A licensed vocational nurse applicant was denied a license by the Board of Vocational Nursing and Psychiatric Technicians after the applicant disclosed that he had another healthcare license that had been disciplined in the past. In the prior disciplinary case, the LVN license applicant had been placed on three years of probation for negligence, making incorrect entries on a patient record, a dishonest act and unprofessional conduct. The Board took the position that the new LVN license should also be put on probation just as the prior healthcare license had been.

We took the position that the outcome offered by the Board in settlement and advanced at hearing was unreasonable and would be extremely unfair to the license applicant. The applicant had successfully completed the prior probation, was appropriately remorseful, and had a serious and respectful demeanor at the proceeding.  After our presentation of all of the carefully prepared mitigation and rehabilitation evidence and legal arguments, the Administrative Law Judge granted a clear, unrestricted license, which was adopted by the Board. This result demonstrates the principle that the right law firm, which is not afraid to go to trial and push for a better result, can achieve a superior outcome.  This client was represented by Matthew Truong, Associate Attorney at Ray & Bishop, PLC.

A Board of Registered Nursing case against an RN who was accused of discrepancies in the handling of controlled substances was resolved by negotiation for an order of public reproval, also known as a public reprimand.  A public reproval involves no probation conditions and will drop off of the RN’s license record after three years.  The RN was not required to admit to the truth of the allegations in the accusation.

The Board initially accused the nurse of unprofessional conduct due to incorrect medication entries, as well as gross negligence for the mishandling of controlled substances.  The Board sought to place the RN on probation.  However, through advocacy with the Board and effectively explaining all of the circumstances surrounding the events, we persuaded the Board to drop its insistence on probation and settle for a public reproval.

Cases involving controlled substance errors and Pyxis machine data errors are very difficult to litigate because the reporting party (usually a hospital) may strongly suspect and infer drug diversion, including theft or abuse of drugs.  However, wasting, dosage and documentation errors can and do occur and can be explained and put into context by an effective attorney.  Ray & Bishop, PLC, represents and defends nurses in these types of very difficult cases that can have a severe impact on the careers of nurses.


After a licensing board has issued an order revoking a license, the very next step to keep the license valid and the licensed practice or business running can be to seek a stay from the agency or from a Superior Court judge.  A “stay” is an order to stop the license revocation order from taking effect.  Stay orders can also be used to stop license probation from starting, or to delay a license suspension.

Seeking a stay is an essential part of asking a licensing agency to reconsider its decision, or asking a Superior Court judge to issue a writ of administrative mandamus setting aside the discipline.  A stay can be requested when a petition for reconsideration is filed with a licensing agency under Government Code section 11521.  A stay for reconsideration is usually short – only 10 days.  A stay for a court to consider a petition for writ of administrative mandamus is usually longer, perhaps several months or more.

The short stay of up to 10 days for a board or agency to reconsider its decision is sometimes easy to get, because it is so short.  The purpose is to give the board or agency head days to decide a petition for reconsideration.  A Superior Court stay can be more difficult to get, because the attorney seeking the stay must usually persuade the court that the licensee is likely to win on appeal and the public interest will not suffer due to the stay.  Although strictly speaking not a part of the law, a judge may also consider the hardship upon the licensee, the effect upon a business, how serious the disciplinary case was, and whether an order short of revocation can adequately protect the public.  This calculation can be complicated, and is best presented by an attorney experienced with writs of administrative mandamus.

A stay can provide a valuable lifeline to remain at a job or in business while a licensee fights harsh or unjust board or agency discipline.  Even if an appeal is ultimately unsuccessful, a stay can provide valuable time to prepare one’s finances or business for the fallout from a license revocation.  A business might be sold or passed to a partner or family member, a past career resuscitated, or a spouse might be given time to get back into the workforce to cushion the blow.  Ray & Bishop, PLC, has won many stays for clients in the very difficult aftermath of an order of license revocation.  Contact us to see if we can help you at www.calicenselaw.com.

Under Business and Professions Code section 805, a hospital peer review committee makes a required report to the Medical Board of California.  An “805 Report,” as it’s called, is typically filed if a physician is denied hospital privileges or loses hospital privileges for longer than 30 days.  Suspensions longer than 14 days can require an 805 report, as can abandoning an application or resigning privileges with an investigation pending.  An 805 report must be filed within 15 days after the adverse event.  805 reports are not only filed by hospitals for loss or denial of privileges, but also by organizations such as Kaiser Permanente for loss of employment.

