Are you being investigated as a doctor for failure to keep legible medical records?
Have you received an administrative complaint against your physician’s license for failure to keep legible medical records that identifies you by name and professional title? If you have, it is very important that you contact an experienced health care attorney to go over the charges. These charges are serious and can have a negative impact on your license and your ability to practice as a doctor in Florida.
The law states that disciplinary action can be taken against you if you fail to keep legible medical records that identify who you are by name and professional title. Florida law on point here is Florida Statute 458.331(1)(m). That statute says in particular:
(1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s. 456.072(2):
(m) Failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations.
The important thing to note here is that the medical records should identify the license physician or their extender, AND the supervising physician by name and professional title, who are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure. They are the ones who justify the course of treatment by consulting with patient histories, exam results, test results, drugs prescribed, dispensed or administered; along with consultations and hospitalizations. It is also important to note that the statute is for failure to keep legible medical records, not for failure to keep medical records at all, though that would be very serious as well. If you have had complaints made against your license for violation of this statute, you should contact an experienced health care attorney immediately to go over your options. There can be severe repercussions for you if you wait.
There are a range of actions that can be taken against you should the Board of Medicine decide to take disciplinary action against you. The penalties you could face are found in the Disciplinary Guidelines for the Board of Medicine, particularly in Rule 64B8-8.001 in the Florida Administrative Code. The rule states the following for disciplinary guidelines for violation of the statute:
|FIRST OFFENSE:||A reprimand||Denial or two (2) years suspension followed by probation, and an administrative fine from $1,000.00 to $10,000.00.|
|SECOND OFFENSE:||Probation||Suspension followed by probation or denial, and an administrative fine from $5,000.00 to $10,000.00.|
Minimum penalties for a first offense under the guidelines calls for a reprimand to be given, though that can be coupled with other penalties. In fact, it is possible that a renewal of your license could be denied, or you could be suspended for two years followed by probation. Also, you could be assessed an administrative fine between $1,000 and $10,000. For a second offense, you could face probation at a minimum, however you could be suspended, then put on probation or even denied a license. For a second offense, the fees range from $5,000 to $10,000. This is very serious. You should also be aware that these are guidelines that the board should follow in handing out discipline, but are not set in stone, and can be accompanied by other penalties or deviated from. These penalties can be found in Florida Statute 456.072(2), which you should review with your health care attorney.
The board hearing your case can take into account various factors that could affect the discipline you receive. These factors are called aggravating and mitigating circumstances. Aggravating circumstances are factors that can hurt your case. If aggravating circumstances are proven you could face harsher penalties. Mitigating circumstances are factors that can help your case. If mitigating circumstances are proven you could face lesser penalties. These factors can also be found in rule 64B8-8.001(3) in the Florida Administrative Code. If either side can prove with clear and convincing evidence the aggravating or mitigating circumstances, the discipline you face could be altered by the board. Here are the factors:
(a) Exposure of patient or public to injury or potential injury, physical or otherwise: none, slight, severe, or death;
(b) Legal status at the time of the offense: no restraints, or legal constraints;
(c) The number of counts or separate offenses established;
(d) The number of times the same offense or offenses have previously been committed by the licensee or applicant;
(e) The disciplinary history of the applicant or licensee in any jurisdiction and the length of practice;
(f) Pecuniary benefit or self-gain inuring to the applicant or licensee;
(g) The involvement in any violation of Section 458.331, F.S., of the provision of controlled substances for trade, barter or sale, by a licensee. In such cases, the Board will deviate from the penalties recommended above and impose suspension or revocation of licensure.
(h) Where a licensee has been charged with violating the standard of care pursuant to Section 458.331(1)(t), F.S., but the licensee, who is also the records owner pursuant to Section 456.057(1), F.S., fails to keep and/or produce the medical records.
(i) Any other relevant mitigating factors.
The board can take into account any of these factors, or other factors, in your hearing. The board can deviate from the standard disciplinary guidelines if they find that any of these aggravating or mitigating circumstances exist. These are very important factors that you should discuss with your health care attorney.
If you are a licensed health care professional in Florida and have received an administrative complaint for violation of the statutes, you are probably concerned about how this may affect your license. To set up a FREE no obligation consultation with Jeff Howell contact the law firm of Howell, Buchan & Strong, Attorneys at Law at 850-877-7776. We represent licensed health care professionals and facilities statewide, including out of state clients who are concerned about the status of their Florida license.