State Requirement Mandates Doctors Post Signs Telling Patients Who Licenses Them

Cheryl Clark, for HealthLeaders Media , May 11, 2009

California doctors will now have to post a sign or tell patients about the agency they can complain to if they're not happy with care after the Medical Board of California unanimously approved the mandate on Friday.

If unchanged after a series of regulatory hearings this summer, the requirement will take effect as early as this fall, says board spokeswoman Candis Cohen.

Physicians who have waiting rooms will have to post the following notice in 48-point type in their office waiting rooms or in an area "visible to patients on the premises where the licensee provides the licensed services:"

Medical doctors are licensed
and regulated by the
Medical Board of California
(800) 633-2322

Physicians who don't have waiting rooms, such as anesthesiologists or radiologists, would have to include the notice in a written statement that is signed and dated by the patient or the patient's representative stating that the patient understands the physician is licensed and regulated by the medical board.

The statement must be retained in patient medical records.

The physician also may opt to include the notice in a statement on letterhead, discharge instructions or other document given to a patent or the patient's representative, where the notice is placed immediately above the signature line for the patient in at least 14-point type.

Board officials say they need such a rule because too many patients are unaware about the existence of the board, which can investigate their complaints and may launch disciplinary actions against doctors with malpractice or other performance issues.  Otherwise the patient may have no other recourse except going to an attorney.

In California, many other professions are required to post signs, such as building contractors, pest control operators, barbers, cosmetologists, and auto repair shops.

The day before the vote, the board's education committee heard objections from representatives of the California Medical Association, who said that requiring such notices does not create an atmosphere of mutual trust for the physician-patient relationship.

CMA officials told the committee that the rule would place an "additional burden on physicians," says CMA spokeswoman  Amber Beck. She adds that the CMA supports "giving information to patients that is useful for them to make decisions on their healthcare needs."

James Hay, MD, the CMA's liaison to the Medical Board of California, says, "This proposed rule does not seem to me to be a worthwhile thing to foster that doctor-patient relationship." If the Medical Board is supposed to educate the public, but hasn't done it, "that's the medical board's problem," he says.

California is not the only state with a posting requirement for doctors. Texas, Kansas, Georgia, and Idaho are among other states that have similar sign rules.

If patients knew who to complain to, disciplinary actions may be more promptly taken against physicians, the board argues.
Now, when the agency hears of a physician's alleged misconduct, investigators first look for court filings. "They routinely come across people who have sued doctors for malpractice but who have not filed a complaint with the Medical Board," says Julianne D'Angelo Fellmeth, who was hired as the board's Enforcement Monitor. Occasionally, the court has issued large awards against physicians after long courtroom proceedings before the medical board receives notice about the case.

A physician's failure to provide proper notice of the board's authority could come with penalties or fines, says Fellmeth, an attorney with the Center for Public Interest Law at the University of San Diego.

"Consumers have the right to know that if they do not feel that their physician is acting professionally, that the overseeing licensing agency should be informed of their concerns," says board member Mary Lynn Moran, MD. She said similar sign requirements are even required of cab drivers.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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