Probable Cause

by Jayne Mittan, PA-C

As you were recently informed, I’ve been appointed to the Probable Cause Panel for the Florida Board of Medicine and the Board of Osteopathic Medicine.  What exactly does that mean?

The Board of Medicine has a separate Probable Cause Panel for North and South Florida.  The Board of Osteopathic Medicine has just one panel.  Each panel is made up of two physicians, one layperson, and now, one PA.  I am serving as the PA member of all three panels.  The panel determines whether there is enough evidence for the state to seek formal discipline against a physician or PA.  Past records show that in more than 85% of cases presented, the state decided not to seek disciplinary action.

A complaint against a physician or PA can be initiated by virtually anyone in the state.  Complaints may come from patients, employees, employers, or medical malpractice lawsuits.

Once a complaint is filed, a letter is sent to the physician or PA to notify him/her of the investigation.  An investigator will conduct interviews, gather pertinent documents and medical records, and research the practitioner’s professional license.  The charged practitioner has a chance to contest the complaint and provide supporting documentation.  Many choose to hire an attorney to represent them in the complaint process.   The Legislature acted in 1997 to speed up the process by requiring that all complaints filed against medical practitioners be processed to the Probable Cause Panel within six months.  The Probable Cause Panel then reviews the gathered information and determines whether the state should proceed with discipline.  In rare cases, the state will recommend an emergency order to suspend or restrict a doctor or PA’s license.

If the panel finds that the complaint is legally and medically sufficient, an Administrative Complaint is filed.  This is the official notice that the state is seeking formal discipline against a practitioner.  The complaint will outline all of the charges and include possible penalties.  These penalties include a confidential letter of guidance or a public letter of concern, fines, community service, probation, suspension or revocation of their license.

In the next step, one of two things may happen.  The first is an Administrative hearing.   This looks and feels like a trial.  Lawyers for the practitioner and the state go in front of a judge, who in turn makes a recommendation to the Board of Medicine.  The second is a consent agreement.  It is a form of settlement between the state and the practitioner.  Because of the cost of a hearing, more than 90% of accused practitioners opt for the consent agreement.  The agreement is then forwarded to the Board of Medicine, which can accept or reject it.

My role in all of this is to participate in any complaints made against any physician assistants licensed in Florida.  Every week the state delivers reams of paper to my office for me to review.  The panels meet on Fridays, usually by telephone conference call.  With me covering all three panels, there is a meeting almost every Friday.  Sometimes I will have 2 meetings on a Friday if more than one panel decides to meet the same day.  Fortunately, this doesn’t happen often.

It really is an honor and a privilege to be the first PA appointed to this cause.  Just think.  Before this, we had no voice at all in these proceedings.  The physician and layperson members were deciding our colleagues’ fate.  At least I can now represent the PA side of the issues.

 It has made me a better PA in my own practice as well.  I try to place myself in the place of the PA who is being investigated.  I always ask myself the question, “Given the same set of circumstances, what would I have done?”  This experience has caused me to come up with a list of the top ten ways to stay off of the state’s agenda.  Most of these you have heard before, but they bear repeating:

1. Document, document, document.  If you didn’t write it down, it didn’t happen.
2. Know your limitations.
3. Know the Florida Physician Assistant Practice Act.  Go to www.fapaonline.org for details.
4. Communicate with your supervising physician.
5. Communicate with your patients.
6. Communicate with your staff.  Make sure they know your role as well as you does.
7. Be sure you are being properly supervised.  If your physician is out of town on vacation, so are you, unless you have a designated alternate supervisor and meet the state requirements for supervision.  (See #3 above)
8. Check the Department of Health website regularly to be sure your supervisors are properly documented.
9. Keep records of your CME, especially those specifically required by the state.
10. Maintain your FAPA membership so you can be up to date with legislation and other issues that affect us.

A lot of this is common sense, but believe me, this is serious business.  The state is charged to protect the health and safety of the citizens of Florida and they are very dedicated to this charge.  It’s nice to know you have a PA on the panel, but do yourself a favor and don’t get on the agenda to start with.  Life is too short for that kind of stress.