Research
How a complaint against a licensee is filed
Two very different things reach a health board under the same word. One is a complaint anybody may write. The other is a report an employer is required by statute to send, on a clock, whether anyone complained or not.
Who is allowed to complain
Washington opens its complaint section with an unusually wide grant. An individual, an impaired practitioner programme, or a voluntary substance abuse monitoring programme approved by a disciplining authority may submit a written complaint to the disciplining authority charging a licence holder or applicant with unprofessional conduct and specifying the grounds for it.
The same sentence covers a second route that is not an accusation at all. Those parties may instead report information to the disciplining authority, or to an approved monitoring or impaired practitioner programme, indicating that the licence holder may not be able to practise their profession with reasonable skill and safety to consumers as a result of a mental or physical condition.
The distinction matters because the second route is about capacity rather than conduct, and it exists so that a concern about impairment does not have to be dressed up as a charge of misconduct to be actionable.
California approaches the same ground administratively. Each of the boards it names shall prescribe and promulgate forms on which members of the public and other licensees or certificate holders may file written complaints to the board alleging any act of misconduct in, or connected with, the performance of professional services by the licensee.
Neither statute conditions a complaint on being a patient of the licensee. The Washington provision names an individual, and the California one names members of the public and other licensees.
The report an employer must send
The heavier obligation in the Washington section is not a complaint at all. Every licence holder, corporation, organisation, health care facility, and state and local governmental agency that employs a licence holder shall report to the disciplining authority when the employed licence holder's services have been terminated or restricted based upon a final determination that the licence holder has either committed an act or acts that may constitute unprofessional conduct, or may not be able to practise with reasonable skill and safety as a result of a mental or physical condition.
The clock is short and explicit. All such reports must be submitted as soon as possible, but no later than twenty days after a determination has been made.
The statute lists what a report should contain if known, and the list is deliberately practical: the name, address and telephone number of the person making the report; the same for the licence 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; the court, filing date and docket number if court action is involved; and any further information that would aid evaluation.
Failure of a licence 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.
Two protections sit around the obligation. Mandatory reports are exempt from public inspection and copying to the extent permitted by the state public records chapter, or to the extent that inspection or copying would invade or violate a person's right to privacy, and a person is immune from civil liability, direct or derivative, for providing information in good faith under the section.
What the regulator does with it
Receipt is not investigation, and Washington says so. If the disciplining authority determines that a complaint merits investigation, or if it has reason to believe without a formal complaint that a licence holder or applicant may have engaged in unprofessional conduct, it shall investigate.
The statute tells the regulator what to weigh in deciding. In determining whether to investigate, the disciplining authority shall consider any prior complaints it has received, any prior findings of fact, any stipulations to informal disposition, and any comparable action taken by other state disciplining authorities.
Two situations remove the discretion entirely. The disciplining authority shall initiate an investigation in every instance where it receives information that a health care provider has been disqualified from participating in the federal medicare or medicaid programmes, or where there is a pattern of complaints, arrests, or other actions that may not have resulted in a formal adjudication of wrongdoing but which, considered together, demonstrate a pattern of similar conduct that without investigation likely poses a risk to the safety of the licence holder's patients.
That second trigger is the interesting one, because it is expressly about matters that did not result in a finding. A pattern of unadjudicated complaints is itself a mandatory reason to look.
The powers that follow are substantial. The Washington disciplining authority may investigate all complaints or reports, hold hearings, issue subpoenas and administer oaths, take depositions, compel attendance of witnesses, conduct practice reviews, and issue citations and assess fines for failure to produce documents. It may also take emergency action ordering summary suspension of a licence, or restriction or limitation of practice, pending proceedings, with a show cause hearing to be provided within fourteen days of a request by the affected licence holder.
What the two sides are told
Virginia writes the notification duties into the same section that makes investigative material confidential, which is a useful place to look for them.
Whenever a complaint or report has been filed about a person licensed, certified, or registered by a health regulatory board, the source and the subject of that complaint or report shall be provided information about the investigative and disciplinary procedures at the Department of Health Professions.
The licensee gets the document itself, on a defined trigger. Prior to interviewing a licensee who is the subject of a complaint or report, or at the time the licensee is first notified in writing of it, whichever occurs first, the licensee shall be provided with a copy of the complaint or report and any records or supporting documentation, unless doing so would materially obstruct a criminal or regulatory investigation.
If the board concludes that a disciplinary proceeding will not be instituted, it may send an advisory letter to the person who was the subject of the complaint. The board may also inform the source that an investigation was conducted, that the matter concluded without a disciplinary proceeding, what process the board followed, and where appropriate that an advisory letter was communicated.
The source is told something else at the same time, which cuts the other way. In providing that information, the board shall inform the source that they are subject to the section's requirements relating to confidentiality and discovery.
