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The 20 Major Mistakes Physicians Make After Being Notified of a Department of Health Investigation

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The investigation of a complaint which could lead to the revocation of a physician’s license to practice, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the physician who receives it. Yet, in many cases, attorneys are consulted by physicians after the entire investigation is over and the damage is already done. Often, the mistakes that have been made severely compromise an attorney’s ability to achieve a favorable result for the physician.

These are the ten biggest mistakes we see in the physician cases we are called upon to defend after a Department of Health investigation of them is commenced:

1. Contacting the Department of Health (DOH) investigator and providing him/her an oral statement or oral interview.

2. Making a written statement in response to the “invitation” extended by the DOH investigator to do so.

3. Providing a copy of their curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so.

4. Believing that if they “just explain it” the investigation will be closed and the case dropped.

5. Failing to submit a timely objection to a DOH subpoena, when there is a subpoena, and there are valid grounds to do so (e.g., patient does not want records released, patient privacy).

6. Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

7. Delegating the task of providing a complete copy of the patient medical record to office staff, resulting in an incomplete or partial copy being provided.

8. Failing to keep an exact copy of any document, letter or statement provided to the investigator.

9. Believing that the investigator has knowledge or experience in the medical or health care matters being investigated.

10. Believing that the investigator is merely attempting to ascertain the truth of the matter and, if the truth is known, this will result in the matter being dismissed.

11. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

12. Believing that because they haven’t heard anything for six or eight months (or even years in some instances) that the matter has “gone away.”

13. Believing that the case is indefensible so there is no reason to even try to advocate for getting it dismissed.

14. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

15. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of the Board of Medicine for a decision.

16. Taking legal advice from their non-lawyer colleagues regarding what they should do in defending themselves in the investigation.

17. Attempting to defend themselves without the assistance of an attorney.

18. Believing that, because they know someone on (or previously on) the Board of Medicine, with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

19. Providing copies of medical records to the DOH Investigator and signing a “Certificate of Completeness” so that the DOH can use these against them in its future disciplinary proceedings against them.

20. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them and to communicate with the DOH investigator for them.

The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.

To learn more about how The Health Law Firm can assist you if you are being investigated by the DOH, click here.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Physicians.

The attorneys of The Health Law Firm provide legal representation to osteopathic physicians in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.  To contact The Health Law Firm, please call (407) 331-6620 or visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

 

 

 

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Florida Department of Health and Law Enforcement Investigate School Providing Nurse Practitioner Courses

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A subpoena purportedly issued by the Clerk of Court for Seminole County, Florida, recently requested academic records on advanced registered nurse practitioner (ARNP) students, including preceptorship agreements for clinical courses they had taken. A follow-up inquiry revealed that the Florida Department of Health was behind the subpoena, seeking evidence concerning possible fraudulent practices involving the supervision of those clinicals.

Apparently South University, which has its main campus and headquarters located in Savannah, Georgia, but offers courses in Florida, had agreements with one or more physicians in the Orlando area to furnish training for nurse practitioner students within their medical practices. Under the terms of the agreement, the physician was required to provide a nurse practitioner to supervise the student taking the clinicals.

However, what is being investigated is the allegation that no nurse practitioners were actually used to supervise those clinicals and the students. Instead, it is apparently being alleged that the names of various licensed advanced registered nurse practitioners (ARNPs) were used without their knowledge and put down as the supervisors for those students’ clinicals. Supposedly at least 20 names of nurse practitioners have been fraudulently used in this manner. Apparently the names of the nurse practitioners were also fraudulently signed to attestations that the students had actually completed the hours of clinical training. Usually there were four quarters or rotations of clinicals required of each student, encompassing hundreds of hours of clinical time.

It is estimated that over 100 advanced registered nurse practitioner (ARNP) students went through this program and graduated. Based on their advanced degrees, they were licensed as advanced registered nurse practitioners (ARNPs) by the Florida Department of Health.

Will those unsupervised student clinical hours be disallowed?

