Medical License Defense: Beyond the Basics
Proactive Measures
While medical license defense addresses issues after they arise, proactive measures can prevent problems altogether. Anticipation and preemptive action play a crucial role. A skilled medical license lawyer examines contracts, non-compete agreements, partnership terms, by-laws, email exchanges, OPPEs, FPPEs, and more—anticipating potential pitfalls.
California Medical Board (CMB): Safeguarding Trust
The CMB upholds public trust by regulating medical licenses and ensuring physician accountability. However, this noble mission can sometimes be overshadowed, turning the system against highly qualified physicians. Our expertise allows us to navigate the medical board system, understanding both published and unpublished rules essential for safeguarding your license.
Investigations and Enforcement
The CMB investigates complaints against licensed physicians, taking action based on sustained violations. Methods include stipulated discipline, and the board has the authority to post relevant information on a physician’s profile indefinitely or for a limited period, depending on the violation.
By taking proactive steps and seeking expert legal advice, you can protect your medical license and ensure your career remains secure.
The Medical Board's website details report to patient requirements for discipline stating:
Licensees serving a probationary term for the violations cited above are required to provide a separate disclosure to a patient, or patient's guardian or health care surrogate, before the patient's first visit following the probationary order.
The separate disclosure must include:
- The licensee's probation status;
- The length of the probation;
- The probation end date;
- All practice restrictions placed on the licensee by the Medical Board of California (Board);
- The Board's telephone number; and
- An explanation of how the patient can find further information about the licensee's probation on the licensee's profile page on the Board's online license information internet website.
Hospital / Medical Group License Issues
Navigating the complexities of medical licensing is challenging, especially when a doctor has had privileges limited, has potential information to disclose during credentialing, when facing investigation, FPPE, OPPE or PIPs, accusations, or disciplinary actions.
Earlier rather than after the fact, a medical license lawyer can change the course of a potentially adverse action. If a negative license action has started, our medical license lawyers play a crucial role in minimizing the damage and safeguarding your rights and career.
License Acquisition and Renewal:
Most applications for a medical or healthcare license are easily submitted and readily accepted. Medical license lawyers assist physicians and other healthcare providers in obtaining their initial licenses primarily in instances where there are complications, disclosure issues or other potential roadblocks.
For non-citizen applicants our immigration lawyer, Oksana Tyskova is the daughter of two Ukraine physicians. You can trust Oksana’s judgment and commitment.
Defending Physician Licenses: Expert Legal Support
When healthcare professionals face allegations of misconduct, negligence, or violations of medical practice standards, medical license lawyers are essential for their defense. We protect physicians during state medical board investigations, advocating for fair treatment and due process. However, it’s important to note that due process for physicians is often balanced against the perceived need to protect the public, making it a challenging process.
Our Approach:
- Strong Defenses: We prepare robust defenses, gathering comprehensive evidence to support our clients.
- Advocacy: We advocate for fair treatment, ensuring that physicians’ rights and needs are thoroughly vetted.
- Technical Expertise: Our lawyers present highly technical defenses, delving into the facts and medical details in an authoritative manner.
By leveraging our expertise, we help physicians navigate the complexities of medical board investigations and protect their professional licenses.
Disciplinary Appeals: Protecting Physician Licenses
When physicians face disciplinary actions such as suspension, revocation, or probation, medical license lawyers are essential for navigating the appeals process. These lawyers challenge adverse rulings and present evidence to demonstrate the physician’s competence and commitment to patient care. These reviews take place in the context of peer review and/or medical board hearings.
Key Steps in the Appeals Process:
- Appealing Decisions: Medical license lawyers handle the appellate process, ensuring that all necessary evidence is presented and issues preserved. The review process requires proper preparation at the actual peer review hearing so that a proper legal record is made and preserved.
- Internal Reviews: Check your by-laws, as some peer review systems allow for internal reviews, which are a type of appellate review. Internal appeals may be a prerequisite before filing in the Superior Court.
Understanding the Hierarchy:
- Medical Boards: California medical licenses are issued by the Medical Board of California or the Osteopathic Medical Board of California. These boards operate under the supervision of the Department of Consumer Affairs. Peer review actions are often reported to the board (sometimes when such reporting is not mandatory). A top quality peer review lawyer sees ahead and anticipates that peer review proceedings may escalate to board review.
