Part III: Investigation of the Complaint

The third installment in our series on the steps involved in a disciplinary procedure against medical providers (or those allegedly practicing medicine without a license) focuses on the investigation of the complaint.

After submission and initial review, if the complaint is within the Texas Medical Board’s (TMB) jurisdiction, an investigation is initiated. The TMB may gather medical records, interview the complainant, interview the physician in question, and collect other relevant information to determine the validity of the complaint. And, in many cases, the TMB will seek the opinion of medical experts (peers) to assess the care provided. These experts review the case and provide their opinions on whether the physician's actions were within the standard of care.

The investigation phase conducted by the TMB is a critical step in evaluating the validity of a complaint and determining whether it warrants disciplinary action. It generally involves a thorough examination of the allegations, gathering evidence, and assessing the physician's actions and specifically includes a number of steps or actions.

Assignment to an Investigator:

Once a complaint passes the initial review, it is assigned to an investigator employed by the TMB. Investigators may have backgrounds in law enforcement, healthcare, or other relevant fields. They are responsible for conducting a comprehensive inquiry into the allegations.

Interviews:

Investigators may interview the complainant, the physician, and any relevant witnesses to gather information and perspectives on the allegations. These interviews help build a comprehensive understanding of the circumstances surrounding the complaint.

Medical Records and Documentation Review:

The investigator will request and review medical records, relevant documents, and any other evidence related to the complaint. This may include patient records, communications between the physician and patient, and any supporting documentation.

Expert Opinions:

The TMB may seek the input of medical experts or peers who can evaluate the medical care provided by the physician. These experts assess whether the doctor's actions align with accepted medical standards and practices. Their opinions are crucial in determining if there was a deviation from the standard of care.

Site Visits:

In rare cases, investigators may conduct site visits to the physician's practice or healthcare facility to gather additional information. This may involve observing the environment and procedures in place.

Collaboration with Law Enforcement:

If the allegations involve potential criminal activities, the TMB has a statutory duty to cooperate with law enforcement and may collaborate with these agencies to conduct a joint investigation. This is particularly relevant in cases of fraud, drug diversion, or other criminal offenses.

Physician's Response:

Throughout the investigation, the physician has the opportunity at certain stages to respond to the allegations and provide their side of the story. The TMB will consider the physician's perspective as part of the overall evaluation.

Confidentiality and Privacy:

The TMB takes measures to maintain the confidentiality of the investigation process. However, certain information may become part of the public record if disciplinary action is ultimately taken.

Time Frame:

The duration of the investigation can vary based on the complexity of the case, availability of information, and other factors. Some investigations may be resolved relatively quickly, while others may take months.

Case Disposition:

After the investigation is complete, the findings are presented to the TMB's Enforcement Committee. The committee reviews the evidence and determines whether there is sufficient cause to pursue disciplinary action against the physician.

It is important to note that investigations are conducted with the goal of protecting the public and ensuring the highest standards of medical care. The TMB aims to be fair, but thorough in its assessments. Accordingly, legal representation, guidance, and advocacy is critical to ensuring the response and evidence produced are complete and effective. The best outcome is, of course, for the TMB to determine that the complaint does not warrant further action. Active participation in this and in each phase of the board complaint process is essential to ensuring the best opportunity for that outcome.