The question is whether action will be taken by the Florida Department of Health, or another organization, to disallow those clinical nurse practitioner hours gained by students in this manner. If so, many who are currently licensed as nurse practitioners who went through this program may lose their licenses and be required to retake required clinical hours. Both the students and the college were apparently unaware of the fraudulent activity.

This case is reminiscent of the massage therapist cases rising in 2012.

This situation seems somewhat similar to the situation that over 180 Florida licensed massage therapists (LMTs) found themselves during 2012. Click here to read one of our prior blogs on this story.

In the case of the massage therapists, each of them had taken courses and graduated from a school in another state. However, when they moved to Florida they had to have the courses re-certified by a Florida approved college and take the additional required courses for Florida licensure. They went to a well known, reputable private college offering massage therapy courses. They paid their tuition and were provided documentation showing that their out of state credits had been transferred in. They were provided other documents by the college showing that they had completed all course requirements and met the standards for licensure. They received their Florida licenses based on this.

Later it was discovered that the registrar at that college had actually been stealing the tuition money paid by these massage therapists and not enrolling them in the college. She was falsifying college documents, including course completion certificates, diplomas, transcripts and other documents using the college’s official seal on them. To see a class action law suit filed discussing this scheme in greater detail, click here.

When the Florida Department of Health found out about this situation, it reacted in a “knee-jerk” fashion and did an emergency suspension of hundreds of massage therapist’s licenses, many of them with no advance notice to the massage therapists. To see a blog I wrote on this, click here.

Hundreds of massage therapist who could not afford to pay a lawyer to mount a legal defense wound up having their licenses revoked or felt compelled to voluntary relinquish their licenses. They lost their national certification in massage therapy because of this.

However, the massage therapists who challenged the revocation and demanded a formal administrative hearing on it, many of whom we represented, were successful in keeping their licenses, mainly because they were not at fault and did not know what the crooked registrar was doing.

Actions to take if you are a nurse practitioner notified of licensure action or that you are under investigation:

Following are the recommendations we would make to any potential client contacting us who has been notified that he or she may be under investigation by the Florida Department of Health or law enforcement authorities:

1. Do not talk to or make any statement, oral or written, to any investigator without first consulting with an experienced health law attorney.

2. Immediately obtain the services of an experienced health law attorney to represent you in the case.

3. Check with your professional liability insurance carrier for any professional liability insurance you had at the time or currently have to see if they will cover the matter. Your current policy may not cover it unless you had it when the events occurred. However, it might.

4. Do not respond to any subpoena for records for testimony until you have consulted with an experienced health law attorney. Even a current professional liability insurance policy should cover you in responding to a subpoena or if a deposition is sought.

5. Do not, under any circumstances, voluntarily relinquish your license, without retaining any experienced health law attorney familiar with this matter to represent you. Such a relinquishment may be the equivalent of a revocation and reported to national reporting bodies as such.

6. If charges arise and you are offered the right to a hearing, always elect a formal administration hearing at which you dispute the issues. Do not elect an informal hearing. In an informal hearing, you have to agree that the charges against you are true, in effect, admitting you are guilty. Do not make that common mistake.

If you desire to see information on emergency suspension orders and emergency restriction orders, click here.

 

Contact Health Law Attorneys Experienced with Department of Health (DOH) Investigations of Nurse Practitioners.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students and ARNPs in Department of Health (DOH) investigations, licensure defense representation, investigation representation, Department of Health investigations, Board of Nursing investigations , administrative hearings, emergency suspension orders, emergency restriction orders and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for nurses, legal representation for nursing students, legal representation for ARNPs, legal representation for ARNP students, Licensure Defense Representation, Investigation Representation, Department of Health Investigations, Board of Nursing Investigations , Administrative Hearings, Emergency Suspension Orders, Emergency Restriction Orders, nurse attorney, legal representation for health care professionals, health law defense attorney, nursing student defense attorney, ARNP defense attorney, legal representation for licensure issues, legal representation for medical students, legal representation for investigations of health care professionals, DOH investigation defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

 

Texas Appeals Court Affirms$1.37 Million in Sanctions Against Doctor who Sued Hospital Former Employers

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 16, 2016, an appeals court in Texas affirmed a $1.37 million sanction against a doctor. The physician was ordered to pay the fine after the dismissal of a defamation lawsuit he filed against his former employers. The decision affirmed that the actions of his former employers, Baylor College of Medicine (Baylor) and Texas Children’s Hospital, did not cause the litigation fees which the court assessed to the doctor as sanctions.

