Research · 7 min read
How a Complaint Against a Clinician Is Handled, and What Becomes Public
Two states write the process into statute: who may complain, when an employer has to report, when the regulator has no discretion to decline, and which parts of the file a member of the public can be told.
Key takeaways
- Washington's RCW 18.130.080 treats a complaint as an input to a decision: the disciplining authority investigates if the complaint merits it, judged against prior complaints, findings, stipulations and other states' actions.
- Two Washington triggers remove that discretion — federal Medicare or Medicaid disqualification, and a pattern of complaints or arrests that never produced a formal adjudication.
- Washington employers must report a termination or restriction based on a final determination within twenty days, with named contents, and those mandatory reports are exempt from public inspection to the extent the public records chapter permits.
- RCW 18.130.110 requires findings and an order in both directions, including an order of dismissal with public exoneration, and requires reporting of statements of charges and final orders to the complainant, professional organizations, the public and counterpart boards in other states.
- California's Business and Professions Code section 800 builds a confidential central file per licensee and requires it to be purged where a complaint has gone unacted upon for five years or has been found without merit.
- California's section 803.1 lists what named boards must disclose to an inquiring member of the public, and handles settlements by count and context rather than by amount.
Answer first: a complaint starts a decision, not an investigation
Washington's RCW 18.130.080 sets out who may raise a matter and what the regulator does next, and the two are not the same step.
An individual, an impaired practitioner program, or a voluntary substance abuse monitoring program approved by a disciplining authority may submit a written complaint to the disciplining authority charging a license holder or applicant with unprofessional conduct and specifying the grounds. The same subsection allows a report of information indicating that the license holder may not be able to practice with reasonable skill and safety as a result of a mental or physical condition.
What happens next is a judgment. If the disciplining authority determines that a complaint merits investigation, or if it has reason to believe without a formal complaint that a license holder or applicant may have engaged in unprofessional conduct, it shall investigate. In deciding whether to investigate, the statute directs it to consider any prior complaints received, any prior findings of fact under the cited section, any stipulations to informal disposition, and any comparable action taken by other state disciplining authorities.
The word merits is doing the work. A complaint is an input to a decision about whether to investigate, and the statute says the decision is made against a history rather than against the single document in front of the reviewer.
A complaint is also not the only route in. The statute allows the disciplining authority to act on reason to believe without a formal complaint at all.
The two situations where Washington removes the discretion
RCW 18.130.080 names two circumstances in which the disciplining authority shall initiate an investigation, notwithstanding the general discretion.
The first is where the disciplining authority receives information that a health care provider has been disqualified from participating in the federal Medicare program under Title XVIII of the Social Security Act, or the federal Medicaid program under Title XIX.
The second is where there is a pattern of complaints, arrests, or other actions that may not have resulted in a formal adjudication of wrongdoing, but when considered together demonstrate a pattern of similar conduct that, without investigation, likely poses a risk to the safety of the license holder's patients.
That second trigger is unusual and worth reading closely. It is expressly built for matters that never produced a finding. A set of complaints that individually went nowhere can, taken together, compel an investigation that no single one of them would have compelled.
Employers have to report, on a clock, with named contents
The part of the Washington statute that consumers rarely see is the duty it places on employers, which produces reports that no patient filed.
Every license holder, corporation, organization, health care facility, and state and local governmental agency that employs a license holder shall report to the disciplining authority when the employed license holder's services have been terminated or restricted based upon a final determination that the license holder has either committed an act or acts that may constitute unprofessional conduct, or may not be able to practice with reasonable skill and safety as a result of a mental or physical condition.
The clock is stated. All such reports must be submitted as soon as possible, but no later than twenty days after a determination has been made.
The contents are stated too, if known: the name, address, and telephone number of the person making the report; the same three for the license holder being reported; the case number of any patient whose treatment is the subject of the report; a brief description or summary of the facts that gave rise to the report, including dates of occurrences; if court action is involved, the name of the court, the date of filing, and the docket number; and any further information that would aid in the evaluation of the report.
The statute then removes those mandatory reports from the public record. They are exempt from public inspection and copying to the extent permitted under the state's public records chapter, or to the extent that inspection or copying would invade or violate a person's right to privacy as set forth in the cited section.