The 805 report is the vehicle by which hospitals and employers can inform the Medical Board of California about physician discipline.  The 805 report is required due to discipline for a “medical disciplinary cause or reason.”  Under Business and Professions Code section 805(a)(6), a “medical disciplinary cause or reason” is “that aspect of a licentiate’s competence or professional conduct that is reasonably likely to be detrimental to patient safety or to the delivery of patient care.”

The best way to avoid the Medical Board investigation and resulting discipline that can be caused by an 805 report is to never get one filed.  Since a $50,000 fine awaits a hospital that fails to file a required report, a required report must be filed.  However, if a triggering event can be avoided – for example, by shortening suspension to under 14 days or a restriction of privileges to under 30 days – the 805 report can be avoided.  If an outcome is expected that will trigger an 805 report, a physician should resist the urge to take the easy way out and resign or accept reportable discipline without a fight.  An 805 report, in the long run, can result in discipline that can devastate a physician’s license.

For legal assistance with peer review, negotiating with medical staff regarding hospital sanctions, or dealing with the Medical Board fallout from an 805 report, contact us for legal help with your matter.

In response to a patient complaint, a report of a large malpractice settlement, or a report of a loss of privileges, among other reasons, the Medical Board of California may choose to investigate patient care.  Often, to an unsuspecting California physician, the first sign of trouble is receipt of a request for patient records from something called the “Division of Investigation.”  The request for patient records usually comes in the mail, but may be served by an investigator.  The letter is addressed “Dear Custodian of Records.”   With the letter, there should be a certification form for the custodian of records to fill out to certify what, if any, records are being provided, an authorization of release of records form signed by the patient, and a page with a printout of the applicable law.

There can be some confusion because these documents say they come from “Division of Investigation” at the “Health Quality Investigation Unit.”  In fact, there is no mention at all of the Medical Board of California in these documents.  However, rest assured, it is a Medical Board investigation.  This request for records often will eventually lead to further investigation, and, at a later date, questioning of the treating physician by a Medical Board investigator, an expert medical reviewer (physician), and a Deputy Attorney General.

A physician (or other healthcare professional) served with one of these requests has 15 days to produce the records requested.  If the records are not produced (or a certification that says the person receiving the request has no records), a civil penalty of $1,000.00 for each day that passes beyond the deadline can be assessed.  The rules are contained in Business and Professions Code sections 2225(d) and 2225.5.

A request for patient records is a valuable early warning that a physician disciplinary case may be on the horizon.  Months or years later, resulting events can lead to license probation, suspension or revocation, suspension of board certification, loss of Medicare or MediCal privileges, and other consequences.  A professional license defense attorney can use this opportunity to prepare the physician to defend their license and privileges in the coming investigation.

After a license hearing, the administrative law judge (ALJ) will issue a proposed decision.  Under Government Code section 11517(c)(1), the ALJ has 30 days to issue the proposed decision.  (However, there is no penalty if this deadline is not met.)  Thirty days after the ALJ issues the proposed decision, each side in the case has the right to get a copy of the decision.  Under 11517(c)(2), starting with the date the agency receives the proposed decision, the licensing board or agency has 100 days to decide whether to adopt the proposed decision, reject it, make changes to it that don’t require rejection.

The proposed decision is a unique feature of administrative law.  Most of the time, the proposed decision is an accurate sneak peak of the final outcome of the case.  If the proposed decision is favorable, the licensee or license applicant can breathe a sigh of relief knowing that a good outcome may be just around the corner.  If the proposed decision is unfavorable, the licensee or license applicant can review their options for reconsideration or appeal and consider the career impact of the likely final decision.

However, sometimes a licensing agency will reject a proposed decision.  This most often happens because, 1) the proposed decision imposes a result that is too lenient or generous, or 2) the proposed decision has a technical flaw that is so serious it must be rewritten or decided again.  This rejection is called “non-adoption”.  ALJs try to write proposed decisions that square with the practices and expectations of licensing agencies, and ALJs also try to avoid mistakes, because “non-adoption” is a big headache for everyone – the government attorney, the defense attorney, and the clients on each side.  A non-adoption means extra work, added expense for the client, and months of uncertainty.

