Tag: IDFPR

Keep Quiet, Lose Your License? Physicians’ Duty to Report a Colleague’s Sexual Misconduct

Posted on by Louis Fine

It’s been five years since the #MeToo movement spurred a long-overdue reckoning with sexual harassment and misconduct in the workplace and elsewhere.  A long and infamous line of high-profile individuals have since found their careers derailed and reputations destroyed by allegations of inappropriate and often illegal behavior. In most of these cases, the focus is justifiably on the alleged perpetrators of these abhorrent actions. But many organizations and professions have also come under scrutiny for their tacit complicity in allowing such conduct to go unchecked or unreported.  

Specifically, others who may have been aware of misconduct turned away or failed to take action which could have prevented further abuses and spared other victims. For physicians and other medical professionals who learn of a colleague’s misconduct  – sexual or otherwise – the failure to report such wrongdoing is not just a moral failure. It can be a breach of professional ethics that threatens their professional licenses as well.

Ethical Obligation to Report Misconduct

The duty to report misconduct within the medical profession is often the only way such transgressions can get the attention of professional licensing boards such as the Illinois Department of Professional Regulation (IDFPR) as well as law enforcement. As the Federation of State Medical Boards (FSMB) put it in its sweeping 2020 Report and Recommendations on Physician Sexual Misconduct:

“In a complaint-based medical regulatory system, it is… essential that patients, physicians and everyone involved in healthcare speak up whenever something unusual, unsafe or inappropriate occurs. All members of the healthcare team, as well as institutions, including state medical boards, hospitals and private medical clinics have a legal as well as an ethical duty to report instances of sexual misconduct and other serious patient safety issues and events. This duty extends beyond physician-patient encounters to reporting inappropriate behavior in interactions with other members of the healthcare team, and in the learning environment.”

Similarly, the Council on Ethical and Judicial Affairs of the American Medical Association (AMA) admonishes that, “A physician should expose, without fear or favor, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.”

However, while the Illinois Medical Practice Act allows for physician reporting of a colleague’s unethical behavior, it neither requires it nor makes a failure to report a basis for disciplinary action.  It provides that licensed physicians “may report to the Disciplinary Board any information the physician… may have that appears to show that a physician is or may be in violation of any of the Act’s provisions.”

But just because reporting sexual misconduct is not mandated under the Act doesn’t mean that failing to report physician sexual misconduct isn’t an ethical violation. “The obligation to report incompetent or unethical conduct that may put patients at risk is recognized in… the ethical standards of the profession,” according to the AMA.

The FMSB was more strident in its 2020 report, concluding that the failure to report sexual misconduct should result in disciplinary action: “Physicians who fail to report known instances of sexual misconduct should be liable for sanction by their state medical board for the breach of their professional duty to report.”

AMA Reporting Guidelines

The AMA has set forth guidelines for how physicians should respond to and report information about a fellow doctor’s patient misconduct. Physicians who become aware of or strongly suspect that conduct threatens patient welfare or otherwise appears to violate ethical or legal standards should:

  • Report the conduct to appropriate clinical authorities in the first instance so that the possible impact on patient welfare can be assessed and remedial action taken.
  • Report directly to the state licensing board when the conduct in question poses an immediate threat to patients’ health and safety or violates state licensing provisions.
  • Report to a higher authority if the conduct continues unchanged despite initial reporting.
  • Protect the privacy of any patients who may be involved to the greatest extent possible, consistent with due process.
  • Report the suspected violation to appropriate authorities.

Regardless of the language contained or not contained in licensing statutes, professionals of all stripes should seize the moment and no longer remain silent when they become aware of harassment or misconduct. While the damage done to victims of sexual misconduct is exponentially greater, the damage to your professional reputation and career could be catastrophic if it is discovered that you were tacitly complicit in allowing such misconduct to continue. 

Louis Fine: Chicago Physician License Defense Attorney

As a former Chief Prosecuting Attorney and administrative law judge for IDFPR, I have seen the serious consequences that an adverse enforcement decision can have on professionals who suddenly find their future in disarray. I understand how and why the Department decides to pursue investigations against physicians, how it handles negotiations, and how to approach formal proceedings in a way that gives my clients the best possible chance of a positive and expeditious outcome.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. Together, we will get you back to your clients and your career.

Saving Careers: A Conversation With Chicago Professional License Defense Lawyer Louis Fine

Posted on by Louis Fine

“Careers are on the line, livelihoods are at stake, and reputations hang in the balance. I never lose sight of that.”

When you ask attorney Louis Fine to describe his practice, his initial response isn’t to tell you about the professional license defense work that has been at the heart of his distinguished career. He doesn’t start by talking about the countless divorces he has handled or the business and real estate deals he has closed. His initial response is much more succinct.

