Archives for February 2011

Arizona Board of Chiropractic Examiners Complaint – Findings

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The Arizona Board of Chiropractic Examiners (“Board”) administers all investigations and complaints regarding licensed doctors of chiropractic (“Doctor”) in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued an informal explanation of the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) the professional self-reports, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s investigation/adjudication process can be broken down into three stages:

1.       Findings
2.       Board Meeting
3.       Formal Hearing

This post will examine the first stage of the complaint process; Findings.  A general time-line for the findings stage is as follows:

1.       All complaints filed with the Board are investigated and brought before the Board.
2.       Once the Board receives the complaint a complaint number is assigned and a file is opened by an investigator.
3.       A copy of the complaint and a subpoena requiring a copy of the patient’s records are sent to the Doctor.
4.       The Board requests a response to the complaint from the Doctor within 10 days.
5.       Once the Board receives the Doctor’s response the complaint is then scheduled for the upcoming Board Meeting.
6.       Prior to the Board Meeting an investigator will contact both the Doctor and the complainant in order to clarify the basis of the complaint.
7.       Next, a Board Meeting is held where the Board will review the complaint for the first time.

Prior to responding to the complaint it is imperative that the chiropractor seek legal counsel.  Submitting a well-reasoned, persuasive response can sometimes be the difference between having the complaint dismissed versus being found to have committed an act of unprofessional conduct. The next stage in the Arizona Board of Chiropractic Examiners complaint process is Board Meeting.

If you have a question about an Arizona Board of Chiropractic Examiners complaint contact Attorney Robert Chelle.

Arizona Legislators Propose to Terminate AHCCCS

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Senate Bill 1519 was passed out of the Appropriations Committee by Arizona legislators Wednesday night. SB 1519 would repeal all Arizona Health Care Cost Containment System (“AHCCCS”) coverage for individuals in Arizona. It is estimated that this would end health insurance coverage for nearly 1.8 million Arizona residents. Under the Bill, Arizona would essentially withdraw from the federal Medicaid program and would forfeit nearly 8 billion dollars in funds from the federal government.

As with any Bill, the Arizona Senate and House must approve it and the Governor must sign it before it becomes a law. There is virtually no chance of that happening with this proposed Bill, however, the mere introduction of it should scare any health care provider in the state. All health care providers that participate in federally funded health care programs would be financially crippled by this proposed law.

This would hit rural health care providers disproportionately hard. Rural health care providers have a much higher patient population on AHCCCS than other providers. In fact, I would guess that some rural hospitals have AHCCCS payer populations of up to 50%. Can you imagine if 50% of a health care providers payers were suddenly without health insurance? It is safe to say those health care providers would be unable to exist without the federal Medicaid payments.

I understand that this Bill is meant to simply elicit a response because the current health care model used throughout the country is not sustainable; however, threatening to pull out of the federal Medicaid program should scare anyone involved in health care.

I have quickly found that Arizona is a state of extreme political views, but this proposed Bill would financially devastate health care providers throughout the state in a way that would be difficult to recover from.

If you have a question about AHCCCS contact Arizona Attorney Robert Chelle.

Arizona Board of Physician Assistants Complaint – Adjudication

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The Arizona Regulatory Board of Physician Assistants (“Board”) administers all investigations and complaints regarding licensed physician assistants (“PA”) in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a document titled Adjudication Process that illustrates the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) the professional self-reports, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s investigation/adjudication process can be broken down into four stages:

1.       Findings
2.       Recommendation
3.       Processing
4.       Adjudication

This post will examine the last stage of the complaint process; Adjudication.  A general time-line for the adjudication stage is as follows:

1.       Prior to determining whether to institute discipline, the Board will interview the PA at one of its quarterly meetings.
2.        The Board will give a brief presentation of the case.
3.       The PA may choose to take questions from the Board prior to making a statement.
4.       If no questions are asked the PA is given a chance to address the Board (up to 5 minutes).
5.       The PA may have legal counsel present and the attorney is allowed to make a brief statement as well.
6.       After all statements are made the Board will move to dismiss the case or find that there has been unprofessional conduct.
7.       If the case is dismissed the complainant may not appeal and the process concludes.
8.       If unprofessional conduct is found the Board may issue:

  • Non-disciplinary advisory letter
  • Letter of reprimand
  • Decree of censure
  • Probation
  • Suspension
  • Restriction
  • Any revocation is forwarded to the Office of Administrative Hearings

9.       The PA has 35 days to appeal the Board’s final order.

Any PA under investigation must stay proactive. Contact an attorney as soon as possible, respond to the investigation respectfully and address the Board deferentially. Being under investigation can be an intimidating process, but it is important to stay calm.  Beyond appealing a Board decision to the Superior Court, the Board ultimately determines your fate and showing respect, is in my opinion, one of the most important things a PA can do during an investigation.

If you have a question about an Arizona Regulatory Board of Physician Assistants complaint contact Attorney Robert Chelle.

