Research · 7 min read
What a State Can Do to a License Short of Revoking It
Revocation is the last item on the list, not the only one. Three state statutes name the intermediate outcomes — restriction, monitoring, a fine per violation, a refund of fees, and a surrender that gets reported to a federal databank.
Key takeaways
- Washington's RCW 18.130.160 lists twelve outcomes on a finding, most of which leave the license in place — restriction, remedial education, supervised monitoring, censure, probation, corrective action and a refund of fees collected from the consumer among them.
- A Washington fine may not exceed five thousand dollars per violation, and a surrender in lieu of other sanctions must be reported to the federal data bank and is not subject to reinstatement.
- Washington requires the disciplining authority to consider public protection or compensation first, and only then rehabilitation of the license holder, with a written explanation required for departing from the sanction schedule.
- A stipulated disposition in Washington is classified by the statute itself as formal disciplinary action for all purposes.
- California's Business and Professions Code section 125.9 authorizes citations with abatement orders and fines capped at five thousand dollars, a thirty-day window to contest, and addition of an unpaid fine to the license renewal fee.
- Washington's capacity proceeding under RCW 18.130.170 is limited to the sole issue of ability to practice safely, and any ordered examination must be narrowly tailored and preceded by a detailed written notice.
Answer first: the statute lists the options, and most of them leave the license in place
Washington's RCW 18.130.160 states what happens after a finding. Upon a finding, after hearing, that a license holder has committed unprofessional conduct or is unable to practice with reasonable skill and safety due to a physical or mental condition, the disciplining authority shall issue an order including sanctions adopted in accordance with the schedule adopted under the cited section, giving proper consideration to any prior findings of fact, any stipulations to informal disposition, and any action taken by other in-state or out-of-state disciplining authorities.
The order must provide for one or any combination of a list. Revocation of the license. Suspension of the license for a fixed or indefinite term. Restriction or limitation of the practice. Requiring the satisfactory completion of a specific program of remedial education or treatment. The monitoring of the practice by a supervisor approved by the disciplining authority. Censure or reprimand. Compliance with conditions of probation for a designated period of time. Payment of a fine for each violation of the chapter, not to exceed five thousand dollars per violation, with funds placed in the health professions account. Denial of the license request. Corrective action. Refund of fees billed to and collected from the consumer. And a surrender of the practitioner's license in lieu of other sanctions, which must be reported to the federal data bank.
Two of those items are easy to skip and worth noticing. Refund of fees billed to and collected from the consumer is a consumer-facing remedy sitting inside a licensing statute. And a voluntary surrender is not a quiet exit in Washington: the statute requires it to be reported to the federal data bank, and provides that surrender or permanent revocation under the section is not subject to a petition for reinstatement under the cited section.
Virginia states its own set at the top of its unprofessional conduct section. Code of Virginia section 54.1-2915 provides that the Board may refuse to issue a certificate or license to any applicant; reprimand any person; place any person on probation for such time as it may designate; impose a monetary penalty or terms as it may designate on any person; suspend any license for a stated period of time or indefinitely; or revoke any license.
The stay, the schedule, and the order of priorities
Washington attaches three qualifications to its list that shape how the sanctions are actually chosen.
The first is a stay power stated in one sentence: any of the actions under the section may be totally or partly stayed by the disciplining authority. A sanction on paper is not necessarily a sanction in effect.
The second is a schedule. In determining what action is appropriate, the disciplining authority must consider the schedule adopted under the cited section. It may deviate from that schedule when selecting appropriate sanctions where a case presents unique circumstances the schedule does not adequately address, but it must issue a written explanation of the basis for not following the schedule.
The third is an ordering rule, and it is the clearest statement of purpose in the statute. Safeguarding the public's health and safety is the paramount responsibility of every disciplining authority. Where the schedule allows flexibility, the disciplining authority must first consider what sanctions are necessary to protect or compensate the public. Only after such provisions have been made may it consider and include requirements designed to rehabilitate the license holder.
The statute also allocates cost. All costs associated with compliance with orders issued under the section are the obligation of the license holder.
And it provides for permanence at the far end: the disciplining authority may order permanent revocation of a license if it finds that the license holder can never be rehabilitated or can never regain the ability to practice with reasonable skill and safety.
A stipulation is formal discipline, and the statute says so
The most commonly misread outcome is the negotiated one, because it does not look like a hearing and does not read like a verdict.
