Editor’s Note: When Dr. Thomas Kline tweeted last week that it’s time for chronic pain patients to “flood state medical boards with online complaints” about being cutoff w/ the CDC and “federal drug police invalid medical excuses, we asked Terri Lewis Ph.D. for an article that shows patients how they can do it and why it might be a good idea. We thank for her this submission to the National Pain Report.
Many patients do not know where to turn when they have concerns about the competency or conduct of a doctor. State medical boards are government agencies, usually housed in state Departments of Health, that are empowered to investigate complaints about doctors and, when warranted, take action against them. These entities are placed alongside other regulatory groups like Boards of Pharmacy, Licensure, and so forth. Members are usually nominated to these positions by the Governor for a specified term. Among their jobs is that of advising legislative bodies and monitoring the impact of regulation on licensed entities like hospitals, nursing homes, physician practices, and pharmacies.
Some of the most common standard-of care complaints include:
- Prescribing the wrong medicine
- Inappropriately prescribing controlled substances
- Failure to diagnose a medical problem that is found later
- Willfully or negligently violating the confidentiality between physician and patient except as required by law
- Disruptive behavior and/or interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care
- Failure to provide appropriate post-operative care
- Failure to respond to a call from a hospital to help a patient in a traumatic situation
The Medical Practice Act defines unprofessional conduct in each state. Although laws vary from state to state, some examples of unprofessional conduct include the following:
- Physician abuse of a patient
- Inadequate record keeping
- Failing to meet the standard of care
- Prescribing drugs in excess or without legitimate reason
- Failing to meet continuing medical education requirements
- Conviction of a felony
- Delegating the practice of medicine to an unlicensed individual
Minor fee disagreements and poor customer service are not considered unprofessional conduct. Disagreements about changes to the patient treatment plan fall into a gray area of monitoring and oversight. A full 25% of survey respondents disclosed that they have lost their primary care physician as a result of changes to state and national laws. More than 30% of respondents report that their pain management physician has terminated their care relationship due to changes in the regulatory environment or disputes about the course of care in the current environment. While survey analysis continues this snapshot of 2884 of 4600 responses indicates that changes to prescribing plans are widespread. The role of patient protections is largely left to a negotiation between the prescribing physician and the patient.
In a recent study state boards were queried about abrupt changes in controlled substances (CS) prescribing, to determine whether states have action plans in place to manage such situations, and were asked to describe the components of any such plans.
A total of 51 medical boards were contacted to determine states’ experiences with abrupt changes in CS prescribing, the extent of consumer complaints attributed to these events, and the types of plans in place to manage these situations. Forty-six executive directors of medical boards responded. Twenty boards (43.5%) confirmed that their state had experienced abrupt loss of CS providers and 11 (55%) of these executive directors indicated that the loss resulted in increased consumer complaints. The majority of executive directors (86%) had no corrective action plan. Six executive directors reported some type of action plan or process consisting of regulatory action, patient-provider connection, professional education, patient education, or public notice.
Most states do not have operational plans in place and the majority of state regulations are silent on abrupted care that includes step therapies, abandonment, or resulting harms. Further it is difficult to detect and confirm patient harm in the current system unless a patient files a report with their state medical board and requests an investigation. A few have key strategies that may be useful in addressing potential problems following abrupt loss of a prescriber. While state medical boards can play a significant role in the development of comprehensive preparedness plans to mitigate damage from the loss of CS prescribers in the community it is largely a function of insurance networks and local business practice. This makes for a very uneven delivery environment.
The majority of reports regarding physician misconduct remain unreported. There is concern that legitimate complaints to Boards are often inadequately investigated. In my own work, I have found that each state board operates differently with varying degrees of quality and accountability to the public. Some are politically oriented, while others are quite responsive to public concerns about safety and quality. There are no consistent operating practices from state to state.
Each state has its own response system found in the links attached here:
State Medical Boards snapshot (link)
Summary of state laws
Issues by state (searchable filter)
Pain management regulations by state (links)
Chronic care and use of opioids policy
PDMP Overview by state (links)
Medical Cannabis overview by state (links)
Federation of state medical boards (FSMB.org). Search for information about your own state physician regulating board. To understand how physicians are regulated in the USA, explore this link-
To find out information about your state Medical Board, go to this link-
Find out about your physician’s training, licensing, and history of complaints,