Complaint: General Office Practices/Protocols
No. California law does not require physicians to have a male or female chaperone;
however, if having a chaperone or assistant in the exam room makes the patient feel
more comfortable and at ease, then the physician should accommodate the patient's
request if possible or allow a friend or relative to accompany the patient.
Yes, the physician can choose to not accept a new patient who does not want to sign
the Arbitration Agreement.
No. A physician has a right to determine whom to accept as a patient, just as a patient has the right to choose their physician.
However, B&P Code Section 125.6 (and Civil Code 51) does not allow a physician to discriminate against a prospective patient on the basis of race,
gender, disability, sexual orientation, citizenship or marital status.
A physician also may terminate a patient without cause as long as the termination is handled appropriately (see Question
"
Can a physician refuse to treat a current patient?").
There are no specific laws governing a physician's responsibility in regard to filling out forms or providing reports. Physicians can choose not to complete discretionary paperwork
if, in their medical opinion, the services/equipment is not medically indicated. Patients requesting completion of applications for disability benefits, FMLA, and/or work restrictions
may contact their treating physician for assistance. Patients should contact their attorney if one is involved, or the disability or Workers' Compensation program, requesting the
information as they may have specific rules and/or laws regarding the timely filing of forms/reports. They also may have alternatives that the patient can use if the physician won't
cooperate. The Medical Practice Act does not preclude the physician from charging for this service.
Yes, but the physician needs to follow appropriate guidelines. See California Medical
Association (CMA) guidelines in regard to terminating the doctor/patient relationship.
The CMA guidelines indicate a physician must notify the patient in writing informing
the patient:
- the last day the physician will provide care, assuring the patient at least 15 days
of emergency treatment and prescriptions before discontinuing service;
- alternative sources of medical care; i.e., referral to another physician, the patient's
insurer/HMO, or the local county's medical society; and
- information necessary to obtain the patient's medical records compiled during this
physician's care.
No. While there is no law mandating a physician provide "back up or cross covering"
care when he/she is unavailable, most physicians do have emergency coverage available
when they are unavailable, whether it be with another physician or directing the
patient to Urgent Care or to a hospital's emergency department.
There is no general law requiring a physician to maintain medical records for a
specific period of time. However, there are situations or government health plans
that require a provider/physician to maintain their records for a certain period
of time. Several laws specify a three-year retention period: Welfare and Institutions
Code section 14124.1 (which relates to Medi-Cal patients), Health and Safety Code
section 1797.98(e) (for services reimbursed by Emergency Medical Services Fund),
and Health and Safety Code section 11191 (when a physician prescribes, dispenses
or administers a Schedule II controlled substance). The Knox-Keene Act requires
that HMO medical records be maintained a minimum of two years to ensure that compliance
with the act can be validated by the Department of Corporations. In Workers' Compensation
Cases, qualified medical evaluators must maintain medical-legal reports for five
years. Health and Safety Code section 123145 indicates that providers who are licensed
under section 1205 as a medical clinic shall preserve the records for seven years.
However, there is no general statute which relates to all other types of medical
records.
The Board receives and investigates a number of complaints about physician prescribing concerns which are sent by someone other than the patient.
These complaints can be difficult to investigate when the patient does not consent to allow the Board to evaluate the care and treatment. It is very
helpful in these situations if the Board is provided with as much information as possible, including but not limited to, the patient's name, patient's
date of birth, what specific medication(s) is/are being prescribed and the quantity and frequency. Sometimes this information can be obtained from the
pharmacy where the prescriptions are filled. The Board will try to validate the information and in the event that sufficient evidence is available to support a
possible violation of the law, an investigational subpoena will be issued for the patient's medical records.
The Board has very limited jurisdiction over independent evaluation reports. The
role of the evaluator is to provide an "independent opinion" of the individual's
condition after 1) examining the patient and/or 2) reviewing the records of the
treatment obtained by the other treating physicians involved in the patient's care.