“I help people who need help.”

It’s an apt description for someone who has made assisting others the defining characteristic not only of his law practice, but also of his volunteer and philanthropic work in the community. It’s also a description born of necessity.

“When my kids were very young, they would ask me what it was that I did as a lawyer,” Louis says. “They could understand that a fireman fights fires, that an engineer drives a train, or that an astronaut goes into space, but they couldn’t wrap their heads around what exactly a lawyer was. So I thought about the essence of what I do, and it really comes down to helping people work through difficult problems or achieve a personal or professional goal.”

Protecting Careers and Livelihoods

Louis has devoted a significant amount of his practice to protecting the careers and livelihoods of licensed professionals in Chicago and throughout Illinois. He understands that threats to someone’s license to practice or engage in their chosen career strike at the essence of who they are.

“Whether you’re a physician, an accountant, a hairstylist, or a real estate appraiser, you invested a lot of blood, sweat, and tears in your career,” he says. “It’s not just the years of education and training or the tens or hundreds of thousand dollars in student loans. And it’s not just about being able to make a living. Your career can define who you are and how people perceive you, and how you perceive yourself.”

And when a licensed professional sees an envelope in the mail from the Illinois Department of Financial and Professional Regulation (IDFPR) advising that they are under investigation or may be subject to disciplinary action, all of that hangs in the balance. It can be easy to panic.

“I often get a call right after someone gets that dreaded letter or notice from IDFPR,” Louis says. “There is a lot of understandable anxiety and concern, often mixed with righteous indignation or disbelief.”

He says that in addition to reviewing the complaint and gathering the facts, his initial task is helping clients take a breath and explaining to them what is happening – and what isn’t.

“Things are always scarier when you don’t understand what’s going on. I try to put things in context and provide clients with some peace of mind that, while IDFPR actions must be addressed seriously, it isn’t necessarily the catastrophe it may appear to be,” he says.

“In any career where you are serving others, you’re going to make someone unhappy. There will always be at least one patient or client who thinks you have wronged them or that you were incompetent or worse,” Louis advises. “Many of these complaints involve nothing of substance. That is why many if not most IDFPR complaints and investigations are resolved either after an informal hearing or without any action being taken at all.”

Understanding IDFPR Inside and Out

However, Louis knows better than anyone that when the IDFPR believes that a licensed professional has engaged in misconduct and launches an investigation or commences disciplinary proceedings, things can be deadly serious.

He also knows how and why the IDFPR makes the decisions and takes the actions they do. That’s because he used to be the one making the decisions and taking the actions.

Louis served as IDFPR’s Chief Prosecuting Attorney and as an administrative law judge for many years, giving him unique insight into how the board handles licensure issues and how to navigate the process in a way that is most likely to lead to a positive outcome for a licensee. His experience investigating and prosecuting licensed professionals also made him appreciate how unfair the disciplinary process can sometimes be.

“The IDFPR’s procedural rules and practices put licensees at a sometimes crippling disadvantage in disciplinary proceedings,” Louis says. “For example, a licensee’s ability to pursue the discovery necessary to defend themselves is extremely limited. In fact, the extent of allowable discovery is determined by the very people who are prosecuting the case.”

The other big problem, according to Louis, is that the hearing officers presiding over disciplinary proceedings are not independent.

“They are employed and paid by the IDFPR, just as the prosecuting attorneys are,” he notes. “Whether a hearing officer is consciously biased or not, the fact that their paychecks are coming from the very same folks who are seeking to discipline a respondent creates an implicit conflict of interest and calls into question the fairness of the entire process.”

Despite these challenges, Louis has successfully defended countless Illinois professionals, protecting their licenses and helping them move forward with their careers and lives. And as Louis will be the first to tell you, helping is what his job is all about.

You Can’t Please Everyone: What To Do – and What NOT To Do – When You Receive an Illinois Professional License Complaint

Posted on by Louis Fine

Illinois licensed professionals of all stripes – from physicians and accountants to hairstylists and mortgage brokers – work with countless clients and patients throughout their long careers. As a Chicago professional license defense attorney, I’ve done the same. If you are one of those professionals, you are probably great at what you do, skilled and ethical, and with a long roster of folks singing your praises and leaving you glowing reviews.

But you can’t please everyone.

It is almost inevitable that one of the people you’ve served over the years will have some gripe about their experience with you, whether justified or not. That means the odds are pretty good that you will open your mail one day to find an unexpected and unwelcome letter from the Illinois Department of Financial and Professional Regulation (IDFPR) advising you that someone has lodged a professional license complaint against you and/or that you are under investigation.