RCW 18.130.160 provides that the license holder may enter into a stipulated disposition of charges that includes one or more of the section's sanctions, but only after a statement of charges has been issued and the license holder has been afforded the opportunity for a hearing and has elected on the record to forgo it.
The stipulation must either contain one or more specific findings of unprofessional conduct or inability to practice, or a statement by the license holder acknowledging that the evidence is sufficient to justify one or more specified findings.
Then the sentence that settles its status: the stipulation entered into pursuant to that subsection shall be considered formal disciplinary action for all purposes.
That matters for anyone reading a license record. A stipulated outcome is not a lesser category of event under this statute, and other provisions that turn on the existence of formal discipline will treat it as one.
California's citation route, which does not require a disciplinary case at all
California authorizes a separate, faster mechanism that stops short of a disciplinary proceeding. Business and Professions Code section 125.9 permits a board, bureau, or commission within the Department of Consumer Affairs, along with two named boards, to establish by regulation a system for issuing a citation to a licensee, which may contain an order of abatement or an order to pay an administrative fine, where the licensee is in violation of the applicable licensing act or a regulation adopted under it.
The system must contain stated features. Citations shall be in writing and shall describe with particularity the nature of the violation, including specific reference to the provision of law determined to have been violated. Where appropriate, the citation shall contain an order of abatement fixing a reasonable time for abatement.
The fine is capped and the cap is stated twice. In no event shall the administrative fine exceed five thousand dollars for each inspection or each investigation made with respect to the violation, or five thousand dollars for each violation or count if the violation involves fraudulent billing submitted to an insurance company, the Medi-Cal program, or Medicare. In assessing a fine, the board must give due consideration to the appropriateness of the amount with respect to factors such as the gravity of the violation, the good faith of the licensee, and the history of previous violations.
The contest window is thirty days. A citation or fine assessment must inform the licensee that a hearing to contest the finding of a violation must be requested by written notice within thirty days of the date of issuance, and that if no hearing is requested, payment of any fine shall not constitute an admission of the violation charged.
Non-payment has a specific consequence. Failure to pay a fine or comply with an order of abatement within thirty days, unless the citation is being appealed, may result in disciplinary action. Where a citation is not contested and a fine is not paid, the full amount of the assessed fine shall be added to the fee for renewal of the license, and a license shall not be renewed without payment of both the renewal fee and the fine.
One further sentence changes how a paid citation should be read. If a fine is paid to satisfy an assessment based on the finding of a violation, payment of the fine and compliance with the order of abatement, if applicable, shall be represented as satisfactory resolution of the matter for purposes of public disclosure.
The capacity track, which is not a punishment track
Washington runs a separate proceeding for a license holder who may be unable to practice safely for reasons of health, and it is deliberately narrow.
RCW 18.130.170 provides that if the disciplining authority believes a license holder may be unable to practice with reasonable skill and safety by reason of any mental or physical condition, a statement of charges shall be served and notice issued providing an opportunity for a hearing. The hearing shall be limited to the sole issue of the capacity of the license holder to practice with reasonable skill and safety, and if the disciplining authority so determines, it shall impose such sanctions under the sanctions section as is deemed necessary to protect the public.
The examination power comes with procedural conditions that read like a checklist. The disciplining authority may require a license holder to submit to a mental or physical examination by one or more licensed or certified health professionals it designates, but only after written notice that includes a statement of the specific conduct, event, or circumstances justifying an examination; a summary of the evidence supporting the concern and the grounds for believing that evidence credible and reliable; a statement of the nature, purpose, scope, and content of the intended examination; a statement of the license holder's right to respond in writing within twenty days to challenge the grounds or the manner or form of the examination; and a statement that a timely response suspends the examination while the response is under consideration.
A timely challenge is reviewed either by a panel of disciplining authority members who have not been involved with the allegations or by a neutral decision maker approved by the disciplining authority, who must prepare a written decision on whether there is reasonable cause and whether the manner or form is appropriate. All such examinations shall be narrowly tailored to address only the alleged condition and the ability to practice with reasonable skill and safety. The cost of an ordered examination is paid out of the health professions account, and the license holder may submit examination reports from professionals of their own choosing and expense.
Taken together, the three states show the same structural fact from different angles. The interesting part of a license record is rarely the presence or absence of a revocation. It is the intermediate outcome — a restriction, a monitoring condition, a probation term, a citation and fine, or a stipulated disposition that the statute itself classifies as formal discipline.
