the licensee, the board may re-open the case if similar complaints are received later. When a pattern of wrongdoing begins to emerge, the board heightens its interest in complaints that, on their own, seem less concerning.
The Board’s Options When It Reviews a Case
Each board member has a copy of the investigator’s report and all of the relevant records when it reviews a case. The legal standard the board must meet to take public disciplinary action is called “probable cause,” which means there must be better than a 50-50 chance that the wrongdoing occurred.
After discussing the case and considering the evidence available and the risk to the public, the board will take one of more of the following actions:
- Dismiss the complaint and close the case without action
- Close the case and issue a confidential Letter of Education or Letter of Warning to the licensee
- Continue the investigation by
- Referring the case back to the investigator for further investigation
- Referring the case to peer reviewers for expert opinion, or
- Ordering the licensee to submit to a confidential evaluation
- Request that the director of legal affairs seek a settlement with the licensee. If a settlement is reached and approved by the board, it becomes public information.
- File a public statement of charges and refer the case for prosecution to the Office of the Attorney General.
- Summarily suspend some or all of the licensee’s privileges to practice and order a hearing within 30-45 days. The board issues an emergency suspension in the most serious cases when continued public harm is likely.
What Makes an Investigation Take So Long
A case remains under investigation until the board decides to close the file or order a hearing. You may be disappointed if you expect the investigation to be completed within a few weeks. The investigative process can take months or longer for one or more of the following reasons:
- The investigators receive and work on many cases at the same time.
- The licensee may not be prompt in supplying records or a report.
- The hospital may fight a subpoena for records.
- The hospital may not be able to find specimens that are needed.
- Thousands of pages of patient records have to be sorted.
- Mental health records require patient consent before they may be shared with the board.
- A licensee may have to get a confidential competency evaluation that takes several weeks or even months to schedule.
- A licensee may go to the board and then the courts with an appeal of an order for a competency or mental/physical or substance abuse evaluation.
- Competency cases may require peer review before the board can rule.
- Board staff is investigating many cases concurrently.
- The board reviews cases every eight weeks or so.
What Is Public Information and What Is Not
An investigation is confidential. It cannot be shared with the public, the complainant, or the licensee involved. The public may know only when the board files charges against a licensee. Only then is the investigative file shared with the physician or licensed acupuncturist who is charged. The investigative file is never open for view by the complainant or the public. The board is careful to follow Iowa law on which records may be made public or shared with certain individuals or agencies and when that may occur.
The Board’s Record in a Year
Of the nearly 700+ complaints the board receives each year, it finds sufficient grounds to file formal charges on about 10 percent of the cases. The majority of cases are closed without action (70%) or with a confidential Letter of Education or Warning (20%).
Statement of Charges
The board may file a statement of charges if it finds probable cause that a licensee violated Iowa law or the board’s rules. The statement of charges notifies the public that legal action is being initiated against the licensee and the licensee will be given an opportunity for due process. The licensee is served with several legal documents that include charges and an order for a hearing. This is the beginning of what is called a “contested case,” which makes a multi-step “due process” available to the licensee to defend himself or herself before the board with opportunity for several levels of appeal.
Once the board files charges, the case is referred to the Office of the Attorney General and an assistant attorney general is assigned to prosecute the case on behalf of the state, meaning the public interest of Iowans. Most licensees hire a private attorney to assist them through this legal process and to assure their interests are protected.
Settlement or Hearing
The board office schedules a hearing when the two sides—the licensee and the state—have an opportunity to present evidence related to the charges to the board. State law encourages the board to enter into informal settlement negotiations prior to the initiation of a hearing. In most circumstances the state makes a settlement offer. If no settlement is attempted or reached, the case proceeds to hearing. A panel of board members (fewer than a quorum of six) may hear most cases. In a few cases, the full board (a quorum of the board or at least six board members) must hear the case.
Whether a Hearing Is Open or Closed to the Public
The board office notifies the public when a hearing is scheduled. While a hearing may be open to the public at the discretion of the licensee involved, most licensees choose a closed hearing. The decision to close the hearing to the public is often made at the beginning of the hearing.
Administrative Law Judge
An administrative law judge (ALJ) from the Iowa Department of Inspections and Appeals presides over board hearings. The ALJ rules on matters of law and assists the board in preparing the Findings of Fact, Conclusions of Law, and Decision and Order of the board based on the evidence presented during the hearing.
Disposition of Cases
The board has a range of actions that it is authorized to take following a hearing or as part of a settlement. The board may impose any combination of these actions it finds appropriate:
- Dismiss the charges and close the case without formal action;
- Dismiss the case and close it without action;
- Issue the licensee a formal Citation and Warning;
- Place a license on probation subject to monitoring or conditions;
- Restrict a license;
- Suspend or revoke a license to practice under an Iowa license;
- Accept a voluntary surrender of a license; and/or
- Issue a civil penalty not to exceed $10,000.
The licensee or his or her attorney, the assistant attorney general, or the full board may appeal a hearing panel’s proposed decision within 30 days. Only when the full board accepts or amends a decision after the appeals or appeal period are over is the decision final. At that time the decision becomes an official legal act of the board and any sanctions are imposed. The decision is open to the public, posted on the board’s website and reported to the National Practitioner Data Bank and the Federation’s Disciplinary Alert. All parties to a contested case then have the right to appeal the final decision of the board within a time frame set by law. When all administrative remedies are exhausted with the board, the parties to the case may appeal the board’s decision to the state’s courts. In the meantime, the sanctions imposed by the board are enforced.
Investigative files, investigative reports, and other investigative information in the board’s or peer review committee’s possession are privileged and confidential. These materials are not subject to discovery, subpoena, or other means of legal compulsion for their release except to the licensee and the board. The board may only release investigative materials to a licensee in cases where formal charges against the licensee have been filed.
Investigative information may, however, be released to the applicable licensing authority in another state in which the licensee is licensed or has applied for a license. It is not uncommon for the receiving state to halt the licensure process in that state until the board completes its investigation and decision making.
If the board's investigative information indicates a crime has been committed, board staff may share investigative information with the appropriate law enforcement agency, e.g., the local police or DEA.
Members of the board, its staff and peer review committee members are protected by Iowa law from civil liability. Board members and staff are immune from suit for their role in any act, omission, or decision of the board, as long as they act in good faith. A person who files a report or a complaint is also immune from civil liability if the reporter acts without malice.
Mandatory Reporting of Peers
State law requires a licensee to report a peer who may have violated the law or board rules by omission or wrongdoing. A physician is required to report another physician but not other health practitioners. Likewise, a licensed acupuncturist must report a fellow licensed acupuncturist but not another health professional. Licensees who fail to comply with mandatory reporting may be subject to board discipline.
A colleague concerned about a peer with a possible impairment issue may meet the obligation of reporting the matter to the board by contacting the Iowa Physician Health Program.