Arizona Board of Physician Assistants Complaint – Processing

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The Arizona Regulatory Board of Physician Assistants (“Board”) administers all investigations and complaints regarding licensed physician assistants (“PA”) in Arizona. The Board imposes disciplinary action if they determine that a violation has occurred. The Board has issued a document titled Adjudication Process that illustrates the complaint process. An investigation by the Board is initiated when; 1) a complaint is filed, 2) the professional self-reports, and 3) when an organization is required by law to report a possible violation to the Board. The Board’s investigation/adjudication process can be broken down into four stages:

1. Findings
2. Recommendation
3. Processing
4. Adjudication

This post will examine the third stage of the complaint process; Processing. A general time-line for the processing stage is as follows:

1. Once the Staff Investigational Review Committee (“SIRC”) recommends disciplinary action the Executive Director (“ED”) determines where the case is forwarded.
2. If the SIRC recommends the suspension of revocation of a PA’s license the ED may decide to forward the case an Administrative Law Judge(“ALJ”) with the Office of Administrative Hearings (“OAH”).
3. The OAH also handles cases that the ED feels is too complex for a formal interview in front of the Board.
4. Once forwarded to the OAH an ALJ conducts a formal hearing and submits a formal recommendation to the Board.
5. The Board can accept, reject or modify the ALJ’s recommendation.

The final stage in the Arizona Regulatory Board of Physician Assistants complaint process is the Adjudication stage. It is important to remember that a PA can retain legal counsel at any point during the complaint process. I would recommend obtaining counsel prior to responding to any complaint, but it is never too late for sound legal advice.

If you have a question about an Arizona Regulatory Board of Physician Assistants complaint contact Attorney Robert Chelle.

Arizona Board of Physician Assistants Complaint – Recommendation

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The Arizona Regulatory Board of Physician Assistants (“Board”) administers all investigations and complaints regarding licensed physician assistants (“PA”) in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a document titled Adjudication Process that illustrates the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) the professional self-reports, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s investigation/adjudication process can be broken down into four stages:

1.       Findings
2.       Recommendation
3.       Processing
4.       Adjudication

This post will examine the second stage of the complaint process; Recommendation.  A general time-line for the recommendation stage is as follows:

1.       The Staff Investigational Review Committee (“SIRC”) recommends whether the PA should be disciplined.
2.       The SIRC includes the case review manager, the Chief Medical Consultant and the board operations manager.  An assistant attorney general is included in the process if legal advice is needed.
3.       The SIRC determines if the facts and records regarding the complained of behavior is accurate and thorough.
4.       If the members agree that the case is ready for adjudication and the assistant attorney general advises that due process has been met the SIRC develops a recommendation.
5.       The SIRC will then recommend whether disciplinary action should be taken.
6.       After a recommendation is given the case then moves into the processing phase.

Once the complaint has reached the recommendation phase the PA has no role in the process until a formal interview in front of the Board is scheduled.  The processing stage of the complaint process will be discussed in the next post.

If you have a question about an Arizona Regulatory Board of Physician Assistants complaint contact Attorney Robert Chelle.

Arizona Board of Physician Assistants Complaint – Findings

The Arizona Regulatory Board of Physician Assistants (“Board”) administers all investigations and complaints regarding licensed physician assistants (“PA”) in Arizona. The Board imposes disciplinary action if they determine that a violation has occurred. The Board has issued a document titled Adjudication Process that illustrates the complaint process. An investigation by the Board is initiated when; 1) a complaint is filed, 2) the professional self-reports, and 3) when an organization is required by law to report a possible violation to the Board. The Board’s investigation/adjudication process can be broken down into four stages:

1. Findings
2. Recommendation
3. Processing
4. Adjudication

This post will examine the first stage of the complaint process; Findings. A general time-line for the findings stage is as follows:

1. A complaint is filed.
2. The Board determines if they have jurisdiction.
3. If so, a Lead Investigator is assigned.
4. The Lead investigator contacts the complainant, the PA and the supervising physician.
5. A response is requested from the PA (generally 30 days to respond).
6. Quality of care cases are given medical review by a medical consultant.
7. If the medical consultant cannot substantiate the claims the Chief Medical Consultant forwards the case to the Executive Director for dismissal.
8. When the medical consultant finds the PA did not meet the standard of care, the PA receives the report and is given another opportunity to respond to the specific findings of the medical consultant.
9. Non-quality of care cases follow the same procedures, however, no medical review is given.

Prior to responding to the complaint it is imperative that the PA seek legal counsel. Submitting a well-reasoned, persuasive response can sometimes be the difference between having the complaint dismissed versus being found to have committed an act of unprofessional conduct. The next stage in the Arizona Regulatory Board of Physician Assistants complaint process is Recommendation.

If you have a question about an Arizona Regulatory Board of Physician Assistants complaint contact Attorney Robert Chelle.

