Board complaints - the newest threat to chiropractors

It used to be that the worst thing that could happen to a chiropractor was a malpractice lawsuit. Today, a complaint from a state Board of Chiropractic Examiners can be nearly as bad -- or, sometimes, even worse. As one lawyer put it in an article for Medical Economics: "Few doctors realize that a patient's complaint to the state medical board could pose an even greater threat to their careers and livelihoods."

While the majority of board actions come from patient complaints, board actions can be spurred by complaints from other DCs (frequently motivated by professional jealousy or political animosity) or from insurance providers alleging inappropriate or unnecessary care.

"You can't know the terrible feeling you get from learning that you are the subject of a licensing board investigation until you've experienced it," one doctor stated in an article by John H. McCord, DPM for The Center for Peer Review Justice. "It felt like a lynch mob was after me."

What makes things worse is that, unlike a lawsuit, you have few rights when it comes to board complaints. Attorney Mary Nester explained that, "because a license investigation is not a criminal action, you are afforded no constitutional rights to confront your accuser or have an attorney appointed to represent you. Further, because a license investigation is not a civil action, you may not be entitled to discovery of evidence that the agency may have to support its case. Some agencies may withhold evidence indicating that you did nothing wrong... Most licensing boards have the authority to subpoena records without being obligated to notify you of this action. The board may obtain and review your personnel file, including any disciplinary records, your school records, patient records and, depending on the source of the complaint, quite possibly your own medical records."

Her final warning is the most ominous: "Take every board investigation seriously. Do not presume that because you are innocent, you will ultimately prevail."  Remember: completed license complaints that result in letters of concern, stipulations or board disciplinary action are part of the PUBLIC RECORD.  They are available (usually via the internet) for anyone to see, including preferred providers, managed care companies, and your patients.  Board complaints and discipline actions must be disclosed to insurers, other state licensing agencies and credentialing firms.  An adverse action will remain on your record for the life of your license.

Obviously, board complaints have gone from being minor and rare irritations to serious threats that could put your license - and your entire career - in jeopardy.

In addition, they can cost you huge sums of money. "The cost of defending yourself in a disciplinary case is not cheap," said McCord. "Most attorneys with expertise in disciplinary issues charge between $150 and $300 per hour and the eventual total can run into six figures, depending on the complexity of your case."

That isn't an exaggeration. Although one source puts the average cost for defending a chiropractic board dispute at $15,000, it's likely that they will become as expensive as those filed against other types of practitioners. In one extreme case, a psychologist spent more than $400,000 battling an accusation from his board. Although he was ultimately allowed to remain in practice, the process took several years.

Until recently, professional liability insurance policies didn't cover the cost of defending board complaints or disputes, but today, these actions post a greater threat to chiropractors and such coverage is vital. Margaret A. Bogie, a property and casualty insurance consultant and executive administrator of the American Psychological Association Insurance Trust, emphasizes that "Licensing board coverage is a major difference between insurance policies because it provides unique coverage for a previously uninsurable risk."

When comparing malpractice insurance policies, be sure to look specifically for board dispute defense coverage, which will help protect you in case of a patient care-related complaint. Without it, you could be faced with a devastating financial burden of defending yourself against a board complaint that could be far more damaging that any lawsuit.

SOURCES: "Resources for Successful Independent Practice," by Margaret A. Bogie, California Psychologist;

"Board Complaints," by John H. McCord, DPM, The Center for Peer Review Justice; "The threat worse than malpractice," by James Hilliard, Medical Economics; "Defending yourself against a BON Complaint," by Mary Nester, Advance for Nurses.