- Initial Disciplinary Process: The initial process is often biased towards discipline. Peer review moves quickly and there is little chance to prepare. The medical board is semi-secret so there is a star chamber feel to many interviews at the board. In each instance you need to make your best effort to stop the process, negotiate a resolution or win the hearing. However, if you do not succeed, with proper preparation, appeals can be successful.
Our Approach:
- Preparation: We meticulously prepare for the initial disciplinary process to set up a strong foundation for potential appeals.
- Success in Appeals: Our experience shows that well-prepared cases often succeed when appealed to the California Superior Court. We know the existing legal exceptions to help our attorneys and we anticipate future developments in the law that can be favorable to our clients if these issues are properly addressed and preserved.
By leveraging our expertise, we help physicians protect their licenses and continue their practice with confidence.
The Board Supervises You, But Who Supervises the Medical Board?
While a California medical license is issued by either the Medical Board of California or the Osteopathic Medical Board of California, these boards operate under a hierarchy of supervision that many physicians are unaware of. A medical board attorney routinely interfaces with the enforcement or licensing divisions of these agencies, but above them is the Department of Consumer Affairs.
Understanding the Hierarchy:
- Medical Boards: These boards are political entities, with members often being political appointees. They may be highly qualified but they have certain outlooks that many be evidence based or it may be bias.
- Department of Consumer Affairs: This department oversees the medical boards and influences which cases are acted upon and which are negotiated easily, often swayed by political winds.
Navigating Political Influences:
- Changing Standards: Sometimes, long-accepted conduct becomes suspect due to shifting political climates.
- Expert Guidance: We keep track of these changes and advise our physician clients accordingly, ensuring they remain compliant and protected.
By understanding this hierarchy and the political influences at play, physicians can better navigate the complexities of maintaining their medical licenses.
The California Medical License & Discipline Process: In Detail
Understanding the complexities of the California medical license and discipline process is crucial for providing the most creative and effective defense. With over 40 years of experience representing physicians, Daniel Horowitz, alongside Dr. Mark Ravis (a lawyer and doctor), brings a unique perspective to the table. They think both inside and outside the box, leveraging their deep understanding of the disciplinary and regulatory structure.
Complex Defenses:
- Underground Regulations: One example of their innovative approach is raising issues of “underground regulations” as a defense to disciplinary actions. This involves obtaining communications between the Attorney General’s office and the Board, as well as analyzing public meeting data.
- Unequal Application of the Rules: The Due Process and Equal Protection clauses of our Constitution apply in the licensing field.
Expertise Matters:
- Creative Legal Strategies: The best physician defense attorneys identify and raise these complex issues. While it may not be below the standard of care for other law firms to miss these nuances, top license attorneys look for creative solutions and incorporate them into your defense.
By leveraging their extensive experience and deep understanding of the system, Daniel Horowitz and Dr. Mark Ravis provide robust defenses for physicians facing disciplinary actions.
Why is Law Enforcement Control of the MBC & OMBC Important?
The influence of the Department of Consumer Affairs on the Medical Board of California (MBC) and the Osteopathic Medical Board of California (OMBC) is both political and operational. These boards are advised by Deputy Attorney Generals, who are lawyers working for the State of California Attorney General. This connection is crucial because their legal advice, policy positions, and “grey area” judgments are politically driven by the Attorney General.
Key Points:
- Political Influence: Medical license enforcement is administered by the MBC and OMBC but controlled by political appointees to the boards and supervising law enforcement agencies.
- Hierarchy of Control: The Governor controls the boards, while the Attorney General controls the lawyers. Public policy, often termed Consumer Protection, places your license in the hands of politicians.
Impact of Political Motivations:
- Attorney General’s Role: The Attorney General is a highly politically motivated individual. For instance, Vice President Harris previously held this position, and her political ambitions likely influenced her decisions, appointments, and policies.
Understanding this hierarchy and the political influences at play is essential for navigating the complexities of medical license enforcement and protecting your professional standing.
Of interest: Daniel Horowitz litigated against Vice President Harris when she was a District Attorney in Alameda County.
Horowitz Describes VP Harris in Court
The Corporate Practice of Medicine: Navigating Political Influences
It’s surprising to realize that your medical license is ultimately controlled by law enforcement. The wave of California opioid license actions against physicians is a prime example of politically motivated attacks that were later dialed back. Our physician lawyers actively fought against this political takeover of the medical boards.
CASE IN POINT - Revised Opioid Guidelines:
- Political Motivations: The initial guidelines were driven by political agendas, causing significant damage to medical careers and patient care.
