One of our most frequent issues at the firm is clients calling who have become the subject of a California licensing board investigation.  Investigations are handled primarily two ways, either by an enforcement analyst or technician inside a licensing agency’s offices, or in the field by outside investigators who work for either the board itself (such as the Medical and Dental Boards) or the Department of Consumer Affairs (all other boards).

If an investigation can be completed from the desk of a board employee in Sacramento, the questioning of a licensee usually consists of a letter asking for a written response.  Such investigations can broadly be placed into two categories: requests for documents and information concerning a criminal conviction or discipline against another license held by the licensee, or, minor investigations which might be closed with the receipt of a satisfactory written response.  A licensee should have all such written communications reviewed by an attorney.  A response concerning a consumer complaint should be consistent with the complete case file.  A reply to a board concerning a criminal conviction or other license discipline must be consistent with the available records concerning the incident and penalty.  Inconsistent statements may be interpreted as dishonesty.  Also, be cautious, there is always the possibility that a rather benign inquiry from a licensing agency may be a prelude to an in-depth investigation.

A much more complicated question is the extent to which a licensee should cooperate with an investigator in the field (such as a Medical Board Investigator or a Department of Consumer Affairs Investigator) who is investigating allegations of wrongdoing against that licensee.  We generally follow these principles when clients face investigation: First, do not sign a release for your personal records, particularly medical records, except upon the advice of an attorney.  Preservation of confidentiality is paramount.  Would you freely seek medical or psychiatric treatment if you knew that a stranger, possibly seeking to damage your livelihood, would one day pour through your personal records? The decision to sign a release must be very carefully made. Second, never submit to drug testing at an interview.  The taking of one’s body fluids is a similar invasion of privacy, and body fluids can be tested in a variety of ways.  Third, all communications with an investigator must be through a lawyer or with a lawyer present.  Only the presence of a lawyer at an interview can ensure that  the interview is accurately reported on later, the investigator will not act improperly, and can ensure that the licensee can decline to answer questions or to leave when he or she wants without pressure or intimidation.  Fourth, we counsel against signed statements – investigators sometimes prepare statements for a quick signature by the licensee, which may contain in them very harmful admissions.

Having cautioned clients about the many possible traps in a board field investigation, we still counsel that the client should be cooperative,  Examining the difference between a police investigation and a licensing agency investigation is instructive to explain why. The difference between an investigation by a board investigator concerning possible board discipline and a police investigator in a criminal investigation is that a state licensing agency has much broader powers to punish, using a much lower standard of proof, than the police investigator can through the D.A. and the courts.  Therefore, while a citizen who exercises his rights against self incrimination may shield himself from prosecution successfully, a licensee will rarely if ever deter a licensing agency from seeking and imposing discipline through non-cooperation if the licensing agency believes its licensee is incompetent, impaired or has committed serious misconduct.  Licensing agency investigations arise from concerns for public safety.  Therefore, the licensee should look at the investigation as an opportunity to reassure the licensing agency that the licensee is competent and safe to practice.  Finally, above all, be honest.  Betraying the trust of the licensing agency can be seen as worse than the conduct that triggered the investigation in the first place.

A phenomenon we observe in our law firm every day is the Domino Effect of license discipline.  Simply put, discipline against one’s license, a license denial, or a criminal conviction, can in turn result in discipline against out of state licenses, other agency licenses, and affect employment, memberships, clearances and registrations.  The clearest illustration of this effect is concerning a physician.

Let’s say that a physician does his residency in the state of Florida, where he gets his license, then moves back to California, where he applies for a license.  However, after he got the Florida license, but before the California application, he was convicted of drug possession.  As a result of the conviction, California denies his license application.  That license denial becomes a public record.  Florida becomes aware of the license denial in California, leading Florida to discovery of the drug conviction, and then Florida takes away the physician’s license as well.  The physician appeals the California license denial, but in the process, that appeal opens a case that results in a press release or email blast concerning the physician.  If the physician wins the appeal but obtains, for example, a probationary license, his license record will show, indefinitely, the cloud over his license by showing that the license was granted on probation and even may offer a link to the disciplinary documents.  A license denial followed by probation will then likely have to be disclosed whenever the physician applies for other state licenses, for acceptance to a health insurance plan, for membership in referral services, for hospital privileges, and the list goes on.

