Complaints to the Minnesota Board of Medical Practice in FY 2000
By: KENT G. HARBISON & CYNTHIA J. MOYER
November 2000
For most physicians and other professionals regulated by the Minnesota Board of Medical Practice, the only reminder that the board even exists occurs when they renew their licenses or comply with continuing medical education requirements. For others, however, the board is a much more active and potentially ominous part of their lives. They are the physicians and other health care professionals who receive notices that someone has filed a complaint against them with the board. The good news is that the total number of complaints filed with the board in fiscal year (FY) 2000 (July 1, 19999, to June 30, 2000) decreased for the fifth consecutive year. The bad news is that the number of complaints for FY 2000 was still large, 786. (Because of widely varying complaint categories among states, it is difficult to make a reliable comparison between the number of complaints in Minnesota and those in other states with comparable numbers of licensed physicians. According to the most recent data from the national Federation of State Medical Boards, however, the number of complaints filed in Minnesota seems to be slightly above the average for states with a similar number of licensed physicians.)
Each year the board is required to submit an annual report to the Minnesota Legislature and the governor summarizing an array of information about complaints filed with and investigated by the board. The report for FY 2000 reflects interesting and perhaps surprising data about the investigative and complaint-processing functions of the board.
Complaint reporting requirements were first implemented in 1980, and during the first several years of reporting requirements, the number of complaints against physicians and other persons regulated by the board was relatively small but increased steadily each year. The high mark was FY 1993, when the board received 1,254 complaints. Each year since 1993 (with the exception of FY 1995), the number of complaints has declined.
In FY 2000, 15,592 physicians had active Minnesota medical licenses. The total number of health care practitioners regulated by the board for FY 2000 was 17,900. The other regulated professionals include physical therapists, physician assistants, respiratory care practitioners, athletic trainers, and acupuncture practitioners. (Physical therapists are now licensed by the Board of Physical Therapy although the Board of Medical Practice has been administering that board.) Of the 786 complaints filed with the board in FY 2000, one can assume that the overwhelming majority were against physicians, since physicians make up about 87 percent of the professionals regulated by the board. This means that approximately 5 percent of the Minnesota physicians with active licenses in 2000 were the subjects of complaints. (The board's report does not indicate the percent of complaints that were filed against physicians as opposed to other health care professionals licensed by the board, but it is likely that only a comparatively small number of the complaints were filed against nonphysicians.)
Whenever the board receives a complaint, it first determines whether the subject matter falls within its jurisdiction. After the board eliminates those complaints outside its jurisdiction, it processes and investigates the complaints using its own staff and investigators and attorneys from the attorney general's office. The 786 complaints received in FY 2000 alleged 1,221 different types of violations. Those were in addition to the pending complaints that had been left over from the previous year or years. For example, as of June 30, 2000, the board still had 514 complaints yet to be processed and/or investigated from past years. In fact, at any given time in the past few years, the board has had a minimum of 400 pending complaints.
Although these are daunting numbers, some of the complaints do not require extensive analysis or investigation. A few cases are dismissed with little or no in-depth investigation, either because they cannot be substantiated or because they have already been resolved without the need for any board action. In such cases, the board typically sends a letter to the physician indicating that the complaint has been reviewed, analyzed, and dismissed without further action. On some rare occasions, complaints are dismissed without the physicians even knowing that a complaint had ever been filed.
If the board determines preliminarily that a complaint justifies some type of response from the physician or further investigation (including personal interviews and document reviews), it will notify the physician of the allegations and request a response. Sometimes the board requests the physician's side of the story in the form of written response; other times, an investigator will conduct a personal interview with the physician. The board will also advise physicians that they have a right to legal counsel in preparing their response or participating in the investigative interview.
After the investigation information is collected, the board usually decides upon one of three main options: It may dismiss the complaint and close the file; it may require the physician to attend an informal conference with one of its medical coordinators to discuss the allegations and the physician's response; or it may require the physician to participate in a more formal conference before one of its complaint review committees. The physician is entitled to be represented by an attorney at either of the latter two types of conferences. Even if a physician is required to participate in a conference with a medical coordinator or complaint review committee, the case may be discussed.
The board disposed of 744 complaints in FY 2000 through a variety of methods, including dismissals, nondisciplinary corrective action plans, and disciplinary orders. The total number of disciplinary orders issued by the board in FY 2000 was 57 (up slightly from 1999). This figure includes 19 orders reinstating licenses that had previously been subject to certain conditions or restrictions. The disciplinary orders included sanctions ranging from reprimands and/or monetary penalties to license restrictions and license suspensions. The board's medical coordinators conducted 73 conferences. For FY 2000 the board suspended or revoked the licenses of two physicians, a very small number considering the total number of complaints filed and processed.