- 2023 Revisions: The revised opioid prescription guidelines released in 2023 represent a major retreat from the previous, overly restrictive policies.
Impact on Physicians and Patients:
- Medical Careers: Many physicians’ careers were adversely affected by the old guidelines.
- Patient Care: Numerous patients suffered due to the restrictive, politically driven policies.
By understanding these political influences, physicians can better navigate the complexities of the corporate practice of medicine and protect their professional standing.
Is the DOC Control Over Medical License Regulation a “Secret”?
The Department of Consumer Affairs is very open about its control of California Medical License grants and regulation. Their website describes their responsibilities as including:
How the Department of Consumer Affairs Controls the Medical Board
“Licensing Licensing only those professionals who pass specialized examinations and meet experience and education requirements ensures that only qualified individuals are legally permitted to provide services. Licensing also ensures that practitioners perform their duties to a certain standard and provides consumers with a means of recourse if a service is not delivered fairly or competently. Note: Certain occupations are registered or certified, rather than being licensed. Registration and certification do not require passing a test. The Department also helps licensees maintain high standards of competence, quality, service, and ethical behavior through licensee education programs. Educating licensees and consumers also reduces fraud and lessens the need for (and costs of) investigation and prosecution of violators and other enforcement actions. The Department believes that combining education with enforcement is the most effective approach to making the marketplace safe for consumers.
Enforcement Enforcement of consumer laws is one of DCA's primary responsibilities. The Department's enforcement staff works with the Office of the Attorney General and local district attorneys to reduce fraud in the marketplace. Resulting disciplinary actions may include Temporary Restraining Orders; Interim Suspension Orders; and license probations, suspensions, or revocations. The Department also has the authority to assess fines and issue Citations, Notices of Violation, Letters of Reprimand, and Cease and Desist orders. In less severe cases, enforcement staff works with licensees to eliminate or prevent performance problems."
The relationship is right on the paperwork. Here is a recent Medical Board Accusation. It is filed (see the stamp) by the Medical Board. The caption reads “Xavier Beccera, Attorney General of California”. (Ron Bonta is now the AG.) The complainant is Maureen Forsyth who is the Executive Director of the Physician Assistant Board. (The Medical Board of California regulates PA’s). So again, it is no secret, the Board and the Attorney General work together but strangely, the lawyer for the Board is by any fair analysis ABOVE the board :] because the Dept. of Consumer Affairs is an arm of the Attorney General!
As you read the above, did you think you were reading from the site of the medical boards? Remember you weren't. This was the Department of Consumer Affairs!
Administrative Law Hearings: A Different Arena:
- Unlike courtroom trials, administrative law hearings are less formal.
- Administrative law judges (ALJs) preside over these hearings. They act as neutral judicial officers, conducting proceedings and settlement conferences.
- The setting lacks the familiar legal drama—it’s more bureaucratic than theatrical.
- Hearsay is admissible and many other courtroom rules of evidence are bent or broken.
- Making a proper “record” so an appeal can take place is critical.
The Decision-Making Phase: Where Unfairness Lurks:
- ALJs review evidence and arguments presented during the hearing.
- In most cases, the ALJ drafts a recommendation or proposed decision.
- Here’s the twist: The agency’s governing body (often the medical board) reviews the ALJ’s recommendation and issues the final decision. The judge is just an advisor!
- Parties involved usually retain the right to appeal this decision through administrative or judicial channels.
The Corrupting Lens: Criminal Trial vs. Administrative Hearing:
- Imagine if this were a criminal trial:
- The judge’s impartiality would be unquestioned.
- The jury would weigh evidence and render a verdict.
- Appeals would follow established legal procedures.
- However, in administrative hearings:
- The ALJ’s recommendation isn’t final; it’s subject to agency review.
- The agency’s decision may not align with the ALJ’s findings.
- The lack of true judicial independence raises concerns.
Seeking Redress: The Writ of Mandate:
- If you don’t prevail, you can seek review by the superior court.
- This legal remedy, known as a “writ of mandate,” challenges the administrative decision.
- It’s a lifeline for those caught in the web of administrative unfairness..
The basic hearing process proceeds this way:
Demanding an Administrative Hearing
1. An Accusation is served on the doctor.
2. The doctor is entitled to dispute the charges and demand an administrative hearing. There is a 15 day period to file the request. (Government Code Section 11506) The name of the official form is “Notice of Defense” and this has to be sent to the Board and also to ...... (you can guess) ... the Deputy Attorney General.
