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Post Online, Get Investigated By State Medical Board

12754_hand_cuffsEarlier this month, a survey of state medical boards published in the Annals of Internal Medicine showed that many state medical boards were willing to investigate physicians for lack of online “professionalism.”

The authors of this study created 10 vignettes regarding online physician behavior and then queried state medical boards regarding their likelihood of “investigating” physicians based upon the scenarios. Percentages of state medical boards that were “likely” or “very likely” to investigate a physicians for behaviors were as follows:

Citing misleading information about clinical outcomes — 81%
Using patient images without consent — 79%
Misrepresenting credentials — 77%
Inappropriately contacting patients — 77%
Online posts depicting alcohol intoxication — 73%
Violating patient confidentiality — 65%
Using discriminatory speech — 60%
Using derogatory speech toward patients — 46%
Online posts depicting alcohol use without intoxication — 40%
Providing clinical narratives without violation of confidentiality — 16%

Think about the implication of some of these circumstances.
It takes 4 years of college, 4 years of medical school, 2-6 years of residency, and hundreds of thousands of dollars in expenses in order to obtain a medical license.

Based on this article, there is theoretically the potential for a medical board to take away 10-16 years of work because a physician makes a post about drinking alcohol or because a physician writes about a patient’s case — even without violating a patient’s confidentiality. Even if a license is not revoked, an investigation could be initiated based on vague and sometimes anonymous complaints about “discriminatory” or “derogatory” speech or citing “misleading” information. Such complaints would require that a physician retain legal counsel in order to proceed through a drawn-out investigation. The expenses involved in the investigation may not be covered by malpractice insurance.

For those who have never had the experience of being “investigated” by a state medical board, the process do not have to follow the rules of court, may involve threats from investigators or pressure to immediately sign “confessions,” and it is not uncommon for investigations to quickly become witch hunts. Here are some of one lawyer’s experiences in dealing with Licensing Boards.
Remember the issue with Amanda Trujillo, RN who was investigated by the Arizona State Nursing Board for informing a patient about her surgical options? That case turned into an 8 month inquiry into every complaint alleged against Amanda for the prior 3+ years at multiple hospitals in multiple states. The Nursing Board also reportedly informed her that they would further discipline her if she continued publishing their communications with her.

A couple of things work in a physician’s favor if being investigated by a medical board. A medical license is usually considered “property”, which may allow a physician to pursue a due process claim if a medical board takes inappropriate actions against a physician’s license or does not follow proper procedure in pursuing those actions. This Washington Supreme Court case contains a very good discussion about the problems involved in actions taken against a physician’s license. Also, in many states, attorney’s fees are awarded for successful due process violation actions.

Don’t be afraid to fight back against inappropriate state medical board claims. As Glenn Reynolds likes to say on Instapundit … punch back twice as hard.


  1. Can’t get some state Medical Boards to pull a license of even physicians with multiple judgments, but they’re on top of those social media accounts!

  2. Also note: If licensed in more than one state, a cause of action by one Board becomes a cause of action by each and every board of each and every license you hold. Each one with different rules/procedures/punishments etc. for the “bootstrap” action… I would not hold any extra licenses ‘just in case’ – it just adds more boards to ‘investigate’ you once the ball starts rolling…

  3. Trujillo’s case just got closed (with penalties) in December. Check out www-dot-azbn-dot-gov.

  4. A lot of the older doctors hopped on the “support Amanda Trujillo” bandwagon before hearing both sides of the story. The allegations against her are pretty substantial (including multiple episodes of falsifying her credentials and disregarding doctor’s orders), check the link at the end of the first paragraph: http://notratched.net/nnr/2012/03/27/documentation-from-the-az-bon-on-amanda-trujillo

    • I don’t condone falsifying credentials or disregarding doctors’ orders – in most cases. For example, forgetting to change credentials when a situation changes or not following an order that may harm the patient are both understandable.
      That being said, I don’t think anyone would be able to come out of an in-depth investigation of several years of their professional career smelling like roses.
      I’ve actually considered creating a fund to do an in-depth investigation on the director of the Arizona Nursing Board to prove the point.
      Not going there … yet.

  5. If you want to get rid of what you consider a “bad apple” all you have to do is carefully word your complaint. It doesn’t excuse the fact that she entered a “nursing order” allowed under the Cerner system for the patient to talk to a case manger about other options. That the surgeon threw a hissy and demanded her termination. The nurse was not the surgeon’s employee. She was a hospital employee. This could have been handled internally. She probably shot herself in the foot with the internet stuff. But then again I never read anything negative about the blogger Flea who live blogged about his malpractice trial. Same difference. The bottom line is Banner Del Webb has a bad rep from the nurses who have worked there. Also I hope that as a nurse my hospital would not summarily dismiss me because a doc was unhappy. After working for 2 for profit organizations, I have found myself in the position of being “not a team player”. It sucks for nurses that they can’t speak out without fear of reprisal. The greatest stressor is having a job with absolute responsibility with no power. Such is life for nurses.

    • “The greatest stressor is having a job with absolute responsibility with no power. Such is life for nurses.”
      It adversely affects patient care and it shouldn’t be that way.

  6. I, for one, was happy to see so many docs support Ms. Trujillo in the beginning, when I too thought she was being cornered and threatened. The more that she and others posted in public, the more I began to see that there must be at least one other side to this story.

    When a nurse job-hops in lieu of remediation, removes Foley’s and orders cheeseburgers for cardiac patients, ignores urgent pt. needs (like breathing!)brings a minor child into a home health pt’s residence, mis-represents her credentials, and orders a “middle-of-the-night” hospice consult for a pt. admitted for a hip fx….and not even on the UNOS list…..we have an unstable nurse. She states she “lost her edge” due to a “medical problem”…..but still wanted to be a nursing Army of one, saving her patients from the big, bad doctors and her less-valuable peers. These are hallmarks of poor judgement, if not a mental issue of some type.

  7. Thought you might be interested in this case where an OBGYN got in some trouble for posting on her facebook about an anonymous patient:


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