The case had previously made its way up to the Texas Supreme Court, which makes the November 16, 2016, opinion the second time the Texas Fourteenth Court of Appeals has weighed in on the case. Additionally, it is the second time it has held the sanctions were merited for Dr. Rahul K. Nath.

The Back Story of the Case.

According to the opinion, Dr. Nath was employed by Baylor as a plastic surgeon and was affiliated with Texas Children’s Hospital. He was fired in 2004 and in February 2006 filed a lawsuit against his former supervisor at Baylor and Texas Children’s. According to court documents, Dr. Nath had accused his former supervisor of making defamatory statements about him after he stopped working. The alleged defamatory statements included that Dr. Nath had been fired, was unqualified and lacked professional ethics and integrity. (Note: We are just stating what was alleged in the lawsuit.)

To read the opinion in full, click here.

Were the Former Employers Responsible for the Accumulated Attorney and Litigation Fees?

The court was considering whether the behavior of Baylor or Texas Children’s was ultimately responsible for the fees accumulated litigation fees and expenses in the case. Previously, the trial court found that both Texas Children’s and Baylor’s actions had not caused the expenses for which Dr. Nath was sanctioned. The trial court wrote that the amount was appropriate as it was “far less” than the actual fees incurred by either party in defending Dr. Nath’s claims.

On appeal, Dr. Nath argued that the trial court hadn’t held a proper evidentiary inquiry, that it had based its sanctions award on “conclusory and self-serving” affidavits. Dr. Nath claimed that he was wrongly denied discovery in the case. To learn more about Dr. Nath’s challenge, click here.

Despite Dr. Nath’s arguments, the Fourteenth Court disagreed, holding that the trial court followed the exact instructions from the Supreme Court before deciding to impose the sanctions. Additionally, the court found that there was evidence in the record to support the conclusion that neither Texas Children’s nor Baylor’s conduct caused the expenses that were passed on to Dr. Nath as sanctions.

Adequate Supporting Evidence.

The first time the case came before the Fourteenth Court of Appeals, it affirmed the sanctions against Dr. Nath. The high court held that there was evidence to support the trial court’s finding of bad faith and improper purpose on Dr. Nath’s part with regard to certain filings in the case.

Dr. Nath appealed, and the Texas Supreme Court held that the trial court didn’t abuse its discretion in finding the doctor had exercised bad faith and improper purpose in certain filings. The high court remanded it back to the trial court to consider to what extent, if any, Texas Children’s and Baylor’s actions may have “caused the expenses for which recovery is sought.”

After a hearing, the trial court determined that neither employer’s behavior caused the expenses, and again imposed the sanctions against Nath. In appealing that ruling to the Fourteenth Court of Appeals, Dr. Nath argued that the trial court had made procedural errors in hearings and evidence submission in reaffirming the sanctions.

The trial court granted Texas Children’s and Baylor’s motions in June 2010, and also sanctioned Dr. Nath $726,000 for a portion of Texas Children’s fees in defending the suit and $644,500 for a portion of Baylor’s. The Fourteenth Court of Appeals affirmed that ruling, and Dr. Nath appealed to the state Supreme Court.
To learn more about defamatory statements and how to handle such claims, click here to read one of my prior blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Knaub, Kelly. “Texas Appeals Court Affirms Doc’s $1.3M Sanction.” Law360. (November 16, 2016). Web.

Knaub, Kelly. “Doc To Challenge $1.3M Sanction Before Texas High Court.” Law360. (January 15, 2014). Web.

“Texas Appeals Court Affirms Doc’s $1.3M Sanction.” LexisNexis. (November 16, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for health care professionals, health law defense attorney, legal representation for defamatory statements against health care professionals, legal representation for defamation lawsuit against a healthcare professional, healthcare litigation defense attorney, legal counsel for health care professionals, Legal representation for clients involved in the health care industry, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.