Don’t Make a Potentially Bad Professional License Situation Potentially Worse

Such a letter can make bills and junk mail look good. A notice from the IDFPR can get your heart racing and blood boiling. After all, everything you’ve worked so hard for is under attack. Adverse action by the IDFPR can result in the suspension or revocation of your license, threaten your Illinois professional license renewal, and destroy your career, your livelihood, and your reputation.

When you get an IDFPR notice, you have a critical choice to make. You can react emotionally and angrily; with righteous indignation at the complaining client/patient or the IDFPR. But acting out of emotions such as fear or anger can only make the situation worse and create problems that would not have existed had you only proceeded in a calm, thoughtful, and responsive way. So, keep these four tips in mind if and when you find out that the IDFPR is investigating a professional license complaint against you:

  1. Keep Calm and Carry On

While your heart may start beating faster when you get a professional license complaint or notice of investigation, don’t panic. One, panic and irrationality rarely lead to good things and wise decisions. More importantly, panic is likely unwarranted. Many if not most IDFPR complaints and investigations are resolved either after an informal hearing or without the Department taking any action at all. Not that you shouldn’t take the matter seriously. You should absolutely retain an experienced Illinois professional license defense lawyer and respond in a complete and timely manner.

  1. Ignorance Isn’t Bliss

As unfounded as you believe the complaint or the IDFPR’s basis for investigating you may be, ignorance is not bliss. Failing to respond – or responding in a dismissive and contemptuous manner – just because you believe the matter to be bogus will create problems where perhaps none existed. Don’t angrily crumple up the letter or shove it in your desk drawer. Just failing to respond in a timely fashion to an initial IDFPR inquiry could subject you to discipline, even if there was no merit to the underlying complaint.

  1. Bite Your Tongue

One of the worst things you can do is respond directly to or take any adverse action against the person who filed the complaint. In particular, do not under any circumstances take out your frustrations online or get involved in a social media spat with the complainant about their allegations and issues. For licensed physicians especially, breaches of online professionalism standards have been the subject of increasing scrutiny and disciplinary action by state medical boards.

  1. Hire an Experienced IDFPR Defense Attorney

The policies and procedures that govern IDFPR investigations, hearings, and imposition of sanctions are unique, complicated, and often unwritten and informal. The rules can also be terribly unfair. Even skilled and experienced attorneys who do not practice before IDFPR can find themselves at a loss when dealing with licensure issues. You are no doubt intelligent and know your profession well, but don’t make the mistake of thinking that you can or should handle an IDFPR investigation on your own. Your reputation, career, and livelihood are at stake. Defending yourself before the IDFPR is a gamble you can’t afford. Call an experienced Chicago professional license defense attorney as soon as possible after you’ve received that dreaded letter, and let them ease your fears and take the steps necessary to protect your license and your future.

Louis Fine: Chicago Professional License Defense Lawyer

As a former Chief Prosecuting Attorney and administrative law judge for IDFPR, I have seen the serious consequences that an adverse enforcement decision can have on professionals who suddenly find their future in disarray. I understand how and why the Department decides to pursue investigations, how it handles negotiations, and how to approach formal proceedings in a way that gives my clients the best possible chance of a positive and expeditious outcome when Illinois professional licensing issues arise.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. Together, we will get you back to your clients and your career.

No Time to Roll The Dice: 3 Reasons You Need a Professional License Defense Attorney When IDFPR Comes Calling

Posted on by Louis Fine

If you hold a professional license in Illinois, the Illinois Department of Financial and Professional Regulation (IDFPR) holds your career in its hands. If they deny your Illinois professional license renewal, notify you of a complaint, launch an investigation, or start disciplinary proceedings against you, everything is on the line.

Everything you worked so hard for, everything you studied for, every bit of time and energy and money you’ve invested in your career depends on the decisions these regulators make. And if you attempt to navigate the complex and often unfair IDFPR investigative and disciplinary process on your own without the help of an Illinois professional license defense lawyer, you are taking a huge gamble with your future.

Unfortunately, many otherwise intelligent and prudent professionals take that gamble only to later regret it when their Illinois professional license renewal is denied or the IDFPR takes disciplinary action that results in the suspension or loss of their license or other damaging sanctions.

To take from the movie The Untouchables, going up against the IDFPR without an experienced Illinois professional license defense attorney in your corner is like bringing a knife to a gunfight.

Here are three reasons you need to hire a professional license lawyer when the IDFPR threatens your career:

  1. You Don’t Know What You Don’t Know

The policies and procedures that govern IDFPR license applications and renewals, investigations, hearings, and imposition of sanctions are unique, complicated, and often unwritten and informal. Even skilled and experienced attorneys who do not practice before IDFPR can find themselves at a loss when dealing with licensure issues. You may be the target of a completely meritless client/patient complaint; you may have all of the facts on your side and the documentation or witnesses to prove it. But all of your arguments and evidence may never see the light of day if you don’t know the proper way to present your case.