So far there is no major problem.
Who Makes the Final Decision?
In a crazy, circular route, the Administrative Law Judge submits a proposed decision. The proposed decision is the Board. This is the same Board that brought the charges and the Board is advised by the Attorney General who prosecuted the charges. The Board then issues a final decision can be a verbatim adoption of the judge’s ruling, a complete rejection or anything in between. So the judge is an advisor and a fact gatherer. The same group that led the prosecution makes the decision. It is not quite a Stalin show trial but it is not a “fair trial” as we generally understand the concept. (To paraphrase Grace Slick in one of her Jefferson Airplane offshoot songs, “A fair trial is no trial at all”.)
Access to a fully powerful court and judge is available only after the Board issues its “final decision”. Then physician can then challenge the decision before a Superior Court judge.
Is There Any Medical Board, Osteopathic Board Independence?
There is some independence depending upon how political the appointees are and how much push back they give to the Attorney General control. It is also true that the CMB and the OMBC have specific tasks that are influenced by but independent of the Department of Consumer Affairs. A critical task that remains somewhat independent is review of medically based complaints.
Who Makes the Final Decision After a Medical Board Hearing?
In the California medical license disciplinary process, the Administrative Law Judge (ALJ) submits a proposed decision to the Medical Board. This is the same Board that brought the charges and is advised by the Attorney General who prosecuted the case. The Board can adopt, modify, or reject the ALJ’s proposed decision1. Essentially, the judge acts as an advisor and fact-gatherer, while the Board, influenced by the same group that led the prosecution, makes the final decision.
Understanding the Process:
Appealing the Decision:
- Superior Court: Physicians can challenge the Board’s final decision in the Superior Court, but this is a long, expensive, and stressful process.
- Avoiding the Process: The best strategy is to avoid reaching this stage. If you cannot escape the accusation process, having a leading trial attorney like Daniel Horowitz is crucial. He can build a strong case to convince the ALJ and argue for a favorable decision from the Board. If necessary, he will establish a clear factual record to support your position in an appeal.
By understanding this process and having expert legal representation, you can better protect your medical license and professional standing.
Business & Professions Code section 2220.08
(Independent Medical Review of Complaints)
Business and Professions Code § 2220.08
This critical law relates to complaints against a physician involving the quality of medical care. Unless these are complaints lodged under Business & Professions Code sections 801.01 or 805 a physician cannot be investigated until there is a medical review of the case and cause found to further investigate the matter. Both the Medical Board of California and the Osteopathic Medical Board of California have individuals who qualify and are paid to conduct these examinations. This is an important gatekeeping function as it protects a person holding a California Medical License from scrutiny (in quality of care matters) by non-licensed, non-medical personnel. However, an experienced medical license defense attorney will tell you that both boards have increasingly reduced or lessened the level of medical scrutiny and that a very large number of medical complaints do proceed to investigation.
Medical Consultant Programs
The MBC and the OMBC us a Medical Consultant Program to recruit and train reviewers who act as "consultants" to the Board's Consumer Protection Unit (CPU). Business and Professions Code section 2220.08 (See above) The application to serve as an OMBC consultant is here.
What are the Current “Hot Button” Enforcement Issues?
The Enforcement section of the OMBC lists the names and types of discipline are linked here:
The Medical Board of California lists its enforcement actions here:
Qualifications of the Horowitz Physician Defense Team
Our California medical license lawyers delve deep beyond the paperwork, assessing MBC/OMBC complaints through the lens of political and social forces driving the investigation. Why does one complaint get dismissed while another is aggressively pursued? What are the “hot button” issues that politicians are targeting through political channels?
Expert Team:
- Daniel Horowitz: With over 40 years of experience, Daniel Horowitz brings unparalleled expertise in representing physicians.
- Dr. Mark Ravis: As both a doctor and a lawyer, Dr. Mark Ravis addresses medical, technical, and political issues to provide the best defense possible.
Our Approach:
- Comprehensive Analysis: We examine the political and social context of each complaint to understand the underlying motivations.
- Strategic Defense: By identifying and addressing “hot button” issues, we craft effective defense strategies tailored to each case.
Locations:
- Daniel Horowitz: Located in Lafayette, California (Contra Costa County).
- Dr. Mark Ravis: Based in Calabasas, an hour from Los Angeles.
We represent doctors throughout California, ensuring they receive the best possible defense. If you need help, call our office today.
