Health Center’s Duty to Report Provider Misconduct

Jun 19, 2020 | Employment Law

Under Idaho law, a health center must report a physician or physician assistant (“PA”) to the Board of Medicine for providing treatment that falls below the standard of care for any violation.  However, it is appropriate to only report violations of the standard of care that result in patient harm, represent a pattern of poor medical judgment, or are so egregious as to result in severe discipline or termination of employment. 

Idaho Code § 54-1814 provides the grounds for medical discipline. It governs all individuals licensed to practice medicine, physicians and PAs included. The statue provides 29 specific instances of misconduct and is attached at the conclusion of this memo. However, section seven is most applicable:

(7)  Providing health care that fails to meet the standard of health care provided by other qualified physicians or physician assistants in the same community or similar communities, taking into account his training, experience, and the degree of expertise to which he holds himself out to the public.

Currently, there is no requirement that the violation of the community standards set forth in the disciplinary statute pertaining to licensed physicians must have caused physical harm to the physician’s patients. ​The Board of Medicine may discipline a physician for providing health care that fails to meet the applicable standard of care even if it cannot prove that the physician’s patients have yet suffered any physical harm.

Further, under Idaho Code § 54-1818, a licensed physician that has knowledge of a violation (listed in I.C. § 54-1814) is required to report such violation with reasonable promptness. If a physician fails to report the violation of another physician or PA, it will result in board disciplinary action for the physician.  However, the wrongdoing must have been discovered outside of the peer-review process. 

Idaho Code § 39-1393 provides the duties of the health care center to report physicians in or outside the peer review process and is also attached in full at the end of this memo. Notably, the health center has a duty to report only physicians, not PAs. In relevant part, it states, “[a]ny health care organization in this state that is by law required to conduct peer review or which voluntarily formally elects to conduct professional review actions shall notify the board of medicine of professional review actions taken against physicians licensed in Idaho required to be reported as provided in this section.” A health center must report violations if the health center takes a professional review action against a physician. It also must report if the health center accepts a voluntary sanction lasting longer than 30 days by a physician while the physician is under investigation, to avoid investigation, or in exchange for the health center not conducting an investigation.

The listed statutory sanctions are as follows: a restriction or limitation, revocation, suspension, reduction, or surrender of privileges, denial of request for initial privileges, submission to monitoring the physician’s physical or mental condition or delivery of medical services, termination of employment, or suspension lasting longer than 30 days. Reports must be made to the Board within 15 days of completion of the professional review action by the health center. The report must include a statement of the quality of care concerns or professional conduct that is the basis of the action or investigation and the reportable sanction voluntarily accepted or involuntarily imposed. 

Separately, IDAPA 22.01.03, Rules for the Licensure of Physician Assistants, adopts I.C. § 54-1814 and the other IDAPA rules for medical practice. IDAPA 22.01.01.101.03, Rules of the Board of Medicine for Licensure to Practice Medicine and Surgery and Osteopathic Surgery in Idaho, provides a definition of the standard of care that is similar to the above statute. Therefore, this definition of the standard of care is applicable to physicians and physician assistants. 

Standard Of Care. Providing health care which fails to meet the standard of health care provided by other qualified physicians in the same community or similar communities, includes but is not limited to: 

  1. Being found mentally incompetent or insane by any court of competent jurisdiction. 
  2. Engaging in practice or behavior that demonstrates a manifest incapacity or incompetence to practice medicine. 
  3. Allowing another person or organization to use his or her license to practice medicine. 
  4. Prescribing, selling, administering, distributing or giving any drug legally classified as a controlled substance or recognized as an addictive or dangerous drug to himself or herself or to a spouse, child or stepchild.
  5. Violating any state or federal law or regulation relating to controlled substances. 
  6. Directly promoting surgical procedures or laboratory tests that are unnecessary and not medically indicated. 
  7. Failure to transfer pertinent and necessary medical records to another physician when requested to do so by the subject patient or by his or her legally designated representative.

 

As the rule states “includes but is not limited to” it suggests this list is not exhaustive. 

While given this statutory construction, it appears to be the position of the Board of Medicine that only egregious medical judgment errors need to be reported. The vast majority of reported violations are breaches of the standard of care that result in actual patient harm. Typically, unless a pattern of poor judgment exists, or the poor judgment is egregious, it goes unreported. If the poor judgment results in termination of employment, it is egregious enough to be reported.  

In summary, it is a health center’s duty to report physician misconduct discovered inside or outside of the peer review process to the Board of Medicine. Furthermore, it is also in a health center’s best interest to ensure physicians employed at their facilities report similar misconduct for any other physicians or physician assistant whose misconduct is discovered outside of the peer-review process.  

For physicians and health centers to report misconduct there are two ways of doing so. First, you can complete the form that patients utilize to report misconduct. In this circumstance, the physician or health center would only need to complete the relevant portions. Second, and most common, is to email the Board of Medicine Investigative Specialist, Felicia Kruck. The email should outline the concerns the physician or health center has and any necessary patient information. Either method is sufficient for reporting.

This blog post is designed to provide general information on pertinent legal topics. The statements made are provided for educational purposes only. This blog does not provide legal advice. This blog does not create an attorney-client relationship between you and Smith + Malek, PLLC. If you want to create an attorney-client relationship and have specific questions regarding the application of the law to your own circumstances, you should contact our office.

 

  1. I.C. § 54-1814(7); Haw v. Idaho State Bd. of Medicine, 140 Idaho 152, 90 P.3d 902, (2004).
  2.  Id.
  3. I.C. 54-1818.
  4. Id.
  5. I.C. § 39-1393.
  6. Id.
  7. Id.
  8. Id.
  9. Id.
  10. IDAHO ADMIN. CODE R. 22.01.03, https://adminrules.idaho.gov/rules/2001/22/0103.pdf (last visited Feb. 20, 2020).
  11. IDAHO ADMIN. CODE R. 22.01.01, https://adminrules.idaho.gov/rules/2001/22/0101.pdf (last visited Feb. 20, 2020).
  12. https://bom.idaho.gov/BOMPortal/LINKS/discipline/IDBOM_complaint_form.pdf.
  13. [email protected]