Predicting the Domino Effect of license discipline can be less like predicting the fall of dominoes and more like predicting chess moves.  It is very difficult to predict how some entities – such as other states’ licensing boards or insurance companies – will react to negative licensing information.  The one overriding lesson of the Domino Effect is that a clean disciplinary record is a highly valuable possession.  One should, as a general rule, secure as many desired licenses, memberships or privileges before one is foreseeably tainted by a criminal conviction, license discipline or another reportable event.  In most cases, an indvidual enjoys due process rights with an existing license that may not be present when a license application has been turned down.

The worst part of the Domino Effect is the pernicioius manner in which negative public records available over the internet can damage one’s career and reputation.  Most licensing agencies will make derogatory information available on a license record, in a website listing of disciplinary actions and even in an agency newsletter.  Thusfar licensing agencies see it as their duty to publicize one’s license discipline on the websites and in their publications.  It remains to be seen if the law will curb these practices by requiring that old or irrelevant disciplinary cases be stricken from a licensing agency’s website.

 

 

 

California’s insurance brokers are licensed and disciplined by the Insurance Commissioner through the Department of Insurance (DOI).  It has been my experience that the Department of Insurance takes a firm stance in disciplining its licensees.  In my view there are three reasons that account for this: 1) the Insurance Commissioner is an elected public official who has political concerns should his Department be perceived as being weak in disciplining licensees, 2) the legacy of  the Insurance Commissioner Chuck Quackenbush scandal in 2000, and 3) the subsequent enactment of Insurance Code section 12921 which makes the Insurance Commissioner solely responsible for the administrative settlements.  There are particular public protection issues relative to insurance brokers, because theft of premium monies and the failure to bind insurance, which leaves consumers unprotected and vulnerable, are constant problems.

The DOI also has some powerful tools in its tool chest, including Insurance Code section 1669, which allows for summary revocation of a license (that is, revocation without a hearing), as well as summary denial of a license application, where a licensee or license applicant has been convicted of a felony, has lost another occupational license, or has been convicted of a criminal violation of the Insurance Code.  The Insurance Code also permits the DOI to revoke a license when a licensee is "not of good business reputation" or it is simply "against the public interest" for them to have a license.   No profession, not even physicians, is subject to such vague and broad standards of discipline.

Despite these considerable legal hurdles, we have found that licensees and license applicants can be successfully represented before the DOI.  In the case of the Order of Summary Revocation, the DOI will consider a timely filed Petition for Reconsideration under Government Code section 11521.  In cases where a licensee or applicant is entitled to a hearing, the DOI tends to respect the outcome of administrative hearings, and is very receptive to a strong showing of character fitness or rehabilitation by its licensees or license applicants.  In most of the cases we have handled, those cases that were not dismissed resulted in license restriction.  License restriction by the DOI is less onerous that license probation typically used by other licensing agencies and usually requires little of the licensee or license applicant beyond compliance with all laws until the license restriction is lifted.  Restriction can later be lifted by a petition to the DOI, clearing the insurance broker’s license of discipline.

The pitfalls of a license denial or license discipline case usually arise at the beginning of the case.  License applicants, seeking to avoid disclosure of past indiscretions, sometimes file false or incomplete applications that do not list prior convictions.  Current licensees either fail to notify the DOI of changes to their background information, fail to respond to a demand for information, or make statements that are later used against them.  It is absolutely critical that a license applicant or licensee handle all communications with DOI properly, employing honesty and sincere cooperation in most cases, but exercising one’s right to remain silent in cases that can lead to criminal charges, and of course carefully choosing one’s words in all communications.  The words of the Miranda warning are true here – everything you say can be used against you in a court of law.

 

 

 

 

 

 

 

Earlier this month I had the privilege of participating for three days in the Betty Ford Center’s Professionals in Residence program at this world famous drug and alcohol addiction treatment hospital in Rancho Mirage, California.  This program gave me insight into the Betty Ford Center’s Professionals Program, where licensed professionals, typically physicians and attorneys, receive treatment tailored to their needs.  Betty Ford Center’s longstanding treatment of professionals, particularly physicians, accords their facility a certain stature and credibility that can be critical in a license discipline case.  Of course, if one is struggling with addiction, it is absolutely imperative to confidentially seek treatment before the addiction interferes with work and becomes a board discipline matter.

