Complaint: General Office Practices/Protocols
Are physicians required to have a chaperone present in the room when examining patients?
No. California law does not require physicians to have a male or female chaperone;however, if having a chaperone or assistant in the exam room makes the patient feelmore comfortable and at ease, then the physician should accommodate the patient'srequest if possible or allow a friend or relative to accompany the patient.
Can a physician refuse me as a patient if I choose not to sign the doctor's Arbitration Agreement?
Yes, the physician can choose to not accept a new patient who does not want to signthe Arbitration Agreement.
Does a physician have to accept new patients?
No. A physician has a right to determine whom to accept as a patient, just as a patient has the right to choose their physician. However, B&P Code Section 125.6 (and Civil Code 51) does not allow a physician to discriminate against a prospective patient on the basis of race, gender, disability, sexual orientation, citizenship or marital status. A physician also may terminate a patient without cause as long as the termination is handled appropriately (see Question "Can a physician refuse to treat a current patient?").
Does a physician have to write reports and sign documents for disability or Workers'Compensation purposes? Does this have to be done within a specific time frame? Canthey charge for this service?
There are no specific laws governing a physician's responsibility in regard to filling out forms or providing reports. Physicians can choose not to complete discretionary paperworkif, in their medical opinion, the services/equipment is not medically indicated. Patients requesting completion of applications for disability benefits, FMLA, and/or work restrictionsmay contact their treating physician for assistance. Patients should contact their attorney if one is involved, or the disability or Workers' Compensation program, requesting theinformation as they may have specific rules and/or laws regarding the timely filing of forms/reports. They also may have alternatives that the patient can use if the physician won'tcooperate. The Medical Practice Act does not preclude the physician from charging for this service.
Is a physician required to carry malpractice insurance?
A physician only is required to carry liability insurance in an outpatient surgery setting pursuant to Business and Professions Code section 2216.2. However, a physician mustfollow the reporting requirements cited in Business and Professions Code section 801.01 in regard to lawsuit settlementsand arbitration awards.
Yes, but the physician needs to follow appropriate guidelines. See California MedicalAssociation (CMA) guidelines in regard to terminating the doctor/patient relationship.The CMA guidelines indicate a physician must notify the patient in writing informingthe patient:
- the last day the physician will provide care, assuring the patient at least 15 daysof emergency treatment and prescriptions before discontinuing service;
- alternative sources of medical care; i.e., referral to another physician, the patient'sinsurer/HMO, or the local county's medical society; and
- information necessary to obtain the patient's medical records compiled during thisphysician's care.
Does my physician have to provide a "back up" physician when he/she is unavailable;i.e., during vacations or after-hours care?
No. While there is no law mandating a physician provide "back up or cross covering"care when he/she is unavailable, most physicians do have emergency coverage availablewhen they are unavailable, whether it be with another physician or directing thepatient to Urgent Care or to a hospital's emergency department.
How long must a physician's office maintain a patient's medical records?
There is no general law requiring a physician to maintain medical records for aspecific period of time. However, there are situations or government health plansthat require a provider/physician to maintain their records for a certain periodof time. Several laws specify a three-year retention period: Welfare and InstitutionsCode section 14124.1 (which relates to Medi-Cal patients), Health and Safety Codesection 1797.98(e) (for services reimbursed by Emergency Medical Services Fund),and Health and Safety Code section 11191 (when a physician prescribes, dispensesor administers a Schedule II controlled substance). The Knox-Keene Act requiresthat HMO medical records be maintained a minimum of two years to ensure that compliancewith the act can be validated by the Department of Corporations. In Workers' CompensationCases, qualified medical evaluators must maintain medical-legal reports for fiveyears. Health and Safety Code section 123145 indicates that providers who are licensedunder section 1205 as a medical clinic shall preserve the records for seven years.However, there is no general statute which relates to all other types of medicalrecords.
How do I obtain a death certificate to find out the name of the physician who signed the form?
You may contact the Department of Vital Statistics at (916) 445-1719 to obtain a copy of a death certificate.
Can I file an anonymous complaint on behalf of a family member/friend against aphysician if I believe he/she is overprescribing?
The Board receives and investigates a number of complaints about physician prescribing concerns which are sent by someone other than the patient.These complaints can be difficult to investigate when the patient does not consent to allow the Board to evaluate the care and treatment. It is veryhelpful in these situations if the Board is provided with as much information as possible, including but not limited to, the patient’s name, patient’sdate of birth, what specific medication(s) is/are being prescribed and the quantity and frequency. Sometimes this information can be obtained from thepharmacy where the prescriptions are filled. The Board will try to validate the information and in the event that sufficient evidence is available to support apossible violation of the law, an investigational subpoena will be issued for the patient's medical records.