Failure of a license holder to submit a mandatory report is punishable by a civil penalty not to exceed five hundred dollars and constitutes unprofessional conduct in its own right. Where a hospital or an ambulatory surgical facility has already reported under the cited facility statutes, a separate report is not required. And a person is immune from civil liability, whether direct or derivative, for providing information in good faith to the disciplining authority under the section.
What Washington publishes, including a dismissal
RCW 18.130.110 governs the end of the process, and it treats a clearing as a publishable event rather than a silence.
In the event of a finding of unprofessional conduct, the disciplining authority shall prepare and serve findings of fact and an order as provided in the state's Administrative Procedure Act. If the license holder or applicant is found to have not committed unprofessional conduct, the disciplining authority shall forthwith prepare and serve findings of fact and an order of dismissal of the charges, including public exoneration of the licensee or applicant. The findings and order shall be retained by the disciplining authority as a permanent record.
The distribution list is named. The disciplining authority shall report the issuance of statements of charges and final orders to the person or agency who brought the information to its attention; to appropriate organizations, public or private, which serve the professions; to the public, with notification of the public to include press releases to appropriate local news media and the major news wire services; and to counterpart licensing boards in other states, or associations of state licensing boards.
Two limits follow from that text. The reporting obligation attaches to statements of charges and final orders — which are stages, not the whole file. And the section states that it shall not be construed to require the reporting of any information exempt from public disclosure under the state's public records chapter.
California organizes the same question around a central file
California approaches it from the record rather than from the process. Business and Professions Code section 800 requires each of a long list of named boards — including the Medical Board of California, the Board of Registered Nursing, the California State Board of Pharmacy and the Physician Assistant Board — to create and maintain a central file of the names of all persons holding a license, certificate, or similar authority from that board, providing an individual historical record for each licensee.
The section names what that record holds: any conviction of a crime in California or any other state that constitutes unprofessional conduct under the cited reporting section; any judgment or settlement requiring the licensee or the licensee's insurer to pay damages in excess of three thousand dollars for a claim that injury or death was proximately caused by the licensee's negligence, error, or omission in practice or by rendering unauthorized professional services; any public complaints for which provision is made in the section; and disciplinary information reported under two further cited sections, including any exculpatory or explanatory statements the licensee submits.
Two provisions decide what survives. If a board, division, committee, or panel has failed to act upon a complaint or report within five years, or has found that the complaint or report is without merit, the central file shall be purged of information relating to it. And the contents of any central file that are not public records under another provision of law shall be confidential, with the licensee entitled to inspect and copy their own complete file except for material that would disclose the identity of an information source.
Section 803.1 then states what several named California boards shall disclose to an inquiring member of the public. It covers temporary restraining orders issued; interim suspension orders issued; revocations, suspensions, probations, or limitations on practice ordered by the board, including those made part of a probationary order or stipulated agreement; public letters of reprimand issued; and infractions, citations, or fines imposed. The same section requires disclosure of civil judgments in any amount for a claim of death or personal injury caused by the licensee's negligence, error, or omission in practice, and of arbitration awards in any amount, and requires disclosure of information received regarding felony convictions of a licensee.
Settlements are handled differently, and the difference is instructive. Section 803.1 requires disclosure of settlements only above a stated count within the last ten years — three or more for a licensee in a low-risk category and four or more for a licensee in a high-risk category — with a settlement defined for that purpose as one of thirty thousand dollars or more entered into on or after a stated date. The statute then forbids disclosing the actual dollar amount, and instead requires the board to put the number and amount in context by comparing it to the experience of other licensees in the same specialty as below average, average, or above average over the most recent ten-year period, by reporting the number of years the licensee has been in practice, and by reporting how many licensees in that specialty have entered into a settlement and what percentage that represents.
The same section requires the board to include a stated caution alongside settlement information, noting that some studies have shown no significant correlation between malpractice history and a licensee's competence while recording the state's view that consumers should have access to malpractice information.
Between them, the two states illustrate the same underlying point from opposite directions. A public record about a clinician is a curated output of a statutory process, with entry thresholds, counting rules, purge rules and exemptions written into the statute. It is not a list of everything anyone has ever alleged.