The Betty Ford Center has a twenty seven year track record of successfully treating individuals, both famous and not-so-famous, for the disease of addiction.  As the first licensed chemical dependency treatment hospital in California, Betty Ford has unparalleled facilities and trained medical staff for detoxification at entry and the management of medical issues throughout treatment.  The treatment program focuses upon treatment and recovery in a therapeutic environment, using individual and group counseling, addiction education through dynamic speakers, and fellowship with similarly situated individuals.   The Betty Ford Center also has educational and counseling programs for the families and children of patients, which helps the entire family heal from the ordeal of addiction and invests them in the patient’s recovery.

BFC also offers the Clinical Diagnostic Evaluation, whereby a licensee or license applicant who is suspected of or suspects having an diction problem can be evaluated for addiction.  According to Dr. Harry Hartounian of BFC, about 1/3 of CDE patients are found to be free of addiction, about 1/3 go on to treat at BFC, and finally 1/3 seek treatment elsewhere.  The CDE can be a useful tool to confirm or exclude the diagnosis of substance abuse, allowing the results to be used to demonstrate to a licensing agency the absence of an addiction issue, and facilitating access to confidential chemical dependency treatment with or without the use of insurance.

Accessing chemical dependency evaluation and treatment services is a highly personal decision that involves willingness of the individual involved or the intervention of loved ones around them.  Our firm works with Betty Ford Center and other smaller treatment centers, such as Cornerstone of Southern California in Orange County to provide our clients with quality treatment referrals consistent with their personal and legal needs.  Our effective defense strategies include proactively resolving professional competency issues before they result in license discipline, loss of a license, or to ready a professional who has lost their license to seek relicensure.

 

 

 

 

About one year ago I wrote about a series of embarrassing newspaper articles about the California Board of Registered Nursing, that described how nurses incarcerated in prison retained their licenses due to the sheer ineptitude of the Board of Registered Nursing. The picture painted was nurses running amok while the Board was asleep at the wheel. Meanwhile, in my practice we were received numerous complaints from our nurse clients about how strict and even punitive the Board of Registered Nursing was acting. Which of these views was right? And what is this controversy all about?  In July 2009, we saw another round of revelations, leading to the sacking of three members of the Board of Registered Nursing and apparently the resignation of the longstanding executive officer of the RN Board.  What are the factors behind this focus on, of all the professions, registered nursing, and why was the Governor so quick to move in response to criticism?

The first and most important factor in our view, which is often not well understood by the public, is that the medical treatment you receive in hospitals is largely from nurses and their supervised LVNs and aides, not doctors. Doctors make their rounds, usually spending as little time in the hospital as possible, doctors perform surgeries, and doctors prescribe medicines and treatments. But for the hospitalized patient, almost all care comes from their registered nurse and those supervised by the RN. The registered nurse is the primary advocate for the patient, the individual charged with calling up the doctor and even demanding treatment if a patient is in neglected by their M.D. In fact, in the face of a recalcitrant doctor, the RN is responsible to even go above the head of the doctor to hospital officials if the situation warrants. Therefore, the registered nurse is the key link in the chain of care from hospital and doctor to patient.  Public concerns about the competency of registered nurses are well founded.

A second factor in this debate is the love/hate relationship that California (its people and the rest of its government) has with its regulatory boards.  In early 2005 there was an effort by the Governor to abolish 88 state boards, including the nursing board, citing waste and inefficiency.  The effort died after about one month.  Nevertheless, nearly five years later state boards understandably feel the need to zealously protect the public in carrying out their mission.  The image of board members as political cronies earning six figure salaries to jet around the state to attend a handful of meetings each year makes a popular punching bag for some politicians, the press and advocacy groups.

To the extent the criticism of the Board of Registered Nursing focuses on lengthy delays in investigations and administrative cases, that criticism seems to have merit.  It is also true that many years ago the Board of Registered Nursing exercised lax oversight in the screening of the backgrounds of nursing license applicants.  In requiring livescans and asking simple background information questions at application and renewal the Board has brought itself in line with the common practices of other California licensing boards.