When it becomes a case
A complaint turns into a proceeding at a specific, named document.
In Washington, if the disciplining authority determines upon investigation that there is reason to believe a violation of the unprofessional conduct section has occurred, a statement of charge or charges shall be prepared and served upon the licence holder or applicant at the earliest practical time.
The statement must be accompanied by notice that the licence holder or applicant may request a hearing to contest the charges, and that request must be filed with the disciplining authority within twenty days after service. If the twenty-day limit results in a hardship, the licensee may request for good cause an extension not to exceed sixty additional days, and the disciplining authority shall grant it on finding good cause.
Failure to request a hearing constitutes a default, whereupon the disciplining authority may enter a decision on the basis of the facts available to it. Where a hearing is requested, the time is fixed as soon as convenient but the hearing shall not be held earlier than thirty days after service of the charges.
Washington also carves out one category from the ordinary structure. With regard to complaints alleging only sexual misconduct, the secretary serves as the sole disciplining authority in every aspect of the disciplinary process, and the board or commission reviews all cases and refers to the secretary only those that do not involve clinical expertise or standard of care issues. The same section requires that all victim interviews in sexual misconduct investigations be conducted by a person who has completed training on interviewing victims in a manner that minimises negative impacts.
Key takeaways
- Washington lets an individual or an approved monitoring programme file a written complaint, or report a capacity concern instead.
- Employers in Washington must report a terminated or restricted licence holder within twenty days of the determination.
- Failing to make that report is itself unprofessional conduct and carries a civil penalty.
- Investigation is discretionary in Washington except for federal programme disqualification and unadjudicated patterns.
- Virginia gives the licensee a copy of the complaint before an interview or at first written notice, whichever comes first.
- A Washington case formally begins with a statement of charges, answerable within twenty days of service.
Frequently asked questions
Does a person have to be a patient to complain?
The statutes read here do not say so. Washington provides that an individual, an impaired practitioner programme, or an approved voluntary substance abuse monitoring programme may submit a written complaint charging a licence holder or applicant with unprofessional conduct and specifying the grounds. California requires its boards to prescribe forms on which members of the public and other licensees or certificate holders may file written complaints alleging misconduct connected with professional services.
Is anyone required to report a licensee?
In Washington, employers are. Every licence holder, corporation, organisation, health care facility and state or local governmental agency that employs a licence holder must report when that person's services have been terminated or restricted based on a final determination of possible unprofessional conduct or of inability to practise safely because of a mental or physical condition. The report is due as soon as possible and no later than twenty days after the determination.
What happens if a required report is not made?
Washington attaches two consequences. Failure of a licence holder to submit a mandatory report is punishable by a civil penalty not to exceed five hundred dollars, and it constitutes unprofessional conduct in its own right. The statute also provides immunity from civil liability, whether direct or derivative, for providing information in good faith to the disciplining authority under that section.
Does every complaint get investigated?
No. Washington investigates where the disciplining authority determines the complaint merits it, weighing prior complaints, prior findings of fact, prior informal stipulations and comparable action by other states. Two situations are mandatory: information that a provider has been disqualified from the federal medicare or medicaid programmes, and a pattern of complaints, arrests or other actions that did not result in formal adjudication but together show similar conduct likely to pose a risk to patients.
Does the licensee see the complaint?
In Virginia, yes, on a defined trigger. Before interviewing a licensee who is the subject of a complaint or report, or when the licensee is first notified in writing of it, whichever occurs first, the licensee must be provided with a copy of the complaint or report and any records or supporting documentation, unless that would materially obstruct a criminal or regulatory investigation. Virginia also requires both the source and the subject to be given information about the department's investigative and disciplinary procedures.
When does a complaint become a formal case?
In Washington, when a statement of charges is prepared and served. That happens if the disciplining authority determines upon investigation that there is reason to believe a violation of the unprofessional conduct section occurred. The licensee must file a request for hearing within twenty days after service, with a good-cause extension of up to sixty additional days available, and a requested hearing may not be held earlier than thirty days after service of the charges.
Sources
Each document below is named as it names itself, with the date printed on that document rather than the day it was read.
- Revised Code of Washington 18.130.080, complaints and mandatory reports, including the twenty-day reporting window and the mandatory investigation triggers — Washington State Legislature, 2008
- Revised Code of Washington 18.130.050, authority of the disciplining authority, including subpoenas, practice reviews and emergency summary suspension — Washington State Legislature, 2024
- Revised Code of Washington 18.130.090, statement of charges and request for hearing — Washington State Legislature, 1993
- Code of Virginia section 54.1-2400.2, Confidentiality of information obtained during an investigation or disciplinary proceeding; penalty — Virginia Law, Virginia General Assembly, 2019
- California Business and Professions Code section 800, board central files and prescribed public complaint forms — California Legislative Information, California Legislature, January 2022