What is the Medical Board of California’s Medical Consultant Program?

The Medical Board of California’s Medical Consultant Program is a second step in the screening process for complaints based upon quality of care issues.

The Medical Board screens 1000's of complaints many of which are rejected out of hand. Complaints from patients are often rejected. Complaints from co-workers, employees, pharmacies, insurance companies and law enforcement are viewed more carefully.
The Central Complaint Unit (CCU) has lay people not doctors do the initial review. The initial review by medical board staff determines if there is the type and sufficiency of evidence to trigger referral to a medical consultant.

California law, (Business and Professions Code section 2220.08) requires that upon screening, if a complaint involves quality of care it goes into a special area of review. For the benefit of the accused physician and also to protect the public, medical determinations must be made by a properly trained medical consultant. This MD review is done by the Medical Consultant and
there is a written report. The report recommends whether there should or should not be a further and formal investigation of the physician. The recommendation is not cursory. It will usually include a review of relevant medical records and an opinion with discussion of the facts.

What are the Qualifications of a Medical Board Consultant?

The qualifications for conducting such a review are very light. If we compare, an expert witness in a medical malpractice case will have the standard medical qualifications plus many more. To be a Medical Consultant you only need a current, valid and unrestricted medical license issued by the Board with no complaints within the last three years, no pending accusations, or prior enforcement or disciplinary action. This doesn’t mean that every reviewer has only these qualifications but they certainly are minimal. Board certification is not a requirement. Most frightening is the reimbursement rate. These reviewers earn less than a plumber. They are paid $ 75.00 per hour (March 2024).

What Happens if the Consultant Has Concerns Based Upon his/her Review?

If the consultant sends your case forward you can expect medical record and file requests, interviews with patients and staff and a one on one interview at the medical board office. Internally the HQIU for quality of care investigation. Just like with peer review, complaints that are of an urgent nature such as gross impairment, alcoholism, sexual offenses get priority.

The investigative steps that follow will include a request for all medical records (there are limits as to what they can get under HIPAA and other rules), interviews with patients, interviews with staff and finally the one on one interview with you, the physician.

The one on one interview may include a member of the Attorney General’s office, a medical expert and the primary case investigator. What happens next is the subject of another blog.

Daniel Horowitz and Dr. Mark Ravis (lawyer and doctor) represent doctors under investigation by the medical board. Call us at the earliest opportunity as early action can sometimes forestall more serious future consequences. If the process has proceeded to an Accusation, Daniel Horowitz is one the nation’s leading courtroom and administrative hearing lawyers and he and Dr. Ravis will provide you with the best possible representation.