However, it is most unfortunate that the regulatory pendulum seems to be swinging to the other extreme.  The Board of Registered Nursing may be becoming quick to judge, quick to condemn, and unnecessarily punitive in its approach to the oversight of its licensees.  The purpose of independent licensing boards is that they can be relatively free of the political pressures from other segments of the government.  Unfortunately, actions such as the governor’s undermine that independence and risk seriously damaging the nursing profession in terms of difficulty in attracting sufficient numbers of new nurses and the declining morale among existing nurses.

The image of a “soft on discipline” nursing board is misleading and inaccurate.  I have found the Board of Registered Nursing to be firm in discipline and quite strict in probation oversight.  The Board has exhibited, in my view, a fairness towards its licensees, willing to give a second chance if the licensee is willing to earn it.  Regrettably, second chances may now become a lot harder to come by in Sacramento.

 

 

 

By far the number one question we get in our law offices is about the disclosure of criminal convictions on license applications and license renewal forms.  Some  people see themselves facing the choice of whether to be honest and disclose, almost certainly triggering a license problem, as opposed to lying to possibly get away with it but risking an even more severe license penalty if they are caught lying.  For other individuals, it is not whether to answer yes or no, but rather how they should explain what happened. 

Going to the first issue, when we are asked whether one should disclose a conviction, the answer is almost always yes.  A relatively minor criminal conviction can be aggravated by non-disclosure.  In other words, some minor criminal convictions won’t  trigger license discipline, but lying about the conviction probably will trigger license discipline. 

Expunged convictions must always be revealed.  An expungement in California does nothing to conceal, remove or clear the conviction for licensing purposes.  By the same token, out of state convictions that have been expunged or dismissed after an individual has been convicted should usually be revealed out of an abundance of caution.  The exceptions to this rule are where someone has been found factually innocent or a judge has given them a "true" dismissal ("in the interests of justice").  When in doubt, however, disclosure is the best policy. 

Once a conviction is revealed, almost all licensing agencies will ask for certified court documents and a written explanation.  Certified court documents can be obtained from California courts without difficulty.  Police reports are another matter – they are usually not even obtainable, and if they can be obtained, police agencies, in my experience, have no way to certify them.  California licensing agencies know this and therefore usually will settle for certified court documents.

Finally, there is the explanation.  I advise clients to make their conviction explanations concise, honest and remorseful.  It is a good idea to have the explanation reviewed by an attorney before submitting it.  The explanation should be concise because longer statements might contradict official accounts or devolve into making excuses and blaming others – all very harmful things in an explanation.  The statement must be honest, but since accounts of the incident may differ – the police report may differ from your account , for example- it is better to stick to a short factual summary and forego details.  Finally, remorse must show insight.  Everyone who has a criminal conviction regrets that they got caught.  Showing an understanding of how the bad conduct affects those around us and our society, and can place others in danger, shows true rehabilitation.   

For example, someone who was convicted for DUI might make this statement: "I am sorry that I drove drunk, I spent the night in jail and lost my job when I didn’t show up the next day.  I really regret it."  This statement shows more that someone is sorry for themselves than truly remorseful.  The lesson learned is, next time, don’t get caught!  This is not  helpful.

A better statement is: "I made a terrible mistake driving drunk.  I endangered the other drivers on the road with my carelessness.  Others might have been hurt, even killed."  Many people who have been convicted, even defendants pleading for mercy at their sentencings with the advice of skilled lawyers, fail to show true remorse.  You have just a short statement from which a licensing agency may decide whether to discipline you or not.  Your statement might even be used in a hearing.  It is therefore crucial to reflect upon your mistake and show true insight in your explanation.

It can take courage to make an honest and thoughtful disclosure on a license application or renewal.  However, licensing agencies demand, and expect, honesty.  The character of a licensee or applicant is evaluated (or re-revaluated) based upon what little information the agency has about them.  Lying to the agency is never worth the terrible black mark it makes.

 

 

Unfortunately, a large percentage of individuals facing license discipline fail to hire an experienced license law attorney.  The result is often that the disciplinary hearing is lost.  While the loss of an administrative hearing is tragic, it is not the end of the case.  The Administrative Procedure Act and California law give the licensee some options after a lost hearing.