  1. You May Blow Your Chance To Resolve Things Quickly and Favorably

Your lack of knowledge of the process and how IDFPR prosecuting attorneys think and work also means you may miss out on opportunities to resolve your case sooner, cheaper, and with a more positive outcome. The ability to effectively reach a negotiated resolution with prosecutors depends on understanding the range of consequences, the risks involved in proceeding to a full hearing, and the likelihood of obtaining a successful result. Unless you have had extensive experience defending your professional license (which is hopefully not the case), you will be at an overwhelming disadvantage in negotiations with IDFPR prosecuting attorneys.

  1. The Deck Is Stacked Against You

Even worse, the process can be manifestly unfair and stacked against you. Experienced and aggressive prosecutors have your license in their sights, and the hearing officer who will determine your fate is not necessarily independent and unbiased. IDFPR hearing officers are employed and paid by the IDFPR, just as the prosecuting attorneys are. Whether a hearing officer is consciously biased or not, the fact that their paychecks are coming from the same folks seeking to discipline a respondent creates an implicit conflict of interest and calls into question the fairness of the entire process.

You are no doubt intelligent and know your profession well, but don’t make the mistake of thinking that you can or should handle an IDFPR investigation on your own. Your reputation, career, and livelihood are at stake. Now is not the time to take a flyer and hope for the best.

Louis Fine: Chicago Professional License Defense Attorney

As a former Chief Prosecuting Attorney and administrative law judge for IDFPR, I have seen the serious consequences that an adverse enforcement decision can have on professionals who suddenly find their future in disarray. I understand how and why the Department decides to pursue investigations, how it handles negotiations, and how to approach formal proceedings in a way that gives my clients the best possible chance of a positive and expeditious outcome when Illinois licensing issues arise.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. Together, we will get you back to your clients and your career.

IDFPR Puts Doctors On Notice: Spread COVID-19 Misinformation Or Quack Treatments And We Will Come After Your License

Posted on by Louis Fine

As I discussed in a post a few months back, physicians across the country are being called out for spreading misinformation and disinformation regarding COVID-19, vaccines, and the efficacy of other preventative measures such as masking. During the summer, the Federation of State Medical Boards (FSMB) issued a stern admonition about the misinformation epidemic among members of the profession, stating unequivocally that “Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license.”

Recently, the Illinois Department of Financial and Professional Regulation (IDFPR) explicitly confirmed that they see physician disinformation about COVID-19 as a serious ethics violation warranting equally serious disciplinary action. Illinois doctors who peddle information about the virus or vaccines that is not based on sound science risk losing their professional licenses and careers.

On November 5, 2021, IDFPR issued its “Notice that Advice or Treatment Regarding Covid-19 Must Conform with Evidence-Based Medicine and Standards of Care.” It began by reminding physicians that, as a general matter, “any advice or treatment provided to a patient must conform with evidence-based medicine and standards of care and that failure to do so may subject the individual to disciplinary action under the Medical Practice Act.”

The Department further noted that “Engaging in dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud or harm the public” is a violation of the Medical Practice Act at 225 ILCS 60/22(A)(5). IDFPR makes it clear that it sees COVID-19 misinformation or the recommendation of unproven and unapproved treatments as conduct “likely to deceive, defraud, or harm the public.”

The notice calls out three specific forms of COVID-related misconduct that it views as possible ethical violations:

Issuing Mask Exemptions For Non-Patients

As kids returned to school this fall in districts with mask requirements, reports emerged about physicians issuing medical exemption notes to parents of schoolchildren with whom they did not have a doctor-patient relationship. For example, one Pennsylvania doctor who is vocally anti-mask is facing disciplinary action for posting a stock, four-page exemption letter on the homepage of his practice’s website that invited people to “print your own copy.”

IDFPR stated unequivocally that such conduct is a violation of the Medical Practice Act:

“A physician or other licensed healthcare professional who provides a mask exemption to an individual with whom they do not have a clinician-patient relationship and for whom they have not provided a medical diagnosis that justifies a mask exemption as put forth in the CDC guidelines, is in violation of their respective licensing Act and may be subject to disciplinary action by IDFPR.”

Ivermectin And Other Non-FDA Approved Treatments

Since the pandemic began, people from TV preachers to conspiracy theorists to herbalists to twice-impeached former presidents have peddled all kinds of snake oil for preventing or treating COVID-19. This includes the horse deworming medication Ivermectin.

