Investigative steps may include, but are not limited to the following:
- Obtaining medical records or other information/evidence
- Locating and interviewing the complainant, any witnesses, and the physician
- Obtaining expert review of the case
- Drafting and serving investigational subpoenas
- Inspecting the location where the allegations occurred
- Executing search warrants
- Conducting undercover operations
In general, after information is collected and compiled and the complainant has been
interviewed, the investigator, and perhaps the supervisor or a medical consultant,
interviews the physician to discuss the details of the complaint and ask questions.
Quality of care issues are then reviewed by a medical expert. The standard of proof
for administrative cases is “clear and convincing evidence to a reasonable certainty,” a
much higher standard than for civil litigation cases. This can be very challenging when
pursuing a complaint because administrative charges must be proven before an administrative
law judge who uses this higher and more difficult standard
If the investigation does not support a violation of the law, the complaint is closed.
Also, if the evidence obtained in the investigation shows a violation occurred, but the
violation is insufficient to support administrative action, the case is closed and maintained
on file for future reference. The investigator will notify the complainant and the physician
by telephone or in writing of the disposition of the complaint.
If the investigation reveals sufficient evidence of violations of the
Medical Practice Act or other laws that would warrant discipline against the license,
the case will be referred to the Office of the Attorney General (AG), Health Quality
Enforcement Section, for administrative action.