The first option is reconsideration.  The Administrative Procedure Act permits a licensee or license applicant to ask the administrative agency to reconsider its decision before the decision becomes final.  The petition for reconsideration can be an opportunity, if the agency allows it, to produce additional evidence that was not available at the administrative hearing.  Reconsideration also gives the agency another opportunity to decide the case where the agency feels the outcome was too harsh.

Once an administrative decision has become final, the next step is an appeal to Superior Court, called a writ of administrative mandamus.  The writ process allows a Superior Court judge to review the case record and determine if the agency abused its discretion.  A Superior Court judge can also stay, or stop, the imposition of  a penalty (such as license revocation) while the writ is pending.  The judge can remand a case back to the agency for proceedings in line with the judge’s decision.  Sometimes the licensing agency will settle a case once the writ is granted, to save time and money, rather than send the case through the administrative discipline proceess again.  The deadline to file a writ of administrative mandamus is generally 30 days after the effective date of the decision.

If a writ was not filed or was not successful, the final option is a petition for reinstatement of a lost license.  Some health care licensing agencies require a three year wait before applying for reinstatement, although most agencies permit a petition for reinstatement to be filed after one year.  Some agencies decide these petitions by a short hearing in front of the Board, but some submit the cases to a full-blown hearing before an administrative law judge.  The agency hearing the petition for reinstatement focuses upon the licensee’s rehabilitation, education and personal enrichment activities after the loss of a license.  The petition for reinstatement is not an opportunity to again fight the lost battle over a license.

All in all, licensees get the best legal value from hiring an attorney as soon as possible after a problem starts.  When a lawyer takes a case at the appellate level, significant irreversible damage may have already been done.  Nevertheless, a valuable license can be saved even after a loss at hearing by a skilled aggressive attorney.

 

 

 

The toughest part of a license application is often not the test you had to pass, or the extensive experience information you have to list, but instead is the answer to one simple question: Have you been convicted of a crime?  Actually, this is not really the question the board, bureau, department or agency is asking.  The real question is: Are you a person we can trust with this license?  I will explain.

First, a detour to Costco.  Yes, that warehouse membership store you belong to.  Everyone has seen Costco store security, or, I should say, what they think is store security.  A barely interested employee standing at the exit glances at your cart and puts a highlighter mark (and sometimes a happy face for the kids) on your receipt.  Considering how laughable this security seems, thousands of people brazenly attempt to steal from Costco each year.  At that point, they find out (the hard way) that Costco has a very sophisticated and agressive loss prevention team, which has nothing to do with the folks at the door with the green highlighters.  

Back to licensing agencies.  When an applicant is asked, "Have you been convicted of a crime?," if we assume that this question is the sole source of information for the agency, this is like assuming that Costco’s loss prevention is the bored guy at the door.  The truth is, the agency will run California Department of Justice and FBI background checks to scour the applicant’s background for arrests, indictments, and convictions, even from 20 years ago, even in other states, even for a DUI the applicant got when she was 18.  So then, back to my "real question" point – why does the agency even ask?

This a major part of the "real reason" can be explained in two ways.  One way of looking at it is the agency is giving the applicant a chance to "come clean" with the agency.  Another way of looking at it (and, in my view, the key) is this is a test of the applicant’s honesty.  If the individual with a criminal record answers "no," then even if they swindled their boss 15 years ago, it is not ancient history, because the applicant is still a dishonest person, according to fresh evidence – their license application – sporting a lie told in 2009.  Of course, there is a chance that the licensee will inadvertently lead the agency to a deeply hidden or obscure conviction by disclosure – but guess what? – if the agency can’t prove the conviction (usually true if they can’t find it) they probably can’t use it against the applicant.

Finally, there is the issue of dismissed convictions.  Many people are running around thinking they have a "dismissal" or an "expungement" or that the judge himself ran their record through the shredder.  At least in California, this is rarely the case.  If an applicant hides what they believe is a "dismissed" conviction and it turns out they are wrong, again, they may be seen as lying.  All in all, it is best to only put "no" if a license law attorney with extensive criminal defense experience (like me) reviews the criminal case records and the application side-by-side and declares the disposition of the criminal case a non-disclosable event.  Otherwise, get ready to meet loss prevention – getting past the guy at the door really didn’t mean anything after all.