Noting that the CDC has issued an official health advisory regarding severe illness associated with the use of products containing Ivermectin to prevent or treat COVID-19, IDFPR stated that  “A physician or other licensed healthcare professional who prescribes Ivermectin in a manner inconsistent with the CDC’s recommendations may be subject to discipline.”

COVID-19 Misinformation By Physicians

Finally, IDFPR voiced its strong support for FSMB’s statement on misinformation relating to COVID-19 as quoted above. It also announced that it would follow the joint statement from the American Board of Family Medicine, the American Board of Internal Medicine, and the American Board of Pediatrics about COVID-19 misinformation by physicians in which they concluded that “providing misinformation about a lethal disease is unethical, unprofessional and dangerous.”  That statement also said that the groups “want all physicians certified by our Boards to know that such unethical or unprofessional conduct may prompt their respective Boards to take action that could put their certification at risk.”

The IDFPR also encourages anyone who becomes aware of a licensed health professional’s dissemination of misinformation or practice inconsistent with current state and federal guidelines regarding COVID-19 to file a complaint.

IDFPR’s firm stand against COVID-19 misinformation should put all Illinois medical professionals on notice that their words about COVID vaccines have consequences, not only to the health and well-being of the general public, but to their careers and reputations as well.

Will a Chapter 7 or 13 Bankruptcy Close The Book On Your Professional License?

Posted on by Louis Fine

Bankruptcy happens. It’s not a crime, it’s not a moral failure, it’s not a character flaw. In times of economic upheaval, in particular, even the most hard-working, intelligent, and responsible professionals, from physicians to accountants to hairstylists, can find that their debts have simply become untenable. Filing for bankruptcy can itself be a difficult experience, emotionally, financially, and practically. But if you’re also worried that you might lose your professional license, and thus your ability to support yourself and your family, the anxiety is only compounded.

Fortunately, in most cases, filing a Chapter 7 or 13 bankruptcy proceeding without more will not result in the loss of a professional license.

The Bankruptcy Code Is Designed To Provide Protection, Not Persecution

The law provides for bankruptcy proceedings to give an overwhelmed debtor a second chance and give creditors a chance at recovering at least some of the amounts owed to them. Bankruptcy proceedings may be painful, but they are not supposed to be a persecution.

That is why the Bankruptcy Code prohibits private and public employers from using a bankruptcy filing as the sole reason to terminate an employee or otherwise take adverse action against them.

Specifically, Section 525(b) of the Bankruptcy Code provides that “No private employer may terminate the employment of, or discriminate with respect to employment against” an employee “solely because” the employee:   

  • is or has been a debtor or bankrupt under the Bankruptcy Act;
  • has been insolvent before the commencement of a bankruptcy proceeding or during the case but before the grant or denial of a discharge; or
  • has not paid a debt that is dischargeable or that was discharged under the Bankruptcy Act.

Note the “solely because” language. If other reasons exist for terminating an employee that may tangentially relate to the bankruptcy, such as dishonesty, fraud, or other malfeasance, the Bankruptcy Code won’t necessarily save an employee’s job.

Professional Licenses Are Protected Assets In Bankruptcy

A professional license is a valuable asset, one obtained through a substantial investment of time, effort, and money. In a bankruptcy proceeding under either Chapter 7 or 13, the debtor’s assets become a crucial part of resolving the debts and obligations that led to the filing of bankruptcy in the first place.

But professional licenses are only of value to the licensee; they can’t be transferred or used by a debtor to satisfy their debt. The real threat that bankruptcy poses to a professional license is the risk that a governmental licensing body, like the Illinois Department of Financial and Professional Regulation (IDFPR), will use the proceedings as a basis for denying, suspending, or revoking a license.

But since bankruptcy, as noted, is not designed for punishment, the Bankruptcy Code explicitly protects professional licenses and the ability of licensees to continue to earn a living.

Specifically, Bankruptcy Code Section 525(a) states:

[A] governmental unit may not deny, revoke, suspend, or refuse to renew a license… against a person that is or has been a… debtor under the Bankruptcy Act, or another person with whom such bankrupt or debtor has been associated, solely because such bankrupt or debtor is or has been a debtor under this title or a bankrupt or debtor under the Bankruptcy Act, has been insolvent before the commencement of the case under this title, or during the case but before the debtor is granted or denied a discharge, or has not paid a debt that is dischargeable in the case under this title or that was discharged under the Bankruptcy Act.

Again, the “solely because” language is key. A professional licensee’s bankruptcy, depending on the circumstances, may implicate other issues that could lead to or support disciplinary actions. But the bankruptcy itself, without more, should not threaten a debtor’s professional license.