If a proposed decision is rejected, under law, it becomes a nullity.  The case can be re-litigated to a completely different decision by the licensing board or agency.  However, as a practical matter, the proposed decision still looms large as an influence on the process.  If a board or agency makes a different decision after non-adoption, it usually will copy large parts of the proposed decision into its final decision.

If you have a proposed decision you are not happy with, or your good proposed decision has been non-adopted, call us for legal advice.  Don’t wait until your non-adoption or adverse proposed decision becomes a final, bad result.

The story is a familiar one in our office.  A health care professional comes into the office, furious at their former employer.  The employer called the professional into the hospital personnel office, confronted them with an allegation, and then asks for their resignation.  To give the professional – a registered nurse, physician, respiratory therapist, or other – an extra incentive, the assurance is made: “If you just resign, we won’t report you to the board.”

Months pass.  Perhaps a year or two passes.  Then a letter comes from the board.  Your employer has reported you after all, and an investigation is open.  That assurance amounted to nothing.  Those dirty, rotten …. they lied to me.  Surely the board doesn’t believe them.  They just wanted to get rid of me.

You Can’t Force Your Former Employer to be Silent

Your former employer has a right to report perceived misconduct to the licensing board.  California law provides immunity to persons and entities that make complaints to California licensing boards.  The Civil Code extends legal immunity, and anti-SLAPP provisions in the law may shut down a lawsuit intended to silence a business or individual filing a complaint.  Although the law does not provide unlimited protection, in most scenarios it is extremely unlikely a former employer can be held responsible for a complaint under the libel and slander laws.  Otherwise, no one would ever make a complaint to a licensing board.

The Boards and Even Courts Usually Don’t Care Why a Complaint Was Made

A complaint to a licensing board can be made by a jealous co-worker, a boss who wanted to get rid of you, or even an enemy with an ax to grind.  The board doesn’t care.  If the complaint checks out, it becomes the board’s case, and motivation for making the complaint can become irrelevant.  Dwelling on the bad intent that motivated the original complaint is not a winning defense strategy.

Move Past Bad Blood to be Smart about the Problem 

Anger over the original malicious intent behind a Board complaint makes for a bad case in court.  If behind the complaint there is a serious error, unprofessional conduct or some other actionable cause, the professional license defense attorney must focus on either disproving the allegations or addressing board concerns to avoid or reduce board sanctions.  The bottom line is that complaining about your deceitful employer won’t help in a board discipline hearing.

Ray & Bishop, PLC, can provide effective strategies for dealing with an investigation or disciplinary case by a California healthcare licensing board.  Call us for assistance with your legal problem.

The flashing of squad car lights behind you as you drive home after having a few drinks.  The knock at the door announcing the police.  A hand on your shoulder as you leave the store.  And then, that sinking feeling.  Will I lose my nursing license?  Here are some tips for California nurses for saving your license after an arrest on suspicion of a crime:

  1. Focus on Fighting the Charge with a Great Lawyer

It is possible that weeks or months after your arrest, you might get a letter of inquiry from your licensing agency.  At that point, you will want to reach out to a professional license lawyer for help.  But right after an arrest, hire a top-rated criminal defense attorney who regularly appears in the court where your case will be heard.  A highly-rated lawyer whose office is in the same area as the courthouse is often a good choice.  You can ask your lawyer to call Ray & Bishop, PLC, for advice, we don’t mind.  We give advice to criminal defense attorneys all the time.  If your lawyer says they handle criminal, licensing, and other legal matters, don’t hire them!  No one lawyer can do many areas of law well.  If you need a referral to a good criminal defense attorney, we can help with that too.

  1. Don’t Call Your Licensing Agency, Call Us

Sometimes terrible worry and guilt will drive a nurse to call the Board of Registered Nursing or the Licensed Vocational Nursing Board to ask about the effect of a criminal case on their nursing license.  Don’t do it! First, the staff members at the boards who pick up the phone often don’t know the answer and, in our experience, may give out incorrect information.  Also, don’t be put in the position of telling your licensing agency about your problem – they’re not on your side.  Call Ray & Bishop, PLC, for advice, not the board.

  1. If You Get a Letter, Respond

The Department of Justice sometimes lets the nursing board know that one of its nurses has been arrested or has a criminal case.  When that happens, the board sends out a form letter asking for more information.  The right response depends on whether your case is pending or has wrapped up and what the case is about.  However, it is important to respond – don’t ignore the letter.  A calm, cooperative and cautious approach to the agency sets the best tone for getting the best resolution out of your case.  A professional licensing attorney can help you determine the best message for the situation.

