What a board can order after a finding

The menu is longer than revocation

Washington sets out its sanctions in a single list, and the order in the list is not the order of severity. Upon a finding after hearing that a licence holder has committed unprofessional conduct or is unable to practise with reasonable skill and safety due to a physical or mental condition, the disciplining authority shall issue an order including sanctions, and the order must provide for one or any combination of the enumerated options.

Those options are revocation of the licence; suspension for a fixed or indefinite term; restriction or limitation of the practice; requiring satisfactory completion of a specific programme of remedial education or treatment; monitoring of the practice by a supervisor approved by the disciplining authority; censure or reprimand; compliance with conditions of probation for a designated period; payment of a fine for each violation not to exceed five thousand dollars per violation; denial of the licence request; corrective action; refund of fees billed to and collected from the consumer; and a surrender of the practitioner's licence in lieu of other sanctions.

Two of those are worth pausing on because they are not punishments in the ordinary sense. Refund of fees billed to and collected from the consumer is restitution, and monitoring of the practice by an approved supervisor is a continuing condition rather than a one-off penalty.

Any of the actions may be totally or partly stayed by the disciplining authority, which means an order that reads as a suspension may be operating as probation.

Virginia's Board of Medicine menu runs in parallel: refuse to issue a certificate or licence; reprimand; place on probation for such time as the board designates; impose a monetary penalty or terms; suspend for a stated period or indefinitely; or revoke. Its Board of Pharmacy list adds refusal to admit an applicant to any examination.

The order in which a board is told to think

The Washington section does something unusual: it tells the decision-maker the sequence of its own reasoning.

Safeguarding the public's health and safety is the paramount responsibility of every disciplining authority. In determining what action is appropriate, the disciplining authority must consider the sanction schedule adopted under the chapter.

Where the schedule allows flexibility in determining the appropriate sanction, 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 in the order requirements designed to rehabilitate the licence holder.

Protection and compensation come first as a matter of statutory sequence; rehabilitation of the licensee is permitted only once those are settled. That is a rare instance of a legislature writing down the priority order rather than leaving it to practice.

Departure from the schedule is possible and costly. The disciplining authority may determine that a case presents unique circumstances the schedule does not adequately address and may deviate from it, but must issue a written explanation of the basis for not following the schedule.

What the order carries with it

An order does more than name a sanction. The Washington section also directs what the decision-maker must weigh and who pays for what follows.

In issuing the order, the disciplining authority gives 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. A licensee's history in another state is an input to the sanction, not only to the decision to investigate.

Cost falls on the licensee without qualification. All costs associated with compliance with orders issued under the section are the obligation of the licence holder.

That sentence carries more weight than the fine cap in many cases. A remedial education programme, a treatment programme, or a supervisor approved by the disciplining authority all have costs, and the statute assigns them all to the person under the order.

Virginia attaches its own financial provision at the informal level, allowing a special conference committee to impose a monetary penalty under the section of its code that governs such penalties, alongside the non-financial dispositions available to it.

Who actually decides

The decision-maker is not always the full board, and the two states handle that differently.

Washington routes everything through general administrative law. The procedures governing adjudicative proceedings before agencies under the state administrative procedure act govern all hearings before the disciplining authority, which has in addition to its chapter powers all the powers and duties under that act, including administration of oaths, receipt of evidence, issuance and enforcement of subpoenas, and the taking of depositions.

Virginia builds two named bodies into the statute. A health regulatory board may appoint a special conference committee composed of not less than two members of the board, or for the Board of Medicine not less than two board members and one member of the relevant advisory board, or for the Board of Nursing not less than one board member and one member of the relevant advisory board.

That committee's powers are enumerated. It may exonerate; reinstate; place the practitioner or permit holder on probation with such terms as it deems appropriate; reprimand; modify a previous order; impose a monetary penalty; deny or grant an application; and issue a restricted licence, certification, registration, permit or multistate licensure privilege subject to terms and conditions.

Its order becomes final thirty days after service unless a written request to the board for a hearing is received within that time, with three days added to the thirty-day period where service was accomplished by mail. On a timely request, the board or a panel proceeds to a hearing and the committee's action is vacated.

The endings that cannot be walked back

Some outcomes close a door the statutes then decline to reopen, and those are worth separating from the rest of the menu.

Washington provides for permanent revocation as a distinct outcome with a stated test. The disciplining authority may order permanent revocation of a licence if it finds that the licence holder can never be rehabilitated or can never regain the ability to practise with reasonable skill and safety.

Surrender is the other one. Washington lists a surrender of the practitioner's licence in lieu of other sanctions among its sanctions, and adds that such a surrender must be reported to the federal data bank.

The consequence is stated in its own sentence. Surrender or permanent revocation of a licence under the section is not subject to a petition for reinstatement under the chapter's reinstatement provision.

Virginia allows a comparable route at board level, empowering its health regulatory boards to take appropriate disciplinary action for violations and to accept, in their discretion, the surrender of a licence, certificate, registration, permit or multistate licensure privilege in lieu of disciplinary action. For formal proceedings, Virginia allows a board to convene a panel of at least five members to conduct the proceeding, decide the case and issue a final agency case decision, with a majority decision carrying the same effect as one by the full board, and with no member who participated in the informal proceeding permitted to sit on the formal panel considering the same matter.

Sources

Each document below is named as it names itself, with the date printed on that document rather than the day it was read.

1. Revised Code of Washington 18.130.160, sanctions upon a finding of unprofessional conduct or inability to practise, including the schedule and permanent revocation — Washington State Legislature, 2016
2. Revised Code of Washington 18.130.100, adjudicative proceedings governed by the state Administrative Procedure Act — Washington State Legislature, 1989
3. Code of Virginia section 54.1-2400, General powers and duties of health regulatory boards, including special conference committees and formal panels — Virginia Law, Virginia General Assembly, 2025
4. Code of Virginia section 54.1-2915, the Board of Medicine sanction menu attached to enumerated acts of unprofessional conduct — Virginia Law, Virginia General Assembly, 2020
5. Code of Virginia section 54.1-3316, Board of Pharmacy refusal, revocation, suspension and denial — Virginia Law, Virginia General Assembly, 2007
6. California Business and Professions Code section 2234, directing the board to take action against a licensee charged with unprofessional conduct — California Legislative Information, California Legislature, January 2024