Louis Fine: Chicago Professional License Defense Attorney

If you are a licensed Illinois professional and have concerns about how a bankruptcy might impact your license and career, I welcome the opportunity to meet with you.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Illinois In Top 10 For Serious Medical Disciplinary Actions, New Report Finds

Posted on by Louis Fine

Whether a physician faces disciplinary action by their state medical board depends primarily on their own conduct. Practicing with competence, ethics, and integrity should insulate a doctor from any significant concerns that their license may be put in jeopardy. But it’s not only how you practice, but where you practice, that can determine how likely you are to face the scrutiny of your state’s medical licensing authorities.

Wide Discrepancies In State Medical Boards’ Level of Enforcement Activity

A comprehensive new report by Public Citizen found significant disparities between states in terms of the number of serious disciplinary actions brought against physicians between 2017-2019. The report’s authors concluded that these differences in the frequency of physician discipline had little if anything to do with the quality of a state’s doctors and everything to do with the aggressiveness or laxity of a state’s medical board:

“There is no reason to believe that physicians in any one state are more or less likely to be incompetent or miscreant than the physicians in any other state. Therefore, we believe any observed differences between the boards reflect variations in board performance rather than in physician behavior across different states.”

The report’s authors calculated the rate of serious disciplinary actions per 1,000 physicians in each state with either M.D. only or combined M.D./D.O. medical boards for the years 201, 2018, and 2019. They defined “serious disciplinary actions” as “those that had a clear impact on a physician’s ability to practice.”

The report found that Kentucky had the highest rate of serious physician discipline in the country, with an average of 2.29 serious disciplinary actions per 1,000 physicians per year. The District of Columbia had the lowest rate with only 0.29 serious disciplinary actions per 1,000 physicians per year. That means that the rate of such actions was 7.9 times higher in the state with the most active medical board in the country than in the lowest jurisdiction. 

Illinois ranked 10th on the list, with a rate of 1.51 serious disciplinary actions per 1,000 physicians.

Reasons For Differences In Physician Disciplinary Actions Across States

Public Citizen is an organization that generally favors increased consumer and patient protections and thus advocates for greater regulatory activity and enforcement. Therefore, it is no surprise that they concluded that “low rates of serious disciplinary actions suggest that medical boards are not adequately taking actions to discipline physicians responsible for negligent medical care or whose behavior is unacceptably dangerous to patients.”

The report recommended several policy changes, including:

  • Assuring that revenue from physician license fees funds board activities “instead of sometimes going into the state treasury for general purposes.”
  • Ensuring that boards have adequate staffing
  • Including on medical boards members who have a commitment to safeguarding the public, “not protecting the livelihood of questionable physicians.”
  • Opening the NPDB database to the public so that any person can do a background check on a doctor
  • Increasing state legislative oversight of state medical boards
  • Replacing some medical board members who are physicians with members of the public “with no ties to the medical profession, hospitals, or other providers.”
  • Requiring that medical boards check with the NPDB when they receive complaints about a physician.

This report comes after a year in which physician disciplinary actions plummeted nationwide due to the COVID-19 pandemic. However, until and unless the time comes that COVID-19 is no longer an existential public health threat, it is unlikely that any state medical boards will dramatically change the way they do business.

Louis Fine: Chicago Physician License Defense Attorney

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will get you back to your patients and your practice.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Can You and Should You “Plead the Fifth” In Professional License Proceedings?

Posted on by Louis Fine

As you know from years of watching TV courtroom dramas or the travails of real-life politicians, people under criminal investigation or who are facing charges often “plead the Fifth” -that is, refuse to provide statements or testimony – because they fear that what they say can and will be used against them in those proceedings.

Similarly, many physicians or other professionals licensed by the Illinois Department of Professional Regulation (IDFPR) can find themselves under investigation or facing disciplinary action by the Department for acts which could also be the basis for criminal prosecution. For example, a doctor who improperly prescribes medication could face the loss or suspension of his or her license and also be charged with a crime for such conduct.

In such situations, can or should the respondent in an IDFPR proceeding exercise their rights under the Fifth Amendment when their answers could result in criminal liability?

Fifth Amendment Applies in Disciplinary Proceedings

The Fifth Amendment provides that “No person shall be… compelled in any criminal case to be a witness against himself…” This privilege has also been incorporated in the Illinois Constitution. (See Ill. Const. 1970, art. I, § 10.) The privilege essentially means that no person, without proper immunity, can be required to implicate himself in a crime.

Although by its literal terms applicable only in criminal proceedings, the Fifth Amendment privilege against self-incrimination has long been held to be properly asserted by parties in civil proceedings.