 

 

At the firm we get calls from all types of licensees from jurisdictions around the country.  Many individuals, having had no problems in other states, are surprised when California denies their license application or comes after their license.  This has led us to often observe that California may be the strictest state for license discipline.   But is California really the strictest?  Mostly, it depends upon what type of license you have.

California’s Medical Board is famously strict.  The background questions on the Med Board’s application are extensive.  The background check is thorough.  Any blemish on an applicant’s record, it seems, is cause for further investigation and often denial.  The Medical Board looks for mental illness, substance abuse, chemical dependency, deviancy, anger problems, lack of skill, dishonesty, etc., etc.  It is not surprising that almost 1,000 applications out of 5,000 are denied.

In contrast, California’s nursing boards (registered nursing and vocational nursing) seem to be more lenient.  In part, this could be due to California’s famous nursing shortage and mandated nurse-patient ratios.  However, this could be changing.  California’s nursing boards have come into criticism for not checking into the backgrounds of nurse license applicants, leading to, among other stories, a nurse who is validly licensed while in prison.

Another notable “strictest” is the California Department of Insurance.  If I only had a dime for every call where someone had “no trouble at all” with the 30 other states that had licenses from, only to encounter problems with California.  But who can blame the Department of Insurance?  After the Chuck Quackenbush scandal, where our Commissioner went easy on disciplining insurance companies that supported him politically, the Department of Insurance still wants to avoid any appearance of impropriety at all costs.

One area where California seems to be the leader is in splashing license discipline all over the internet.  These efforts range from the Medical Board’s e-mail notifications to posting disciplinary documents on the internet by most boards and departments.  It is also little-known that most California licensing agencies have the option of pressing ahead with license discipline even when an applicant wishes to withdraw an application or a licensee want to surrender a license.  Once a board has learned of an applicant’s or licensee’s problem, they close off the exits.  Not allowing for a quiet resolution by withdrawal or surrender, they insist on making a public record of license discipline.  In this post-practical obscurity age, California leads the way in publicizing its licensees shortcomings for the good of the public.  We’ll talk about practical obscurity in another blog.

So is California the strictest?  I think so.  As long as our golden shores beckon to professionals all over this country and the world, we can afford to be strict.  Not only is our native population overflowing – our great weather, huge market for services, and diversity make California irresistable.  So long as this is true, California licensing agencies will probe for faults, expose and punish.  It is sad that I must, from time to time, tell a client – “go east – they’re more forgiving over there.”

 

 

 

Many professionals may think that the agency that licenses them is on their side. They are so wrong. The primary goal of a California license agency is public protection. Whether the Medical Board, Department of Insurance or the Chiropractic Board, these agencies impose more regulations and seek to strictly enforce discipline against their licensees.

The equalizers in this process, who counterbalance the awesome power of the Boards, Bureaus and Departments, are the administrative law judges, the Superior Court, and most importantly, the attorneys who appear before them. The rules are relatively simple. Each licensee is constitutionally entitled to due process, meaning simply notice and an opportunity to be heard. The agency cannot punish, but instead only protect the public. The agency must follow its own rules and treat everyone fairly. Violations of these rules will lead to successful appeals before the Superior Court and higher courts.

In a recent case, we succeeded in getting an order of license revocation overturned. The licensee had gone to a hearing without an attorney (regrettable, and unfortunately common these days). The hearing had, of course, gone badly, and his license was revoked. Luckily for the licenseholder, the Department of Insurance violated the rules of due process, and, even more fortunately, he came to me while we could do something about it. After eight months of fighting in court with the Department, the decision was overturned and the license was restored.

Most law is based upon relatively simple rules which anyone can grasp. The lawyer’s job – and what all lawyers must demonstrate to pass the bar – is applying the law to the facts of a specific case to make effective legal arguments. The more experience the lawyer has in a specific area of law, the more insightful the lawyer becomes at applying facts to the law.

It is fortunate that even with the awesome power the licensing agencies have over their licensees, with encouragement from an attorney many judges and courts will stand up to the agencies.