Sources
- Revised Code of Washington 18.130.080 — Unprofessional conduct — Complaint — Investigation — Civil penaltyWho may submit a written complaint or report information; the discretionary investigation standard and the factors the disciplining authority must consider; the two mandatory investigation triggers of federal Medicare or Medicaid disqualification and a pattern of complaints, arrests or other actions without formal adjudication; the employer reporting duty, its twenty-day clock and its enumerated contents; the public-records exemption for mandatory reports; the five hundred dollar civil penalty and unprofessional conduct consequence for failing to report; the hospital and ambulatory surgical facility exception; and the good-faith immunity from civil liability.
- Revised Code of Washington 18.130.110 — Findings of fact — Order — ReportThe requirement to prepare and serve findings of fact and an order on a finding of unprofessional conduct; the requirement to forthwith prepare and serve findings and an order of dismissal including public exoneration where no unprofessional conduct is found; the permanent record requirement; the four categories to which statements of charges and final orders must be reported, including press releases to local news media and the major news wire services and counterpart licensing boards in other states; and the limitation that the section does not require reporting information exempt from public disclosure.
- California Business and Professions Code section 800 — central filesThe list of named California boards required to create and maintain a central file for each licensee; the categories of information the file holds, including convictions constituting unprofessional conduct, judgments or settlements above three thousand dollars for injury or death proximately caused by the licensee's negligence, error or omission, public complaints, and reported disciplinary information with any exculpatory or explanatory statements; the requirement that boards promulgate complaint forms for the public; the five-year and without-merit purge rule; and the confidentiality of file contents that are not public records elsewhere, together with the licensee's right to inspect their own file subject to protection of an information source.
- California Business and Professions Code section 803.1 — disclosure to an inquiring member of the publicThe enforcement actions named boards must disclose, including temporary restraining orders, interim suspension orders, revocations, suspensions, probations or practice limitations including those in a probationary order or stipulated agreement, public letters of reprimand, and infractions, citations or fines; the disclosure of civil judgments and arbitration awards in any amount for death or personal injury caused by the licensee's negligence, error or omission; the disclosure of felony conviction information; the low-risk and high-risk settlement count thresholds within the last ten years and the thirty thousand dollar settlement definition; the prohibition on disclosing the actual settlement amount and the required contextual comparisons; and the required caution accompanying settlement information.
Frequently asked questions
Who can complain about a clinician in Washington?
RCW 18.130.080 permits an individual, an impaired practitioner program, or a voluntary substance abuse monitoring program approved by a disciplining authority to submit a written complaint charging a license holder or applicant with unprofessional conduct and specifying the grounds, or to report information indicating an inability to practice with reasonable skill and safety due to a mental or physical condition.
Does a complaint automatically produce an investigation?
Not in Washington's statute. RCW 18.130.080 provides that the disciplining authority investigates if it determines that the complaint merits investigation, or if it has reason to believe without a formal complaint that unprofessional conduct may have occurred, and directs it to consider prior complaints, prior findings, prior stipulations and comparable action by other state disciplining authorities in deciding.
Is there any situation where the regulator must investigate?
Washington names two. Where it receives information that a health care provider has been disqualified from the federal Medicare or Medicaid programs. And where there is a pattern of complaints, arrests, or other actions that may not have resulted in a formal adjudication of wrongdoing but, considered together, demonstrate a pattern of similar conduct that without investigation likely poses a risk to patient safety.
Does an employer have to report a clinician it lets go?
Under RCW 18.130.080, an employer must report when a license holder's services have been terminated or restricted based on a final determination that the license holder committed acts that may constitute unprofessional conduct, or may be unable to practice with reasonable skill and safety due to a mental or physical condition. The report must be submitted no later than twenty days after the determination, and failure to report carries a civil penalty not to exceed five hundred dollars and constitutes unprofessional conduct.
Is a licensee who is cleared told, or is the matter simply dropped?
RCW 18.130.110 requires the disciplining authority, where the license holder or applicant is found not to have committed unprofessional conduct, to forthwith prepare and serve findings of fact and an order of dismissal of the charges, including public exoneration of the licensee or applicant, and to retain that as a permanent record.
Will a California board tell me about settlements a clinician has paid?
Only under stated counting rules, and never the dollar amount. Business and Professions Code section 803.1 requires disclosure of settlements for a licensee in a low-risk category only where there are three or more within the last ten years, and for a high-risk category only where there are four or more, counting settlements of thirty thousand dollars or more entered into on or after a stated date. The board must not disclose the actual amount, and must instead place it in context against other licensees in the same specialty, alongside a stated caution about the correlation between malpractice history and competence.