If a state medical board takes action against a physician’s license, the physician must receive due process. Failure to follow due process may subject the medical board and its director to lawsuits in state or federal court for damages. In the case below, a physician received a confidential letter of reprimand from the state medical board without receiving due process. The Iowa Supreme Court ruled that the letter constituted discipline of the physician’s license and that the Board failed in its duty to provide due process.
An emergency physician’s hospital privileges were revoked after the death of a patient under his care. The Iowa Board of Medicine investigated the matter and raised concerns because the physician allegedly did not recognize the seriousness of the patient’s condition, ignored concerns of other healthcare providers, and failed to transfer the patient for six hours. The physician then voluntarily ceased practicing medicine. The Board closed its investigation without any finding that the physician had violated any standard of practice and issued the physician a “CONFIDENTIAL LETTER OF WARNING” stating that if the physician returned to practice, the Board would require the physician to undergo a “comprehensive clinical competency evaluation.”
The physician challenged the Board’s ruling, but both the trial court and the court of appeals dismissed the physician’s claims. The court of appeals noted that the Board’s warning letter effectively amounted to an admission that it had “no probable cause to file disciplinary charges” but it concluded that there was no basis for judicial review because the Board’s letter did not result in any Board sanction or other action.
In order for a court to review an administrative agency’s actions, there must be a formal disciplinary action and all administrative remedies must be exhausted. The Board argued that under Iowa Administrative Code, “a letter of warning or education is an informal communication between the board and the licensee and is not formal disciplinary action or a public document.”
The Iowa Supreme Court vacated the appellate court’s decision and reversed the trial court, holding that the warning letter sent by the medical board did impose disciplinary action on the physician’s license in the form of a “competency evaluation” if the physician chose to begin practicing medicine again. The definition of licensee discipline contained in Iowa Code Section 272C.3(2) includes imposing “additional professional education or training, or reexamination, or any combination, as a condition precedent to the reinstatement of a license or of any privilege incident thereto.” The Court held that trying to couch this discipline within a “confidential letter of warning” without conducting a disciplinary proceeding “allows discipline to be imposed without the procedural safeguards of contested case proceedings and without the reporting obligations that safeguard the public by disclosing disciplinary actions.”
To require a competency evaluation, the Board would be required to prove that there was probable cause in doing so and would have to allow the physician to object to the evaluation in a case hearing. The letter precluded these statutory safeguards and prevented the physician from being able to “challenge the obstacle the Board has imposed on his right to practice” while also “undermining the public’s right to know when a physician’s competence has been called into question by a licensing board.”
The Supreme Court specifically noted that its opinion did not prevent the Board from reopening its investigation into the physician’s conduct to determine if discipline was warranted.
Discussion
Reversal of the medical board license action in this case may have been a Pyrrhic victory. By appealing the Board’s decision, the Supreme Court’s opinion is near the top of search engine listings when the physician’s name is searched on the internet. If the physician had no intent of continuing to practice medicine, the Board’s action ended the inquiry without blemishing the physician’s record. Now, regardless of whether the physician wishes to continue practicing medicine, he may be required to engage in a potentially lengthy and costly administrative hearing to clear his name. If any such hearing results in action against his license, the discipline may be published on the Iowa Board of Medicine web site and reported to the National Practitioner Databank.
The case is Irland v. Iowa Board of Medicine, Case No. 18-0353 (2020).
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