I received a medical evaluation with faulty information which resulted in the cancellationof disability, Workers' Compensation, or other benefits. Can I file a complaint?
The Board has very limited jurisdiction over independent evaluation reports. Therole of the evaluator is to provide an "independent opinion" of the individual'scondition after 1) examining the patient and/or 2) reviewing the records of thetreatment obtained by the other treating physicians involved in the patient's care.The Board will normally recommend that disability patients pursue an appeal throughthe disability insurance company.
Worker's compensation independent (IME) and qualified medical examiner (QME) evaluations are governed by the Medical Unit of the Division of Workers' Compensation. This state agency is responsible for regulating the conduct of IMEs and QMEs in workers' compensation cases, and may be able to advise you on other workers' compensation-related issues. You may contact them at DWC - Medical UnitP.O. Box 71010, Oakland, CA 94612 or by telephone at 510-286-3700 or 800-794-6900.
Can the Medical Board help in finding a physician for Medi-Cal, Medicare, a specialistor a IME/QME?
No, the Board does not provide referrals to physicians. You can contact your localmedical association for referrals in various medical specialties or your individualinsurance plan or HMO. To locate the medical association/society in your area youcan log onto the California Medical Association's website at cmadocs.org/partners.
Can a physician treat and prescribe to family, friends or employees?
There is no law which specifically prohibits a physician from evaluating, diagnosing, treating, or prescribing controlledsubstances to a family member, employee or friend. However, the practice is discouraged. There are laws to consider when assessing anyprescribing issues which include, but are not limited to: 1) a physician cannot prescribe without an appropriate prior exam and a medicalindication for the prescription, and 2) an adequate and accurate medical record relating to the provision of services to the patient anddocumenting the medical need for the prescription must be created and maintained by the physician. Basically, a physician must follow thesame practice/protocol for any patient in which medications are prescribed.
Can a physician have a personal relationship with a patient?
Business and Professions Code section 726 states that sexual abuse, misconduct orrelations with a patient are considered unprofessional conduct and grounds for disciplinaryaction. The Board considers any type of personal relationship between the doctorand the patient to be a very serious breach of public trust and investigates thesecomplaints. Please refer to "Complaints: Investigations" which provides general information aboutcomplaint investigations.
What if a personal relationship developed between the physician and the patient and it was consensual?
The fact that the personal relationship between the physician and the patient atsome point was consensual does not negate the fact that the physician breached professionalethics and boundaries, and possibly broke the law, by initiating a personal relationshipwith a patient. Filing a complaint with the Board would be strongly encouraged sothe issue could be investigated in the event that other complaints with similarallegations had been reported.
My teenage child was seen by the physician and the physician refuses to disclosethe reason for the visit. Can I withhold payment of the bill unless the physiciananswers my questions or provides me with the medical record from the visit?
No. Children from the age of 12-17 have the authority to "consent" to some typesof treatment without the permission of their parent or guardian. The physician isobligated to maintain the doctor/patient confidentiality, particularly when thephysician feels that the disclosure of the information will have a negative impacton the relationship with the patient. HIPAA also prevents the disclosure of doctor/patientinformation to the parent. i.e., treatment related to the prevention of sexuallytransmitted diseases.
What is required by the Medical Board to open a medical clinic?
The medical clinic must be wholly owned and controlled by a physician or physicians(a layperson cannot own a clinic). See Business and Professions Code sections 2400- 2417 and Corporations Code sections 13400 - 13410 for the requirements on whatbusiness structures can be used (sole ownerships, professional partnerships, andprofessional corporations). If the physician/owner is practicing under a name otherthan their own name (i.e., a clinic name, like "Sun Valley Medical Clinic"), thephysician must obtain a Fictitious Name Permit(FNP) from the Medical Board. This is separate from any fictitious business namefilings required by city or county governments. Applications for the Medical Board'sFNP can be obtained either on the Board's website or from the Consumer InformationUnit at 1-800-633-2322. If a physician who owns a clinic is a Medicare provider,he or she can obtain certification for the clinic through the Department of PublicHealth without having to apply for an FNP.
How do I obtain copies of my lab results?
Health and Safety Code section 123148 requires the health care professional who requested the test be performed to provide a copy of the results to the patient,if requested either orally or in writing. When the patient requests their lab results, the health care provider should provide the results to the patient within a"reasonable" time period after the results are received by the provider. Results may be disclosed in electronic form if requested by the patient and if deemed mostappropriate by the health care professional who requested the test. In the event that the provider arranges for the test results to be provided by Internet postingor other electronic manner, the results shall be disclosed to a patient in a reasonable time period, but only after the results have been reviewed by the provider.Depending on the results of the tests, some physicians may want the patient to schedule an appointment to review and discuss the results and any follow-up testing ortreatment that might be required. The test results cannot be released by the lab performing the test and must be released by the provider requesting the test(s).