The logic behind applying the privilege in civil cases also applies to administrative actions such as IDFPR investigations and disciplinary proceedings, and can be asserted not only at a hearing, but during the investigation and discovery stage as well.  As the U.S. Supreme Court has stated:

“A witness’ privilege against self-incrimination `not only protects the individual against being involuntarily called as a witness against himself in a criminal prosecution but also privileges him not to answer official questions put to him in any other proceeding, civil or criminal, formal or informal, where the answers might incriminate him in future criminal proceedings.'”

As such, you can “plead the Fifth” before the IDFPR. The question of whether you should exercise your right against self-incrimination is a more complicated question.

A Tough Decision

Anybody faced with this choice faces a variation of the same dilemma. As the Supreme Court put it: a party must weigh “the advantage of the privilege against self-incrimination against the advantage of putting forward his version of the facts[.]” Accordingly, a “party who asserts the privilege against self-incrimination must bear the consequence of lack of evidence.” 

What makes the choice even trickier is that, unlike in criminal proceedings, IDFPR hearing officers can draw an adverse inference from the professional’s refusal to testify and hold it against the professional so long as there is other sufficient evidence to support their findings.

The gravity and implications of exercising your Fifth Amendment rights in an IDFPR proceeding require careful thought and a consideration of all of the possible consequences. It is a decision that will be based on the specific circumstances of your disciplinary matter as well as the possible criminal repercussions of the acts under investigation. It is a decision that should only be made in consultation with your lawyer.

Louis Fine: Chicago Professional License Defense Attorney

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will get you back to you clients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Overworked and Overwhelmed By Pandemic, Physicians Sacrifice Mental Health Due To Fear Of Licensing Repercussions

Posted on by Louis Fine

As the COVID-19 pandemic rages on, America’s physicians and health care professionals often face an unnecessary and dangerous choice about what matters more: their career or their mental health.

This unconscionable dilemma arises largely because physicians who currently may be struggling with mental health issues, or who experienced a rough patch in the past, fear that seeking help will threaten their professional license. Despite the harmful disincentivizing that it causes, overly broad inquiries about physicians’ mental health continue to be asked by medical boards across the country. The repercussions are counterproductive and unfair.

Burnout, Stress, and Anxiety Losing Out To Fear 

The pandemic, approaching its second year, is overwhelming hospitals and health care providers, with patients filling hallways and gift shops and doctors forced to make decisions about rationing care. The non-stop flow of patients for months on end, not all of whom will get the care they need and not all of whom will survive, is taking its toll on those charged with taking care of them.

A recent survey found that half of all American physicians report feeling anxious due to COVID-19-related concerns. Nearly 60 percent report experiencing burnout — a significant leap from 40 percent just two years ago. The problem is even more pronounced among emergency physicians, 87 percent of whom report significantly increased stress levels due to the pandemic.

Despite these numbers, only 13 percent of doctors have sought treatment for their COVID-related mental health issues. The other 87 percent are educated and self-aware individuals who would undoubtedly recommend that a patient get care for their problems if they reported experiencing the same symptoms. Yet they struggle in silence, putting themselves – and their patients – at risk. In perhaps the most well-known recent incident, Lorna Breen, MD, medical director of the emergency department at NewYork-Presbyterian Allen Hospital, committed suicide after telling loved ones she felt useless to her patients and desperately feared seeking treatment.

Physicians report numerous concerns over seeking mental health care: loss of face, loss of privacy, loss of hospital privileges, or the loss of malpractice coverage. But above all, doctors struggling with their mental health fear losing their ability to practice medicine at all.

Invasive and Irrelevant Questioning By Medical Boards

Nearly 40 percent of doctors said they’d be reluctant to seek mental health care due to concerns about obtaining or renewing their license to practice, according to a 2017 paper published in Mayo Clinic Proceedings.

That is because they know that, for years, state licensing boards have been asking broad questions about mental health issues, including inquiries about brief treatment received years or decades ago. Reporting such treatment could trigger a long, drawn-out process that could put their license in peril. Better to not seek treatment at all than risk their career, many conclude.

Fortunately, the profession has finally begun to recognize the problem. The Federation of State Medical Boards (FSMB) released recommendations in 2018 that advised licensing boards to only ask about current mental issues that undermine a physician’s ability to work well. The FSMB concluded that inquiries about topics other than present impairment violate the Americans with Disabilities Act.

Illinois Limited Its Mental Health Questioning in 2016

To its credit, the Illinois Department of Financial and Professional Regulation (IDFPR) significantly narrowed the scope of its mental health licensing questions for physicians in 2016. Before then, the licensing application asked applicants whether they have ever had a disease or condition that limited their ability to practice. 