Table 1
Number of complaints filed each year with the Minnesota Board of Medical Practice since it began keeping records of such information in FY 1980.
Fiscal Year |
Number of Complaints Received |
Percentage Change from Previous Year |
2000 |
786 |
(5) |
1999 |
825 |
(9) |
1998 |
907 |
(3) |
1997 |
938 |
(10) |
1996 |
1,039 |
(13) |
1995 |
1,180 |
11 |
1994 |
1,054 |
(16) |
1993 |
1,254 |
2 |
1992 |
1,226 |
23 |
1991 |
1,001 |
(3) |
1990 |
1,025 |
26 |
1989 |
815 |
14 |
1988 |
714 |
22 |
1987 |
583 |
40 |
1986 |
415 |
83 |
1985 |
227 |
125* |
1984 |
101 |
9 |
1983 |
94 |
22 |
1982 |
77 |
4 |
1981 |
74 |
124 |
1980 |
33 |
* The increased number of complaints starting in 1985 was due primarily to the Legislature's adding reporting requirements to the Medical Practices Act.
The board has divided the complaints within its jurisdiction according to eight general categories: incompetency, unprofessional conduct, illness, actions by another jurisdiction, inadequate medical records, becoming addicted, prescribing practices, sexual misconduct, and miscellaneous (see Table 2).
"Unprofessional conduct" is an extremely broad category based upon a section of the Minnesota statutes that could include a variety of both minor (e.g., rudeness toward patients or staff) and serious transgressions. The statute defines the term as any departure from or failure to conform to the minimal standards of acceptable and prevailing medical practice that may or may not result in actual injury to a patient. Consequently, it is difficult to draw a firm conclusion as to whether the large number of "unprofessional conduct" complaints in FY 2000 reflect a serious problem of a particular nature. The other categories that are the most common are those alleging incompetency or malprescribing practices.
A significant number of the incompetency complaints are based on reports from professional liability insurers who are required to notify the board whenever they pay out a settlement or judgment on behalf of a physician in a malpractice case.
The prescribing category was a common subject of complaints for FY 2000 and has been true for many of the previous years as well. A typical prescribing complaint alleges that a physician has over-prescribed pain medications in the treatment of patients with chronic pain problems.
The illness complaints most frequently arise out of allegations that a physician might be suffering from a physical, emotional, or mental impairment that might affect his or her ability to practice medicine safely. Many of the illness complaints are referred by the board to the Health Professional Services Program, a diversion system established in 1994 to assist impaired physicians in a manner that enables them to continue practicing medicine under certain monitoring requirements.
Table 2
Type and number of complaints filed with the Minnesota Board of Medical Practice, FY 2000.
| Types | Number |
| Incompetency | 236 |
| Unprofessional conduct | 534 |
| Illness | 59 |
| Actions by another jurisdiction | 9 |
| Inadequate medical records | 67 |
| Becoming addicted | 3 |
| Prescribing practices | 69 |
| Sexual misconduct | 27 |
| Miscellaneous | 192 |
Individual complaints may include allegations of more than one violation. Thus, a physician or other health care practitioner who is the subject of a complaint may find that he or she has been accused of misconduct under several of the above nine categories.
The medical records category usually refers to what the board considers incomplete or inappropriate documentation in patient records.
The sexual misconduct category refers not only to obvious inappropriate sexual advances or activities but also to patient boundary violations that could include inappropriate comments or misunderstood examination questions or techniques.
Under Minnesota law, the board is not allowed to identify the person or persons who file complaints against physicians, unless the complaining party authorizes the disclosure. It is not surprising, however, that 34.8 percent of all the complaints filed with the board in FY 2000 came from patients. this number is a very modest increase from the 34.5 percent of complaints filed by patients in FY 1999. On the other hand, the number of complaints filed in FY 2000 by third parties and family members of the patients decreased from the previous year. Other sources include physicians themselves, other health care professionals, law enforcement agencies, hospitals, medical clinic, malpractice insurance carriers, and other state agencies. Indeed, under Minnesota law, physicians are required to file reports against other physicians and even themselves whenever they have personal knowledge of something that is grounds for disciplinary action. There is a very limited and qualified exception to a physician's reporting duty whenever the knowledge is gained in the course of a physician-patient relationship.
Conclusion
The Minnesota Board of Medical Practices continues to deal with hundreds of complaints against physicians and other regulated professionals each year. Even though the number of annual complaints is falling, the board still has a substantial caseload. One positive aspect is that the number of license suspensions or revocations and other public disciplinary actions is relatively small.