Sources
- Revised Code of Washington 18.130.160 — Finding of unprofessional conduct — Orders — Sanctions — Stay — Costs — StipulationsThe requirement to issue an order including scheduled sanctions after a finding, and the factors to be considered; the full list of available sanctions including the five thousand dollar per violation fine, refund of fees billed to and collected from the consumer, and surrender reported to the federal data bank; the stay power; the paramount public protection statement and the requirement to consider protective or compensatory sanctions before rehabilitative ones; the allocation of compliance costs to the license holder; permanent revocation where rehabilitation is impossible; the bar on reinstatement after surrender or permanent revocation; and the stipulated disposition provisions, including the statement that a stipulation is formal disciplinary action for all purposes.
- Revised Code of Washington 18.130.170 — Capacity of license holder to practice — Hearing — Mental or physical examination — Implied consentThe capacity proceeding, its limitation to the sole issue of ability to practice with reasonable skill and safety, and the imposition of sanctions necessary to protect the public; the contents of the written notice of intent to order an examination; the twenty-day response right and its suspensive effect; review by an uninvolved panel or an approved neutral decision maker and the written decision requirement; the requirement that examinations be narrowly tailored; payment of ordered examination costs from the health professions account; and the license holder's right to submit reports from professionals of their own choosing and expense.
- California Business and Professions Code section 125.9 — citation and fine systemThe authority to establish a citation system by regulation; the requirement that citations be in writing and describe the violation with particularity including specific reference to the provision violated; the order of abatement with a reasonable time fixed; the five thousand dollar caps per inspection or investigation and per violation or count for fraudulent billing to an insurance company, Medi-Cal or Medicare; the factors to consider in assessing a fine; the thirty-day hearing request window and the statement that payment without a hearing is not an admission; the consequences of non-payment including addition to the renewal fee and the bar on renewal; and the provision that payment and abatement shall be represented as satisfactory resolution for purposes of public disclosure.
- Code of Virginia section 54.1-2915 — Unprofessional conduct; grounds for refusal or disciplinary actionThe sanctions the Virginia Board of Medicine may impose: refusal to issue a certificate or license, reprimand, probation for such time as it may designate, a monetary penalty or terms as it may designate, suspension for a stated period or indefinitely, and revocation.
Frequently asked questions
What sanctions can a Washington disciplining authority impose?
RCW 18.130.160 lists revocation; suspension for a fixed or indefinite term; restriction or limitation of practice; required completion of a program of remedial education or treatment; monitoring of the practice by an approved supervisor; censure or reprimand; probation conditions for a designated period; a fine not to exceed five thousand dollars per violation; denial of a license request; corrective action; refund of fees billed to and collected from the consumer; and surrender of the license in lieu of other sanctions, which must be reported to the federal data bank.
Can a licensee simply give up the license and end the matter quietly?
Under RCW 18.130.160, a surrender of the practitioner's license in lieu of other sanctions is itself one of the listed sanctions and must be reported to the federal data bank. The section also states that surrender or permanent revocation under it is not subject to a petition for reinstatement under the cited section.
Is a negotiated settlement with the board real discipline?
RCW 18.130.160 states that a stipulation entered into under its stipulated-disposition provision shall be considered formal disciplinary action for all purposes. The stipulation is available only after a statement of charges has issued and the license holder has been offered a hearing and elected on the record to forgo it, and it must contain specific findings or an acknowledgement that the evidence is sufficient to justify them.
What is a citation, and how does it differ from discipline?
California Business and Professions Code section 125.9 lets a board establish by regulation a system of citations that may contain an order of abatement or an administrative fine where a licensee is in violation of the licensing act or its regulations. The fine may not exceed five thousand dollars for each inspection or investigation, or five thousand dollars per violation or count where the violation involves fraudulent billing to an insurance company, Medi-Cal or Medicare. A licensee has thirty days to request a hearing, and if none is requested, payment of the fine does not constitute an admission.
What happens if a California citation fine is not paid?
Section 125.9 provides that failure to pay a fine or comply with an order of abatement within thirty days, unless the citation is being appealed, may result in disciplinary action. Where a citation is not contested and the fine is not paid, the full amount is added to the license renewal fee, and the license shall not be renewed without payment of both.
Can a board order a clinician to be examined?
Washington's RCW 18.130.170 permits it in a capacity proceeding, subject to conditions. Written notice must state the specific conduct justifying the examination, summarize the supporting evidence and the grounds for believing it credible, describe the nature, purpose, scope and content of the intended examination, and inform the license holder of a right to respond in writing within twenty days, which suspends the examination while the response is considered. Any ordered examination must be narrowly tailored to the alleged condition and the ability to practice safely.