If the courtroom is a different world with different rules, state licensure procedures can be an enigma. Unlike law, you are unlikely to find out about past decisions, their reasons and basis, except by word of mouth. Nor do you get to hear what your accuser says. And you may be told only some, or none, of the specific accusations.

As with malpractice, knowing whatever you can ahead of time will be of great importantance to you, and may save a situation from developing.

Medical Malpractice Defense will collect and make available both general and specific state information where possible. Help us by adding your experiences in the forum or by email.

In general, you are likely to hear from a licensure board by either a mailed complaint, asking you to respond, or by a call from an investigator. The latter will likely occur after they have already reviewed the chart in question. The process can either slow, or if a patient safety concern is present very quick.

There are likely three board levels: first the

investigator, then the attorney who takes the investigator's recommendations (both negotiate and act on them),and finally the higher level of hearings and resolution. This last level is usually felt to be the least friendly. There is also usually an appeal level.

A meeting with an investigator is set up if your response does not resolve the concern. At this point a lawyer experienced in this matter is wise. You should get recommendations from those who have been through this process. You may also make use of the state organization for physician health, which is often an arm of the medical society. There are often discussion or support groups locally, and these may have substantial insight into the fit between different attorneys and problems. They also can give important insight into the process in your state.

The investigators will likely judge you in two ways: the clinical issue and an assessment of you in terms of style and character. The investigator is not trained in your speciality, so likely a specialist in your state has provided a review of the chart.

The reviewer will be sent the investigaor's version of your comments for further review. Be sure to provide a written response after the meeting, as this will help the odds that the reviewer does get your arguments more completely. Regarding the clinical issue, you may find that access to the chart is restricted to a brief time prior to the meeting, or some similar option. In a thick chart or complex matter, this is very limiting so you will want you own copy from some other proper means, if at all possible. This is a critical, basic need to resolve early in the process.

Following the meeting, the investigator makes a report which usually goes to a committee a few weeks later. They make a recommendation to pursue or drop the matter, and may prepare a formal charge list. They may also negotiate to some extent with your attorney. This process can be several months or more, in some situations. Unless there is settlement, there will be a hearing, for which you need both an attorney and an expert witness. The hearing is usually a few days, however in complex cases may be broken into stages. Often there is a combination of lay and medical professionals on the panel. This process can be very expensive, and some policies contribute a small amount to the process. (Read the policy and ask an attorney who knows about your company because contingencies, both in the contract and interpreted by the insurer, can stretch or decrease the amount).

If the decision, if adverse in some way, will be reported in the state's disclosure mechanisms and in the National Practitioners Data Bank. Be sure to look into any leverage you have in this process and about what is stated in the report.

Finally there is an appeal level, often about a month after the hearing. In some states, it is stated not to be a neutral risk, and may make matters worse. Learn the specifics about your state.