  1. After a Conviction, Disclose

Board rules require that nurses let their licensing board know about any criminal conviction within 30 days.  A conviction includes a plea of guilty (before sentencing), so even if someone pleads guilty only to be sentenced later, a report must be made within 30 days of the guilty plea.  Also, renewal forms ask about convictions, so there is a “yes” box to be checked.  Failure to disclose a conviction can be unprofessional conduct, which is grounds for discipline.

  1. Don’t Lie to the Board

When a nurse is asked about a conviction, her answer must be truthful, and any written explanation or disclosure must be consistent with the facts of the conviction.  Lying about a criminal conviction can be worse than the conviction itself.  A good professional licensing attorney can make sure that an accurate picture is painted that also includes all of the positive mitigating and rehabilitative facts.  Lying to a board can destroy the trust between the nurse and the board, and make license discipline, if it comes, much more severe.

The Medical Board of California investigates complaints against physicians using its team of investigators who work from its headquarters in Sacramento and from its field offices.  Complaints may come from CURES reports reviews, 805 reports, lawsuits, or patient complaints.  For many complaints, an assigned investigator will contact the physician and ask the physician to come into a Medical Board field office to be interviewed.  The Medical Board has field offices, known as District Offices, in Cerritos, Fresno, San Bernardino, Glendale, San Diego, San Dimas, San Jose, Pleasant Hill, Rancho Cucamonga, Tustin and Valencia, in addition to Sacramento.   We routinely represent physicians in these interviews.  The physician interview is often the last step or one of the last steps before the investigator submits their investigation report to Medical Board Enforcement for it to decide if formal disciplinary action should be taken against the physician.

In these interviews, we have over the last several years increasingly seen the Medical Board have a physician expert in the investigation to join in questioning.  A Medical Board investigation interview may be conducted by the investigator, possibly a supervisor (if the investigator is relatively new or in training), a Deputy Attorney General, and a medical expert, who may be either an expert reviewer or the District Medical Consultant.  District Medical Consultants, or DMCs, working in the field offices, supervise medical expert review of cases or themselves may review cases.  The DMCs provide medical expertise, help decide when and whether to involve an expert reviewer physician, coordinate the involvement of expert reviewers at interviews or may themselves serve as the expert reviewer at the interview, and weigh into the decision whether to recommend discipline against a physician.

An investigator is charged with obtaining medical records from the physician or facility, gathering any other needed information or evidence, then usually submitting that information to the DMC for an evaluation.  The DMC usually makes the call whether to involve an expert reviewer (which will more often happen if the medical practice area involved is outside the expertise of the DMC).   The investigator coordinates with the physician and/or the physician’s attorney, a Deputy Attorney General and the DMC to set up an interview of the physician.  At any interview involving patient care and treatment issues, in addition to an investigator or investigators and usually the Deputy Attorney General, either the DMC or a medical expert reviewer physician will attend to all ask questions of the physician.

The job of the expert reviewer is primarily to assist the investigator in obtaining high quality information for Board Enforcement to prepare the case for disciplinary action.  The expert reviewer or DMC can be sizing up the disciplinary case at the interview and seek evidence to use to discipline the physician later.  The information disparity between physician and Board is highly asymmetric with the Board having a great deal more information than the physician, so the interview is an opportunity for this panel of questioners to seek key admissions and get unfiltered information.  The leverage the Board has over the physician at this stage can make the interview quite perilous for the physician being investigated.

It goes without saying that it is absolutely critical that the physician have legal counsel in one of these interviews.  An attorney can provide a physician with protection in a number of critical ways.  First, understanding the process alone, which this article just partially addresses,  provides valuable insights.  Second, as the license lawyer for the physician we may use a variety of techniques to assemble as complete of a picture as possible of what is happening in the Board investigation.  Third, the lawyer can exercise a degree of control over the process and determine the level of participation in the interview, which can range from asserting the physician’s right to remain silent or even rejecting an interview request, up to providing additional or unsolicited information to the Board through the interview process to help explain and contextualize the subject of the investigation.

As California’s premier license law firm, we defend California physicians on a daily basis.  See our website, www.calicenselaw.com, for more information or to get in touch with us.