Arizona Board of Physical Therapy Complaint – Disciplinary Action

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The Arizona Board of Physical Therapy (“Board”) administers all investigations and complaints regarding licensed physical therapists and certified physical therapist assistants in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a list of Frequently Asked Questions that sheds some light on the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) self-reporting, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s Complaint Review Process can be broken down into:

1.       Filing a Complaint
2.       Investigation
3.       Board Review
4.       Disciplinary Action

This post will examine the final stage of the complaint process; Disciplinary Action.  A general time-line for the disciplinary stage is as follows:

1.       The Board determines if a violation of law has occurred.
2.       If so, the Board will impose disciplinary action, including the following:

  • Decree of Censure
  • Restriction: scope, place or supervision of practice
  • Suspension
  • Revocation
  • Dismissal of Complaint
  • Advisory Letter: non-disciplinary action, but is part of the public record
  • Civil Penalty: between $250 and $10000 per violation

Any physical therapist under investigation must stay proactive. Contact an attorney as soon as possible, respond to the investigation respectfully and address the Board deferentially. Being under investigation can be an intimidating process, but it is important to stay calm.  Beyond appealing a Board decision to the Superior Court, the Board ultimately determines your fate and showing respect, is in my opinion, one of the most important things a physical therapist can do during an investigation.

If you have a question about an Arizona Board of Physical Therapy complaint contact Attorney Robert Chelle.

Arizona Board of Physical Therapy Complaint – Board Review

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The Arizona Board of Physical Therapy (“Board”) administers all investigations and complaints regarding licensed physical therapists and certified physical therapist assistants in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a list of Frequently Asked Questions that sheds some light on the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) self-reporting, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s Complaint Review Process can be broken down into:

1.       Filing a Complaint
2.       Investigation
3.       Board Review
4.       Disciplinary Action

This post will examine the third stage of the complaint process; Board Review.  A general time-line for the board review stage is as follows:

1.       The initial Board review is scheduled during a regular session public meeting.
2.       The Board reviews the complaint, response and relevant medical records.
3.       Both parties are notified and are given the opportunity to address the Board during the meeting.
4.       The professional may be represented by legal counsel in front of the Board.
5.       At the initial review the Board will make one of the following determinations:

  • Dismiss the complaint due to lack of evidence/substance
  • Continue further investigation
  • Vote to move the matter to an informal or formal hearing

The final stage of the complaint process, Disciplinary Action, will be discussed in the next post.

If you have a question about an Arizona Board of Physical Therapy complaint contact Attorney Robert Chelle.

Arizona Board of Physical Therapy Complaint-Investigation

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The Arizona Board of Physical Therapy (“Board”) administers all investigations and complaints regarding licensed physical therapists and certified physical therapist assistants in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a list of Frequently Asked Questions that sheds some light on the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) self-reporting, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s Complaint Review Process can be broken down into:

1.       Filing a Complaint
2.       Investigation
3.       Board Review
4.       Disciplinary Action

This post will examine the second stage of the complaint process; Investigation.  A general time-line for the investigation stage is as follows:

1.       The Board staff initiates an investigation into the allegations behind the complaint.
2.       An investigation can include interviews, medical record review, and an inspection of the facility where the allegation occurred.
3.       The Board staff prepares the file for presentation to the Board.
4.       The file is first reviewed by the Board at a regular session public meeting.
5.       A review of the complaint is scheduled for the next available Board meeting.

The third stage of the Arizona Board of Physical Therapy complaint process, Board Review, will be analyzed next.

If you have a question about an Arizona Board of Physical Therapy complaint contact Attorney Robert Chelle.

Arizona Board of Physical Therapy Complaint – Filing a Complaint

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The Arizona Board of Physical Therapy (“Board”) administers all investigations and complaints regarding licensed physical therapists and certified physical therapist assistants in Arizona.  The Board imposes disciplinary action if they determine that a violation has occurred.  The Board has issued a list of Frequently Asked Questions that sheds some light on the complaint process.  An investigation by the Board is initiated when; 1) a complaint is filed, 2) self-reporting, and 3) when an organization is required by law to report a possible violation to the Board.  The Board’s Complaint Review Process can be broken down into:

1.       Filing a Complaint
2.       Investigation
3.       Board Review
4.       Disciplinary Action

This post will examine the first stage of the complaint process; Filing a Complaint.  A general time-line for the filing a complaint stage is as follows:

1.       A complaint is filed.
2.       The Board staff determines if jurisdiction exists and, if so, establishes a complaint number and a file is opened.
3.       A copy of the complaint is sent to the professional.
4.       The Board requests a written response from the professional within 30 days.
5.       The Board may issue a subpoena to the professional requesting relevant records.

Prior to responding to the complaint it is imperative that the physical therapist seek legal counsel.  Submitting a well-reasoned, persuasive response can sometimes be the difference between having the complaint dismissed versus being found to have committed an act of unprofessional conduct. The next stage in the Arizona Board of Physical Therapy complaint process is Investigation.

If you have a question about an Arizona Board of Physical Therapy complaint contact Attorney Robert Chelle.