The Board will normally recommend that disability patients pursue an appeal through
the disability insurance company.
Worker's compensation independent (IME) and qualified medical examiner (QME) evaluations are
governed by the Medical Unit of the Division of Workers' Compensation. This state agency is
responsible for regulating the conduct of IMEs and QMEs in workers' compensation cases, and may
be able to advise you on other workers' compensation-related issues. You may contact them at DWC - Medical Unit
P.O. Box 71010, Oakland, CA 94612 or by telephone at 510-286-3700 or 800-794-6900.
No, the Board does not provide referrals to physicians. You can contact your local
medical association for referrals in various medical specialties or your individual
insurance plan or HMO. To locate the medical association/society in your area you
can log onto the California Medical Association's website at
cmadocs.org/partners.
There is no law which specifically prohibits a physician from evaluating, diagnosing, treating, or prescribing controlled
substances to a family member, employee or friend. However, the practice is discouraged. There are laws to consider when assessing any
prescribing issues which include, but are not limited to: 1) a physician cannot prescribe without an appropriate prior exam and a medical
indication for the prescription, and 2) an adequate and accurate medical record relating to the provision of services to the patient and
documenting the medical need for the prescription must be created and maintained by the physician. Basically, a physician must follow the
same practice/protocol for any patient in which medications are prescribed.
Business and Professions Code section 726 states that sexual abuse, misconduct or
relations with a patient are considered unprofessional conduct and grounds for disciplinary
action. The Board considers any type of personal relationship between the doctor
and the patient to be a very serious breach of public trust and investigates these
complaints. Please refer to "Complaints: Investigations" which provides general information about
complaint investigations.
The fact that the personal relationship between the physician and the patient at
some point was consensual does not negate the fact that the physician breached professional
ethics and boundaries, and possibly broke the law, by initiating a personal relationship
with a patient. Filing a complaint with the Board would be strongly encouraged so
the issue could be investigated in the event that other complaints with similar
allegations had been reported.
No. Children from the age of 12-17 have the authority to "consent" to some types
of treatment without the permission of their parent or guardian. The physician is
obligated to maintain the doctor/patient confidentiality, particularly when the
physician feels that the disclosure of the information will have a negative impact
on the relationship with the patient. HIPAA also prevents the disclosure of doctor/patient
information to the parent. i.e., treatment related to the prevention of sexually
transmitted diseases.
The medical clinic must be wholly owned and controlled by a physician or physicians
(a layperson cannot own a clinic). See Business and Professions Code sections 2400
- 2417 and Corporations Code sections 13400 - 13410 for the requirements on what
business structures can be used (sole ownerships, professional partnerships, and
professional corporations). If the physician/owner is practicing under a name other
than their own name (i.e., a clinic name, like "Sun Valley Medical Clinic"), the
physician must obtain a
Fictitious Name Permit
(FNP) from the Medical Board. This is separate from any fictitious business name
filings required by city or county governments. Applications for the Medical Board's
FNP can be obtained either on the Board's website or from the Consumer Information
Unit at 1-800-633-2322. If a physician who owns a clinic is a Medicare provider,
he or she can obtain certification for the clinic through the Department of Public
Health without having to apply for an FNP.
Health and Safety Code section 123148 requires the health care professional who requested the test be performed to provide a copy of the results to the patient,
if requested either orally or in writing. When the patient requests their lab results, the health care provider should provide the results to the patient within a
"reasonable" time period after the results are received by the provider. Results may be disclosed in electronic form if requested by the patient and if deemed most
appropriate by the health care professional who requested the test. In the event that the provider arranges for the test results to be provided by Internet posting
or other electronic manner, the results shall be disclosed to a patient in a reasonable time period, but only after the results have been reviewed by the provider.
Depending on the results of the tests, some physicians may want the patient to schedule an appointment to review and discuss the results and any follow-up testing or
treatment that might be required. The test results cannot be released by the lab performing the test and must be released by the provider requesting the test(s).