Now, however, the question asks only about current conditions and present limitations. Specifically: “Do you now have any disease or condition that presently limits your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) a mental or emotional disease or condition; (2) alcohol or other substance abuse; and (3) physical disease or condition. If yes, attach a detailed statement, including an explanation of whether or not you are currently under treatment.”

Nobody, including doctors, should have to choose between their mental health and their livelihood. While no one wants an impaired physician to be treating patients, neither should we want a talented physician sidelined because they had the courage to seek treatment.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

If you have physician licensing questions or concerns, please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Put Up Or Shut Up: The Burden of Proof In Illinois Physician Licensing Hearings

Posted on by Louis Fine

Simply saying something doesn’t make it so. Just because you believe a proposition doesn’t make it true. And wanting a certain result doesn’t entitle a person to get it. If you are going to advocate for a position or seek an outcome based on claims you make, you better have the receipts to back it up. That is a fundamental proposition of our judicial system. A party seeking relief, whether a plaintiff in a civil lawsuit, a prosecutor in a criminal case, or a defeated president in a flurry of desperate and delusional litigation, must meet the applicable burden of proof to prevail. So too must the Illinois Department of Financial and Professional Regulation (IDFPR) when pursuing disciplinary action against a physician, as does a doctor seeking to have their license reinstated.

But, as we have seen over the past month, anyone can file a lawsuit for anything based on nothing whatsoever. As long as you pay the court filing fee, you could sue me today for implanting listening devices in your molars. Of course, as we have also seen, cases based on implausible allegations unsupported by any facts or evidence usually meet a swift demise. And those who bring such frivolous claims without a reasonable basis for doing so can and should face consequences for their actions.

Allegations v. Burden Of Proof

The burden of proof, however, does not refer to what a party must show when they initiate a proceeding, though there does need to be a good faith basis in fact and law for pursuing a case in the first place. Rather, it is what a party must ultimately prove to a judge, jury, or hearing officer to get the relief or result they seek.

When the IDFPR launches disciplinary proceedings in a physician licensing matter, they do so after conducting an investigation and gathering facts to support their filing of a formal complaint. Similarly, it gathers facts and evidence when making a decision as to granting or restoring a license. While the facts that the Department may rely upon may be weak, disputed, or of questionable veracity, IDFPR rarely pursues cases or makes license decisions without at least some evidence that could plausibly justify their efforts.

Allegations in a complaint, as noted, are just that – allegations. And the decision to deny a license renewal or issue a reinstatement can be challenged by an applicant or licensee. This is where the parties need to put up or shut up

Disciplinary Action and Refusals To Renew: Burden of Proof Is On The IDFPR

Section 1110.190 of the Illinois Administrative Code provides that the burden of proof rests with the Department in all cases it institutes by filing a Complaint or Notice of Intent to Refuse to Renew a physician’s license.  An Administrative Law Judge may make a recommendation for discipline only when the IDFPR establishes by clear and convincing evidence that the allegations of the Complaint or Notice are true.

While a somewhat nebulous concept, as all burdens of proof are, “clear and convincing” evidence generally means that degree of proof which, considering all the evidence in the case, produces the “firm and abiding belief that it is highly probable” that the allegations in the IDFPR’s formal complaint are true. This standard falls between the “beyond a reasonable doubt” burden of proof that prosecutors have in criminal cases and the “preponderance of evidence” standard applied in most civil lawsuits.

License Denials And Requests For Reinstatement

“Clear and convincing” evidence is also the standard the Department must meet when filing a Notice of Intent to Deny the issuance of a physician’s license. Specifically, if the Notice of Intent to Deny alleges that the applicant has violated a disciplinary provision of the Medical Practice Act, IDFPR has the burden of proof to prove by clear and convincing evidence that the alleged violation occurred. 

If the Department meets this standard in a physician licensing case, the burden of proof then switches to the physician, who must prove by a preponderance of the evidence that the license should be granted. As noted, preponderance of the evidence is a more lenient standard, meaning that it is more likely than not that the facts supporting the physician’s reasons why they should be issued their license are true.

The preponderance of the evidence standard also applies when a physician files a Petition for Hearing seeking restoration of their license. The burden of proof is on the physician rather than IDFPR in license restoration hearings.

Even when the Department bears the burden of proof, it has many unfair advantages over licensees in terms of gathering and producing evidence. As I have discussed in a previous post, a licensee’s ability to pursue the discovery and obtain the evidence necessary to challenge IDFPR’s allegations is extremely limited. In fact, the extent of allowable discovery is determined by the very people prosecuting the case. The inherent unfairness of IDFPR’s discovery rules is just one of many reasons why physicians need experienced professional license defense counsel at their side when their careers and practices are at stake.

Louis Fine: Chicago Physician Licensing Attorney

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will get you back to your patients and your practice.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.